Pulling the network together: Quasiexperimental trial of a patient-defined support network intervention for promoting engagement in HIV care and medication adherence on mfangano Island, Kenya

Matthew D. Hickey, Charles R. Salmen, Dan Omollo, Brian Mattah, Kathryn J. Fiorella, Elvin H. Geng, Peter Bacchetti, Cinthia Blat, Gor B. Ouma, Daniel Zoughbie, Robert A. Tessler, Marcus R. Salmen, Harold Campbell, Monica Gandhi, Starley Shade, Betty Njoroge, Elizabeth A. Bukusi, Craig R. Cohen

Research output: Contribution to journalArticlepeer-review

36 Scopus citations

Abstract

Background: Despite progress in the global scale-up of antiretroviral therapy, sustained engagement in HIV care remains challenging. Social capital is an important factor for sustained engagement, but interventions designed to harness this powerful social force are uncommon. Methods: We conducted a quasiexperimental study evaluating the impact of the Microclinic Social Network intervention on engagement in HIV care and medication adherence on Mfangano Island, Kenya. The intervention was introduced into 1 of 4 similar communities served by this clinic; comparisons were made between communities using an intention-to-treat analysis. Microclinics, composed of patient-defined support networks, participated in 10 biweekly discussion sessions covering topics ranging from HIV biology to group support and group HIV status disclosure. Nevirapine concentrations in hair were measured before and after study. Results: One hundred thirteen (74%) intervention community participants joined a microclinic group, 86% of whom participated in group HIV status disclosure. Over 22-month follow-up, intervention community participants experienced one-half the rate of ≤90-day clinic absence as those in control communities (adjusted hazard ratio: 0.48; 95% confidence interval: 0.25 to 0.92). Nevirapine hair levels declined in both study arms; in adjusted linear regression analysis, the decline was 6.7 ng/mg less severe in the intervention arm than control arm (95% confidence interval: 22.7 to 16.1). Conclusions: The microclinic intervention is a promising and feasible community-based strategy to improve long-term engagement in HIV care and possibly medication adherence. Reducing treatment interruptions using a social network approach has important implications for individual patient virologic suppression, morbidity, and mortality and for broader community empowerment and engagement in healthcare.

Original languageEnglish
Pages (from-to)e127-e134
JournalJournal of Acquired Immune Deficiency Syndromes
Volume69
Issue number4
DOIs
StatePublished - 2015

Keywords

  • Adherence
  • HIV/AIDS
  • Kenya
  • Retention in care
  • Social network
  • Stigma

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