Authors: Matthew D Hickey, Charles R Salmen, Dan Omollo, Brian Mattah, Elvin H Geng, Peter Bacchetti, Cinthia Blat, Gor Benard Ouma, Kathryn J Fiorella, Daniel Zoughbie, Robert A Tessler, Marcus R Salmen, Monica Gandhi, Starley Shade, Elizabeth A Bukusi, Craig R Cohen.
Status: Presented as oral presentation at the 9th International Conference on HIV Treatment and Prevention Adherence in June 2014. Manuscript in preparation
Background: Despite progress in the global scale-up of antiretroviral therapy (ART), sustained engagement in HIV care remains challenging. Social capital has been identified as an important factor for sustained engagement, but interventions to harness this powerful social force are uncommon.
Methods: We conducted a quasi-experimental study evaluating the impact of a targeted social network intervention on engagement in HIV care at a rural health facility on Mfangano Island, Kenya. 369 (87%) of 426 eligible adult patients on ART were enrolled. The intervention was introduced into one of four similar communities served by this clinic, and comparisons were made between communities using intention- to-treat. Microclinics, composed of patient-defined support networks, participated in 10 bi-weekly discussion sessions covering topics ranging from HIV biology to group support. The curriculum also included voluntary participation in a group HIV status disclosure session. We report impact on disengagement from care, measured by the incidence of ≥90 day gaps in care following a missed clinic appointment, using Cox proportional hazards regression. The model was adjusted for potential clinical and demographic confounders and included robust standard errors to account for clustering.
Results: 113 (74%) intervention community participants joined a microclinic group, 86% of whom participated in group HIV status disclosure. Over 22-months of follow-up, incidence rates of 90-day disengagement were 6.8 per 100 person-years in the intervention group (95%CI 4.2-10.9) and 12.9 (95%CI 9.6-17.3) in control. In the adjusted Cox model, intervention community participants experienced one-half the rate of 90 -day clinic absence as those in control communities (adjusted hazard ratio 0.48, 95%CI 0.25-0.92).
Conclusions: The microclinic intervention holds promise as a feasible community-based strategy to improve long-term engagement in HIV care. 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.