Effects of Integrated Community-Based Care and Group Microfinance on Antiretroviral Therapy Adherence Among Adults Living With HIV in Western Kenya

TL;DR

A study in Kenya found that combining community-based HIV care with microfinance groups significantly improved medication adherence among HIV patients.

Contribution

This study demonstrates that integrating community-based care with microfinance enhances ART adherence in Sub-Saharan Africa.

Findings

After 18 months, medication possession ratios significantly increased for both microfinance groups receiving usual and integrated care.

Four-day ART adherence ratios also improved for participants in microfinance groups with usual care.

The combination of community-based care and microfinance may lead to better HIV viral suppression.

Abstract

Despite the introduction of single-pill antiretroviral therapy (ART), adherence remains suboptimal in Sub-Saharan Africa. The Harambee study evaluated the effects of delivering integrated community-based (ICB) HIV care within small lending and savings groups called microfinance groups in western Kenya. Here, we explore the intervention's, a 2-arm cluster randomized trial, impact on ART adherence.

We calculated the medication possession ratio (MPR) across 18 months at 3 time points using ART refill data from May 2021 to July 2023. As a secondary outcome, we assessed patient-reported 4-day ART adherence changes between study months 0 and 18. Outcomes were analyzed using linear regression models with treatment-by-time interaction terms to estimate time-varying treatment effects and month fixed effects, with standard errors clustered at the appropriate group level.

Baseline mean MPRs were 0.971 for microfinance group members receiving ICB care, 0.989 for microfinance groups receiving usual (facility-based) care, and 0.995 for frequency-matched usual care patients not engaged in microfinance. At 18 months, MPRs were significantly higher among microfinance groups receiving usual care (0.057, P < 0.001) and microfinance groups receiving ICB care (0.048, P < 0.001) compared to baseline. Four-day ART adherence ratios increased for participants enrolled in group microfinance with usual care (0.021, P = 0.05). Findings were consistent across all models and robustness checks.

Combining ICB care with group microfinance significantly increased ART adherence and may contribute to increased HIV viral suppression.

Effects of Integrated Community-Based Care and Group Microfinance on HIV Treatment Adherence in Western Kenya

In Sub-Saharan Africa, many people living with HIV struggle to stay in care, even with better treatment options available. The Harambee study looked at how community-based HIV care linked with microfinance group participation (small loans and financial support) in western Kenya affected patients' ability to adhere to their HIV medication.

To measure this, researchers tracked how patients were picking up with their HIV medication refills from May 2021 to July 2023. They also interviewed patients about their medication adherence.

After 18 months, those who participated in both microfinance and facility-based care had a significant improvement in their HIV medication adherence. Additionally, involvement in microfinance groups increased how consistently patients reported their adherence.

Combining community-based care with microfinance not only improved adherence to HIV treatment but may also help in achieving better health outcomes for patients.

Figures