Table 4 Studies reviewed on the association between the use of alternative medicines and ART outcomes in South Africa

Improved adherence to anti-retroviral therapy among traditionalists: reflections from rural South Africa

Limpopo

A strategy was developed to contribute to improved adherence and a reduction of internalized stigma among HIV infected traditionalists in Waterberg district, South Africa

[76]

The in-vitro and in-vivo effects of Hypoxis hemerocallidea on indinavir pharmacokinetics: modulation of efflux

Not indicated

The combined effect of efflux and metabolism inhibition by H. hemerocallidea has clinical significance on indinavir pharmacokinetics

[78]

Traditional, complementary and alternative medicine use in Sub-Saharan Africa: a systematic review

Sub-Saharan Africa

Traditional, complementary and alternative medicine use in sub-Saharan Africa is significant

[66]

Herbal slimming formulations or remedies interact with antiretroviral therapy

Not indicated

There is potential for reduced or increased serum antiretroviral drug concentrations. Subtherapeutic drug levels could lead to unsatisfactory viral suppression. Herbal products may also contain compounds that interfere with the absorption of antiretrovirals

[86]

Concurrent use of antiretroviral and African traditional medicines amongst people living with HIV/AIDS (PLWA) in the eThekwini metropolitan area of KwaZulu Natal

KwaZulu-Natal

Concurrent ARV and ATM use is quite low when compared to ATM use before HIV diagnosis and after HIV diagnosis but before initiation with ARV

[87]

Traditional, complementary and alternative medicine use by HIV patients a decade after public sector antiretroviral therapy roll out in South Africa: a cross sectional study

KwaZulu-Natal

The use of traditional, complementary and alternative medicine is prevalent amongst a small proportion of HIV infected patients attending public healthcare sector antiretroviral clinics

[67]

Antiretroviral therapy initiation and adherence in rural South Africa: community health workers' perspectives on barriers and facilitators

KwaZulu-Natal

There are a number of factors associated with non-adherence, which includes a dilemma between ART and alternative medicine use

[75]

Inhibition of CYP2B6 by medicinal plant extracts: implication for use of efavirenz and nevirapine-based highly active anti-retroviral therapy (HAART) in resource-limited settings

Not indicated

There is a high probability that standard doses affect drug plasma concentrations, which could lead to toxicity, when drugs that are metabolized by CYP2B6, are co-administered with herbal medicines

[88]

Concurrent use of traditional medicine and ART: perspectives of patients, providers and traditional healers in Durban, South Africa

KwaZulu-Natal

Some patients do not view TAM as an alternative to ART; rather, employ TAM and ART for distinctly different needs

[89]

The potential of Sutherlandia frutescens for herb–drug interaction

Not indicated

Herb–drug interactions have an effect on enzymes responsible for ART drug metabolism and transport

[90]

Why HIV positive patients on antiretroviral treatment and/or cotrimoxazole prophylaxis use traditional medicine: perceptions of health workers, traditional healers and patients: a study in two provinces of South Africa

Western Cape and KwaZulu-Natal

A number of HIV positive patients on ART concurrently use traditional medicine for various reasons

[74]

Factors associated with patterns of plural healthcare utilization among patients taking antiretroviral therapy in rural and urban South Africa: a cross-sectional study

Not indicated

Increased plural healthcare utilization, inequitably distributed between rural and urban areas, is largely a function of higher socioeconomic status, better ability to finance healthcare and factors related to poor quality of care in ART clinics

[91]

The social and clinical characteristics of patients on antiretroviral therapy who are 'lost to follow-up' in KwaZulu-Natal, South Africa: a prospective study

KwaZulu-Natal

The use of alternative medicine and depression are some of the factors contributing to non-adherence and lost to follow-up

[70]

Traditional complementary and alternative medicine and antiretroviral treatment adherence among HIV patients in KwaZulu-Natal, South Africa

KwaZulu-Natal

The use of herbal treatment reduces ARV adherence. It is therefore recommended that patients' use of TCAM be considered in ARV adherence management

[92]

The cultural and community-level acceptance of antiretroviral therapy among traditional healers in Eastern Cape, South Africa

Eastern Cape

Cultural consistencies between traditional and biomedical medicine may strengthen HIV/AIDS treatment programs to provide ART in resource-poor settings

[92]

“That is why I stopped the ART”: Patients' and providers' perspectives on barriers to and enablers of HIV treatment adherence in a South African workplace programme

Not indicated

HIV positive patients stop the use of ART due to the use of traditional medicines

[93]

Patients consulting traditional health practioners in the context of HIV/AIDS in urban areas in KwaZulu-Natal, South Africa

KwaZulu-Natal

A number of HIV positive patients in heath care at the same time consult traditional health practitioners for various reasons, which affects ART adherence

[73]

Use of traditional complementary and alternative medicine for HIV patients in KwaZulu-Natal, South Africa

KwaZulu-Natal

Traditional herbal therapies and TCAM are commonly used by HIV treatment naive outpatients of public health facilities in South Africa

[71]

Self-reported use of traditional, complementary and over-the-counter medicines by HIV-infected patients on antiretroviral therapy in Pretoria, South Africa

Gauteng

HIV-infected patients on ART in this study used a limited range of over-the-counter products as well as those from traditional, complementary and alternative medicine practices

[94]

Use of traditional medicine by HIV-infected individuals in South Africa in the era of antiretroviral therapy

Not indicated

Traditional medicine use is common among individuals with moderate and advanced HIV disease. Concomitant use with ART has the potential for drug interactions and should be discussed routinely in ART counselling

[69]