Abstract:
Introduction In Kenya, distance to health facilities,
inefficient vertical care delivery and limited financial
means are barriers to retention in HIV care. Furthermore,
the increasing burden of non-communicable diseases
(NCDs) among people living with HIV complicates chronic
disease treatment and strains traditional care delivery
models. Potential strategies for improving HIV/NCD
treatment outcomes are differentiated care, community based care and microfinance (MF).
Methods and analysis We will use a cluster randomised
trial to evaluate integrated community-based (ICB) care
incorporated into MF groups in medium and high HIV
prevalence areas in western Kenya. We will conduct
baseline assessments with n=900HIV positive members of
40 existing MF groups. Group clusters will be randomised
to receive either (1) ICB or (2) standard of care (SOC). The
ICB intervention will include: (1) clinical care visits during
MF group meetings inclusive of medical consultations,
NCD management, distribution of antiretroviral therapy
(ART) and NCD medications, and point-of-care laboratory
testing; (2) peer support for ART adherence and (3) facility
referrals as needed. MF groups randomised to SOC will
receive regularly scheduled care at a health facility.
Findings from the two trial arms will be compared with
follow-up data from n=300 matched controls. The primary
outcome will be VS at 18months. Secondary outcomes
will be retention in care, absolute mean change in systolic
blood pressure and absolute mean change in HbA1c level
at 18months. We will use mediation analysis to evaluate
mechanisms through which MF and ICB care impact
outcomes and analyse incremental cost-effectiveness
of the intervention in terms of cost per HIV suppressed
person-time, cost per patient retained in care and cost per
disability-adjusted life-year saved
