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

Pilot and Feasibility Studies

Research

Dan Aburi¹  Victor Omodi¹  Jael Adongo Onyango¹  Sonak D. Pastakia²  Dan N. Tran³  Catherine Kafu⁴  Juddy Wachira⁵  Jamil Said⁶  Marta Wilson-Barthes⁷  Becky Lynn Genberg⁸  Omar Galárraga⁹ 

[1] Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya;Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya;Center for Health Equity and Innovation, Purdue University College of Pharmacy, 640 Eskenazi Ave, 46202, Indianapolis, IN, USA;Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya;Department of Pharmacy Practice, Temple University School of Pharmacy, 3307 N Broad St, 19140, Philadelphia, PA, USA;Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya;School of Literature, Language and Media, Department of Media Studies, University of Witwatersrand, 1 Jan Smuts Avenue, Braamfontein, 2000, Johannesburg, South Africa;Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya;School of Medicine, Department of Behavioral Science, Moi University College of Health Sciences, P.O. Box 4606-30100, Eldoret, Kenya;Academic Model Providing Access to Healthcare, P.O. Box 4606-30100, Eldoret, Kenya;School of Medicine, Department of Human Anatomy, Moi University College of Health Sciences, P.O. Box 4606-30100, Eldoret, Kenya;Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, 02912, Providence, RI, USA;Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, 21205, Baltimore, MD, USA;Department of Health Services, Policy and Practice, Brown University School of Public Health, 121 South Main Street, 02912, Providence, RI, USA;

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

DOI  :  10.1186/s40814-022-01218-6

 received in 2022-02-07, accepted in 2022-11-29,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundThe 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.MethodsFeasibility 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.ResultsOf 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.ConclusionsThis 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 registrationThe original trial was prospectively registered with ClinicalTrials.gov (NCT04417127) on 4 June 2020.

【 授权许可】

CC BY   
© The Author(s) 2022

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