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

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