{ "abstract": "Introduction: The Harambee randomised trial tested the extent to which integrating community-based care with microfinance improves viral suppression and retention in care among people with HIV in Kenya.\n\nMethods: Using a two-arm parallel-cluster randomised controlled trial, we randomised 57 microfinance groups (29 to intervention, 28 to usual (facility-based) care) with 855 members living with HIV (407 in intervention, 448 in usual care). We enrolled n=300 frequency-matched, prospectively followed usual HIV care patients without microfinance. Delivered quarterly during community-based microfinance meetings, the intervention included clinical consultations, diabetes and/or hypertension management, distribution of antiretroviral therapy and non-communicable diseases medications, health education and facility referrals. The primary outcome was viral suppression (<400 HIV-RNA/mL before 1 January 2023; <200 HIV-RNA/mL on or after 1 January 2023) at 18 months. The secondary outcome was retention-in-care (attending >1 scheduled HIV care visit/quarter over 18 months). Between-arm comparisons were done using doubly-robust generalised estimating equations accounting for dropout and confounding (for comparisons to the non-randomised arm).\n\nResults: At enrolment, 94% of participants were virally suppressed. Viral suppression at 18 months was not significantly different between microfinance group members receiving community care versus facility care (OR 1.23, 95% CI 0.51 to 2.95, p=0.64). Viral suppression at 18 months was higher among community-care microfinance members (OR 2.16, 1.48 to 3.19, p<0.001) and facility-care microfinance members (OR 1.42, 1.05 to 1.92, p=0.023), compared with matched facility-care patients not engaged in microfinance. There was evidence of better quarterly retention comparing microfinance group members receiving community care versus facility care (OR 3.79, 2.96 to 4.86, p<0.001). Retention was higher among community-care microfinance members (OR 9.13, 7.13 to 11.70, p<0.001) and facility-care microfinance members (OR 2.40, 2.03 to 2.85, p<0.001), compared with matched facility-care patients.\n\nConclusion: More convenient services can improve retention in HIV care, while economic strengthening likely helps improve clinical HIV outcomes. Research to identify impact mechanisms and scale-up potential is needed.\n\nTrial registration number: NCT04417127.", "abstract_shown": true, "affiliations": [ "Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA", "Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island, USA", "Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya", "Center for Global Public Health, Brown University School of Public Health, Providence, Rhode Island, USA", "Purdue University College of Pharmacy, Indianapolis, Indiana, USA", "Temple University School of Pharmacy, Philadelphia, Pennsylvania, USA", "Moi Teaching and Referral Hospital, Eldoret, Kenya", "New York University Grossman School of Medicine, New York, New York, USA", "Indiana University School of Medicine, Indianapolis, Indiana, USA", "Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada", "Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA", "Department of Mental Health & Behavioral Sciences, Moi University School of Medicine, Eldoret, Kenya" ], "article_type": "research article", "arxiv": null, "author_total": 15, "authors": [ { "affs": [ 0 ], "name": "Becky L Genberg", "orcid": "0000-0002-9450-5311" }, { "affs": [ 1 ], "name": "Jon A Steingrimsson" }, { "affs": [ 2 ], "name": "Catherine Kafu" }, { "affs": [ 3 ], "name": "Marta Wilson-Barthes", "orcid": "0000-0002-9845-7142" }, { "affs": [ 4 ], "name": "Sonak D Pastakia" }, { "affs": [ 5 ], "name": "Dan N Tran" }, { "affs": [ 6 ], "name": "Jamil Said" }, { "affs": [ 7 ], "name": "Rajesh Vedanthan", "orcid": "0000-0001-7138-2382" }, { "affs": [ 8 ], "name": "Suzanne Goodrich" }, { "affs": [ 9 ], "name": "Paula Braitstein" }, { "affs": [ 2 ], "name": "Ben Mosong" }, { "affs": [ 1 ], "name": "Youjin Lee" }, { "affs": [ 1 ], "name": "Joseph W Hogan" }, { "affs": [ 3, 10 ], "name": "Omar Galarraga" }, { "affs": [ 11 ], "name": "Juddy Wachira" } ], "bibtex": "https://research.draconitic.com/paper/d6y8k7vha9jgy.bib", "cited_by": 0, "doi": "10.1136/bmjgh-2025-020130", "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13735365/", "id": "d6y8k7vha9jgy", "issns": [ "2059-7908" ], "landing_url": "https://doi.org/10.1136/bmjgh-2025-020130", "language": "en", "licence": "CC-BY-NC-4.0", "licence_label": "CC BY-NC 4.0", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/", "metadata_licence": null, "native_subjects": [ [ "heading", "1506" ], [ "heading", "Original Research" ], [ "openalex", "2725|HIV/AIDS Research and Interventions" ] ], "openalex": "W7225269425", "pdf_url": "https://gh.bmj.com/content/11/11/e020130.full.pdf", "pmcid": "PMC13735365", "pmid": "42982502", "published": "2026-11-04", "publisher": "BMJ Publishing Group", "ris": "https://research.draconitic.com/paper/d6y8k7vha9jgy.ris", "sources": [ { "first_seen": "2026-11-09T12:21:03Z", "native_id": "PMC13735365", "source": "pmc", "url": "https://doi.org/10.1136/bmjgh-2025-020130" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2725|HIV/AIDS Research and Interventions", "subfield": "infectious-disease" } ], "title": "Integrated community-based HIV+NCD care in microfinance groups in Kenya: results from the Harambee cluster randomised trial", "title_text": "Integrated community-based HIV+NCD care in microfinance groups in Kenya: results from the Harambee cluster randomised trial", "type": "peer-reviewed", "updated_at": "2026-11-09T12:21:03Z", "url": "https://research.draconitic.com/paper/d6y8k7vha9jgy", "venue": "BMJ Global Health", "versions": [] }