The Harambee Study uses two evidence-based approaches – differentiated care and group microfinance – to improve viral suppression and retention in care among adults living with HIV in western Kenya. In this rural region of the country, long distance to health facilities, inefficient vertical care delivery, and limited financial means are barriers to retention in HIV care. This study uses a cluster randomised trial to evaluate the effectiveness and cost-effectiveness of delivering integrated care for HIV, diabetes, and hypertension within community microfinance groups, with the aim of improving adherence to chronic disease care and rates of viral suppression.

HIV and the growing burden of non-communicable diseases in sub-Saharan Africa 

Despite considerable advances in expanding access to antiretroviral therapy (ART) in sub-Saharan Africa (SSA) over the past decade, retention in HIV care remains suboptimal: only half of people living with HIV (PLHIV) in SSA are virally suppressed. In Kenya, long distance to health facilities, inefficient vertical care delivery, and limited means of accessing transportation and food are barriers to routine HIV care engagement. At the same time, non-communicable diseases, including hypertension and diabetes, account for 50% of hospitalisations and 39% of deaths in the country, and NCD management presents a major economic burden to Kenyan households. Over the next 10 years, the prevalence of hypertension is expected to increase from 29 to 35 percent in western Kenya if left unattended. 

Solutions using Differentiated Care and Microfinance

Differentiated care models provide client-centered services that encourage ART adherence and engagement in care while maximizing efficiency. These models can alleviate health system strain by decongesting facilities and freeing resources for sicker or unstable patients. Kenya’s Guidelines on Use of Antiretroviral Drugs for Treating and Preventing HIV Infection recommend differentiated follow-up care for stable patients with HIV. These models can include community-based ART clubs and ART adherence groups, which have shown effectiveness in Kenya and other SSA countries. The effectiveness of differentiated and community-based care depends on the ability of these models to self-sustain. Using self-formed community-based microfinance groups as a platform for care delivery has the potential to improve chronic disease treatment outcomes and reduce economic and geographic barriers to care engagement. 

The Harambee study is testing whether delivering integrated care for HIV, hypertension and diabetes within community-based microfinance groups can improve viral suppression via two mechanisms: improved household economic status and easier access to care.

Better chronic disease outcomes in rural adults living with HIV would, in turn, reduce HIV transmission risks and save costs to health systems and their patients. 

Our cluster randomized trial has just concluded as of August 31, 2023. Keep an eye out for study findings on this website and at upcoming conferences!

Funding support 

This study is funded by the National Institutes of Mental Health (NIMH) of the U.S. National Institutes of Health: award number R01MH118075, identification code NCT04417127. For trial information, visit the site.