1. The Kanyakla study: Randomized controlled trial of a microclinic social network intervention for promoting engagement and retention in HIV care in rural western Kenya
- Author
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Gor Benard Ouma, Elvin Geng, Kathryn J. Fiorella, Eric L. Ding, Elizabeth A. Bukusi, Linda Otieno, Ben L. Pederson, Daniel E. Zoughbie, Pamela Mohamed, Abdi Odhiambo, Matthew D. Hickey, Craig R. Cohen, Charles R. Salmen, Nicholas R. DesLauriers, Brian Mattah, Betty Njoroge, Joyce Obanda, and Moitra, Ethan
- Subjects
RNA viruses ,Male ,Pediatric AIDS ,Comparative Effectiveness Research ,Topography ,Social stigma ,Epidemiology ,Social Stigma ,Psychological intervention ,Social Sciences ,HIV Infections ,Pilot Projects ,Pathology and Laboratory Medicine ,law.invention ,Social Networking ,Geographical Locations ,Randomized controlled trial ,Immunodeficiency Viruses ,Sociology ,law ,Medicine and Health Sciences ,Medicine ,Prospective Studies ,Disengagement theory ,Pediatric ,Islands ,Multidisciplinary ,Rural health ,HIV diagnosis and management ,Middle Aged ,Mental Health ,Social Networks ,Medical Microbiology ,HIV epidemiology ,Research Design ,Viral Pathogens ,Viruses ,HIV/AIDS ,Health education ,Female ,Pathogens ,Network Analysis ,Research Article ,Adult ,medicine.medical_specialty ,Computer and Information Sciences ,Adolescent ,General Science & Technology ,Anti-HIV Agents ,Science ,Clinical Trials and Supportive Activities ,Research and Analysis Methods ,Microbiology ,Social support ,Young Adult ,Clinical Research ,Intervention (counseling) ,Behavioral and Social Science ,Retroviruses ,Humans ,Microbial Pathogens ,Landforms ,business.industry ,Prevention ,Lentivirus ,Organisms ,Biology and Life Sciences ,HIV ,Social Support ,Geomorphology ,Pilot Studies ,Kenya ,Diagnostic medicine ,Health Care ,Good Health and Well Being ,Health Care Facilities ,Family medicine ,People and Places ,Africa ,Earth Sciences ,business - Abstract
Background Existing social relationships are a potential source of “social capital” that can enhance support for sustained retention in HIV care. A previous pilot study of a social network-based ‘microclinic’ intervention, including group health education and facilitated HIV status disclosure, reduced disengagement from HIV care. We conducted a pragmatic randomized trial to evaluate microclinic effectiveness. Methods In nine rural health facilities in western Kenya, we randomized HIV-positive adults with a recent missed clinic visit to either participation in a microclinic or usual care (NCT02474992). We collected visit data at all clinics where participants accessed care and evaluated intervention effect on disengagement from care (≥90-day absence from care after a missed visit) and the proportion of time patients were adherent to clinic visits (‘time-in-care’). We also evaluated changes in social support, HIV status disclosure, and HIV-associated stigma. Results Of 350 eligible patients, 304 (87%) enrolled, with 154 randomized to intervention and 150 to control. Over one year of follow-up, disengagement from care was similar in intervention and control (18% vs 17%, hazard ratio 1.03, 95% CI 0.61–1.75), as was time-in-care (risk difference -2.8%, 95% CI -10.0% to +4.5%). The intervention improved social support for attending clinic appointments (+0.4 units on 5-point scale, 95% CI 0.08–0.63), HIV status disclosure to close social supports (+0.3 persons, 95% CI 0.2–0.5), and reduced stigma (-0.3 units on 5-point scale, 95% CI -0.40 to -0.17). Conclusions The data from our pragmatic randomized trial in rural western Kenya are compatible with the null hypothesis of no difference in HIV care engagement between those who participated in a microclinic intervention and those who did not, despite improvements in proposed intervention mechanisms of action. However, some benefit or harm cannot be ruled out because the confidence intervals were wide. Results differ from a prior quasi-experimental pilot study, highlighting important implementation considerations when evaluating complex social interventions for HIV care. Trial registration Clinical trial number: NCT02474992.
- Published
- 2021