Integrated community-based HIV+NCD care in microfinance groups in Kenya: results from the Harambee cluster randomised trial

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• Picked for Public Health, Environmental and Occupational Health (top studies of the week, 8 November 2026): Cluster trial evaluates community-based integrated HIV and NCD care delivery

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.

Abstract as published, via PubMed.