Search

Introduction During the COVID-19 response, Kenya experienced widespread regional floods, resulting in the displacement of communities and agricultural loss. This study aimed to characterise food insecurity and other social and economic impacts of these emergencies on people living with HIV and to investigate whether and how existing microfinance activities in place before the events influenced social and economic instability.Methods We used sequential explanatory mixed methods guided by a conceptual model. Interviewer-administered surveys (n=200) and follow-up in-depth interviews (n=40) were conducted by phone with people living with HIV in Busia and Trans Nzoia counties between October and December 2020. Socioeconomic factors (microfinance participation, income and social support) and food insecurity were examined with Poisson regression using survey data. Qualitative data were analysed using content analysis to contextualise quantitative findings.Results Among 200 participants, 59.0% were female, median age was 45 years and 73.0% reported being severely food insecure. Microfinance participation was not associated with severe food insecurity (adjusted prevalence ratio, aPR 0.98; 95% CI 0.82, 1.18), but income loss (aPR 1.94; 95% CI 1.13, 3.30; p=0.015) and loss of social support (aPR 1.48; 95% CI 1.18, 1.84; p=0.001) were associated with severe food insecurity. Three main themes emerged: compounding effects of COVID-19 and flooding on food and economic insecurity are early indicators of upstream barriers to HIV treatment; microfinance groups may not have mitigated socioeconomic consequences of COVID-19 and flooding because of unexpected income loss and limits on gathering and displacement; and social support bolsters mental health and medication adherence among microfinance members despite lack of in-person activities.Conclusions In the context of coinciding public health and environmental emergencies, people living with HIV in Kenya experienced widespread food insecurity. Programmatic efforts to support HIV treatment disbursement, coverage and adherence alone are not sufficient during an economic crisis affecting food insecurity. Integrating antiretroviral therapy (ART) dispensing efforts alongside interventions to support food security for people living with HIV could improve ART adherence and reduce mortality during widespread emergencies.

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=900 HIV 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 18 months. Secondary outcomes will be retention in care, absolute mean change in systolic blood pressure and absolute mean change in HbA1c level at 18 months. 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.Ethics and dissemination The Moi University Institutional Research and Ethics Committee approved this study (IREC#0003054). We will share data via the Brown University Digital Repository and disseminate findings via publication.Trial registration number NCT04417127.