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. 2022 Dec 28;8(1):266.
doi: 10.1186/s40814-022-01218-6.

Integrating community-based HIV and non-communicable disease care with microfinance groups: a feasibility study in Western Kenya

Catherine Kafu  1   2 , Juddy Wachira  3   4 , Victor Omodi  3 , Jamil Said  3   5 , Sonak D Pastakia  3   6 , Dan N Tran  3   7 , Jael Adongo Onyango  3 , Dan Aburi  3 , Marta Wilson-Barthes  8 , Omar Galárraga  9 , Becky Lynn Genberg  10
Affiliations

Integrating community-based HIV and non-communicable disease care with microfinance groups: a feasibility study in Western Kenya

Catherine Kafu et al. Pilot Feasibility Stud. .

Abstract

Background: The Harambee study is a cluster randomized trial in Western Kenya that tests the effect, mechanisms, and cost-effectiveness of integrating community-based HIV and non-communicable disease care within microfinance groups on chronic disease treatment outcomes. This paper documents the stages of our feasibility study conducted in preparation for the Harambee trial, which include (1) characterizing the target population and gauging recruitment capacity, (2) determining community acceptability of the integrated intervention and study procedures, and (3) identifying key implementation considerations prior to study start.

Methods: Feasibility research took place between November 2019 and February 2020 in Western Kenya. Mixed methods data collection included surveys administered to 115 leaders of 105 community-based microfinance groups, 7 in-person meetings and two workshops with stakeholders from multiple sectors of the health system, and ascertainment of field notes and geographic coordinates for group meeting locations and HIV healthcare facilities. Quantitative survey data were analyzed using STATA IC/13. Longitude and latitude coordinates were mapped to county boundaries using Esri ArcMap. Qualitative data obtained from stakeholder meetings and field notes were analyzed thematically.

Results: Of the 105 surveyed microfinance groups, 77 met eligibility criteria. Eligible groups had been in existence from 6 months to 18 years and had an average of 22 members. The majority (64%) of groups had at least one member who owned a smartphone. The definition of "active" membership and model of saving and lending differed across groups. Stakeholders perceived the community-based intervention and trial procedures to be acceptable given the minimal risks to participants and the potential to improve HIV treatment outcomes while facilitating care integration. Potential challenges identified by stakeholders included possible conflicts between the trial and existing community-based interventions, fear of group disintegration prior to trial end, clinicians' inability to draw blood for viral load testing in the community, and deviations from standard care protocols.

Conclusions: This study revealed that it was feasible to recruit the number of microfinance groups necessary to ensure that our clinical trial was sufficient powered. Elicitation of stakeholder feedback confirmed that the planned intervention was largely acceptable and was critical to identifying challenges prior to implementation.

Trial registration: The original trial was prospectively registered with ClinicalTrials.gov (NCT04417127) on 4 June 2020.

Keywords: Community-based care; Differentiated care; Feasibility study; Human immunodeficiency viruses (HIV); Implementation science; Microfinance; Non-communicable diseases; Randomized controlled trial.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Schema for the Harambee cluster randomized trial
Fig. 2
Fig. 2
Table banking microfinance model
Fig. 3
Fig. 3
Locations of microfinance group meetings and health facilities where group members receive HIV care
See this image and copyright information in PMC

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