Table 4 Summary of qualitative results from interviews

Factors influencing disengagement from HIV care

Logistical challenges

Quote 1: “Transport was always a challenge because of poverty and yet the distance to the HIV clinic was too long to walk. That was another de-motivating factor and discouraging [for PLWH].” – 69-year-old male, traditional healer

Stigma

Quote 2: “Some of these people were stigmatized to the extent that whenever they tempted to go to the HIV clinic, they would feel out of place, become uncomfortable and end up getting more stressed instead. Sometimes they would just go back home without a single treatment. Some of them actually gave up completely [on clinical care].” – 36-year-old female, traditional healer

Lack of social support

Quote 3: “I did not have any hope. I did not have anyone to support me, no one to lean on, no motivation. I had reached an extent of giving up my HIV treatment.” – 40-year-old female, PLWH

Lack of trusting relationships with HIV clinical staff

Quote 4: “[My client living with HIV] has had many challenges with the HIV clinics, and she fails to open up and disclose her adherence issues to them” 42-year-old female, traditional healer

TH could overcome barriers to HIV care

PLWH have close, trusting relationships with TH

Quote 5: “[My TH] is my counsellor, my friend, and a sister … She is always there for me, and she makes sure I am on the right track. She is my teacher, family, and everything.” – 50-year-old male, PLWH

Quote 6: “I had never disclosed my HIV to anyone—not even my mother. But this healer, he is more than a parent. He treats me very well. He is so close to me and special.… His care cannot be compared to health workers. They also do their best but this one is more special.” – 42-year-old female, PLWH

Factors impacting HIV clinical outcomes

TH-delivered support improved self-efficacy to remain in HIV care

Quote 7: “[The TH] made me believe and trust in myself. I am confident and ready to face whatever challenge that comes my way and continue to access my HIV services.” – 43-year-old female, PLWH

Quote 8: “Before this program, I used to miss a lot my clinic appointments. Sometimes it was difficult to support myself, but that was not an issue anymore. I learnt how to plan and prepare for my next clinic appointment ahead of time and thanks to my healer who is always there to remind me, encourage me, and motivate me.” – 42-year-old female, PLWH

TH-delivered ART readiness counseling prepared clients to reinitiate ART

Quote 9: “[The TH] took his time counseling me very well [before my appointment]. I felt I was prepared and ready to start all over my HIV treatment and care.” – 36-year-old male, PLWH

TH effectively addressed individual barriers to ART adherence

Quote 10: “My healer, she counseled me, told me a lot about HIV, what to do, the benefits and the challenge that comes around with poor adherence. She calls me, reminds me, and sometimes checks on me where necessary to see how I take my medicine.” – 27-year-old male, PLWH

Quote 11: “I monitored their ART adherence. How many tablets they were remaining, and their dates of clinic appointment. [We would] talk about their eating habits.” – 36-year-old female traditional healer

Quote 12: “I encouraged them to involve their family members, to disclose to their spouses and others so that they keep reminding them about the time when to take their HIV medicines.” – 53-year-old male, traditional healer

TH-delivered counseling reduced internalized stigma

Quote 13: “I had reached the worst stage that you can ever imagine but when I met this healer, it was like I was born again … I am no longer miserable. I have no more stigma. I am no longer living in self-denial. I access my HIV treatment with no challenge. I doubt I will consider stopping my HIV treatment ever again.” – 43-year-old male, PLWH

Transportation reimbursement overcame logistic challenges to HIV care

Quote 14: “One of the main supports that was helpful was the transport which was given to us because I did not have to struggle again going to access my HIV treatment. I was motivated and encouraged because I used to be so stressed [about transportation costs].”– 42-year-old female, PLWH

Implementation outcomes

Program acceptability

Quote 15: “So it also helped to update clinic workers about their challenges, and any progress, of these [PLWH] clients as far as HIV treatment and management was concerned. We practically became a bridge between health care providers at the HIV clinic and the clients that we do serve.” – 56-year-old male, traditional healer

Quote 16: “I found this interesting to find that traditional healers are actually helping to improve health services … I think if you are trying to address the challenges that these people face, the traditional healers will give you the first-hand information you want and the issues would be easily dealt with.” – 35-year-old male, HIV clinical liaison

Program appropriateness

Quote 17: “As traditional healers, our [PLWH] clients find it easier to approach us because we are people who belong to the same community. We are people who have lived with them for quite a long time. They are clients whom we have served for a long time, and we do understand them very well.” – 36-year-old male, traditional healer

Quote 18: “Traditional healers helped to sort out issues [to adherence] better than us in the medical sector because they know [the PLWH clients]. People believe in them more than us. They can do better in following up these people, which we can’t do. They know the challenges that people face” – 35-year-old male, HIV clinical liaison

Program feasibility

Quote 19: “This man [my healer] is naturally gifted and talented. He is good at talking and when he says something, it is difficult to refuse or ignore whatever he says. But also, we live together, we see each other all the time and so we have a lot of time to talk and discuss.” – 43-year-old female, PLWH

Sustainment of the program

Quote 20: “They are still on HIV care and I still support them by counselling, guiding and encouraging them never to give up and continue doing the right thing. I still monitor and follow them up. There is no getting tired because I am already connected to them and I cannot give up.” – 36-year-old male, traditional healer (12-month interview)

Quote 21: “I take my HIV treatment so seriously and I have never missed taking my HIV medicines or my clinic appointments. In addition to that, I am still getting support from my healer. He is still there for me providing me with the same counselling and guidance. We see each other quite often and we discuss about my health. Nothing changed after the program ended” – 35-year-old female, PLWH (12-month interview)