Abstract:
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 inter-
vention’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 micro-
finance. 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 con-
sistent 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.
