Integrated community-based HIV+NCD care in microfinance groups in Kenya: results from the Harambee cluster randomised trial
12 affiliations
- 1Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA
- 2Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island, USA
- 3Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- 4Center for Global Public Health, Brown University School of Public Health, Providence, Rhode Island, USA
- 5Purdue University College of Pharmacy, Indianapolis, Indiana, USA
- 6Temple University School of Pharmacy, Philadelphia, Pennsylvania, USA
- 7Moi Teaching and Referral Hospital, Eldoret, Kenya
- 8New York University Grossman School of Medicine, New York, New York, USA
- 9Indiana University School of Medicine, Indianapolis, Indiana, USA
- 10Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- 11Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, Rhode Island, USA
- 12Department of Mental Health & Behavioral Sciences, Moi University School of Medicine, Eldoret, Kenya
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.
Methods: 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).
Results: 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.
Conclusion: 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.
Trial registration number: NCT04417127.
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BibTeX
@article{genberg2026integrated,
title = {{Integrated community-based HIV+NCD care in microfinance groups in Kenya: results from the Harambee cluster randomised trial}},
author = {Becky L Genberg and Jon A Steingrimsson and Catherine Kafu and Marta Wilson-Barthes and Sonak D Pastakia and Dan N Tran and Jamil Said and Rajesh Vedanthan and Suzanne Goodrich and Paula Braitstein and Ben Mosong and Youjin Lee and Joseph W Hogan and Omar Galarraga and Juddy Wachira},
journal = {BMJ Global Health},
year = {2026},
month = nov,
doi = {10.1136/bmjgh-2025-020130},
url = {https://doi.org/10.1136/bmjgh-2025-020130},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Integrated community-based HIV+NCD care in microfinance groups in Kenya: results from the Harambee cluster randomised trial
AU - Becky L Genberg
AU - Jon A Steingrimsson
AU - Catherine Kafu
AU - Marta Wilson-Barthes
AU - Sonak D Pastakia
AU - Dan N Tran
AU - Jamil Said
AU - Rajesh Vedanthan
AU - Suzanne Goodrich
AU - Paula Braitstein
AU - Ben Mosong
AU - Youjin Lee
AU - Joseph W Hogan
AU - Omar Galarraga
AU - Juddy Wachira
PY - 2026
DA - 2026/11/04
JO - BMJ Global Health
DO - 10.1136/bmjgh-2025-020130
UR - https://doi.org/10.1136/bmjgh-2025-020130
AB - 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. Methods: 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). Results: 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. Conclusion: 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. Trial registration number: NCT04417127.
SN - 2059-7908
ER -