Becky L Genberg1, Marta G Wilson-Barthes2, Victor Omodi3, Joseph W Hogan3,4, Jon Steingrimsson4, Juddy Wachira3,5, Sonak Pastakia3,6, Dan N Tran3,7, Zana W Kiragu8, Laura J Ruhl3,9, Molly Rosenberg10, Sylvester Kimaiyo3, Omar Galárraga11. 1. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 2. Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA. 3. Academic Model Providing Access to Healthcare, Eldoret, Kenya. 4. Department of Biostatistics, Brown University School of Public Health, Providence, Rhode Island, USA. 5. Department of Behavioral Science, Moi University College of Health Sciences, School of Medicine, Eldoret, Kenya. 6. Purdue University College of Pharmacy, Center for Health Equity and Innovation, Indianapolis, Indiana. 7. Department of Pharmacy Practice, Temple University School of Pharmacy, Philadelphia, Pennsylvania. 8. Department of Global Health, Boston University School of Public Health, Boston, Massachusetts. 9. Department of Medicine, Indiana University School of Medicine, Indianapolis. 10. Department of Epidemiology and Biostatistics, Indiana University School of Public Health, Bloomington, Indiana. 11. Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.
Abstract
OBJECTIVE: To measure associations between participation in community-based microfinance groups, retention in HIV care, and death among people with HIV (PWH) in low-resource settings. DESIGN AND METHODS: We prospectively analyzed data from 3609 patients enrolled in an HIV care program in western Kenya. HIV patients who were eligible and chose to participate in a Group Integrated Savings for Health Empowerment (GISHE) microfinance group were matched 1 : 2 on age, sex, year of enrollment in HIV care, and location of initial HIV clinic visit to patients not participating in GISHE. Follow-up data were abstracted from medical records from January 2018 through February 2020. Logistic regression analysis examined associations between GISHE participation and two outcomes: retention in HIV care (i.e. >1 HIV care visit attended within 6 months prior to the end of follow-up) and death. Socioeconomic factors associated with HIV outcomes were included in adjusted models. RESULTS: The study population was majority women (78.3%) with a median age of 37.4 years. Microfinance group participants were more likely to be retained in care relative to HIV patients not participating in a microfinance group [adjusted odds ratio (aOR) = 1.31, 95% confidence interval (CI) 1.01-1.71; P = 0.046]. Participation in group microfinance was associated with a reduced odds of death during the follow-up period (aOR = 0.57, 95% CI 0.28-1.09; P = 0.105). CONCLUSION: Participation in group-based microfinance appears to be associated with better HIV treatment outcomes. A randomized trial is needed to assess whether microfinance groups can improve clinical and socioeconomic outcomes among PWH in similar settings.
OBJECTIVE: To measure associations between participation in community-based microfinance groups, retention in HIV care, and death among people with HIV (PWH) in low-resource settings. DESIGN AND METHODS: We prospectively analyzed data from 3609 patients enrolled in an HIV care program in western Kenya. HIV patients who were eligible and chose to participate in a Group Integrated Savings for Health Empowerment (GISHE) microfinance group were matched 1 : 2 on age, sex, year of enrollment in HIV care, and location of initial HIV clinic visit to patients not participating in GISHE. Follow-up data were abstracted from medical records from January 2018 through February 2020. Logistic regression analysis examined associations between GISHE participation and two outcomes: retention in HIV care (i.e. >1 HIV care visit attended within 6 months prior to the end of follow-up) and death. Socioeconomic factors associated with HIV outcomes were included in adjusted models. RESULTS: The study population was majority women (78.3%) with a median age of 37.4 years. Microfinance group participants were more likely to be retained in care relative to HIV patients not participating in a microfinance group [adjusted odds ratio (aOR) = 1.31, 95% confidence interval (CI) 1.01-1.71; P = 0.046]. Participation in group microfinance was associated with a reduced odds of death during the follow-up period (aOR = 0.57, 95% CI 0.28-1.09; P = 0.105). CONCLUSION: Participation in group-based microfinance appears to be associated with better HIV treatment outcomes. A randomized trial is needed to assess whether microfinance groups can improve clinical and socioeconomic outcomes among PWH in similar settings.
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