Microfinance, retention in care, and mortality among patients enrolled in HIV 2 Care in East Africa.

Abstract

OBJECTIVE\nTo measure associations between participation in community-based microfinance groups, retention in HIV care, and death among people living with HIV (PLHIV) in low-resource settings.\n\n\nDESIGN AND METHODS\nWe prospectively analyzed data from 3,609 patients enrolled in an HIV care program in western Kenya. HIV patients who were eligible and chose to participate in a Group Integrated Savings for Health Empowerment (GISHE) microfinance group were matched 1:2 on age, sex, year of enrollment in HIV care, and location of initial HIV clinic visit to patients not participating in GISHE. Follow-up data were abstracted from medical records for January 2018 through February 2020. Logistic regression analysis examined associations between GISHE participation and two outcomes: retention in HIV care (i.e., >1 HIV care visits attended within 6\u200amonths prior to the end of follow up) and death. Socioeconomic factors associated with HIV outcomes were included in adjusted models.\n\n\nRESULTS\nThe study population was majority female (78 3%) with a median age of 37 4\u200ayears. Microfinance group participants were more likely to be retained in care relative to HIV patients not participating in a microfinance group (adjusted OR (aOR)\u200a=\u200a1 31, 95% CI: 1 01 - 1 71; p\u200a=\u200a0.046). Participation in group microfinance was associated with a reduced odds of death during the follow-up period (aOR\u200a=\u200a0 57, 95% CI: 0 28 - 1 09; p\u200a=\u200a0.105).\n\n\nCONCLUSIONS\nParticipation in group-based microfinance appears to be associated with better HIV treatment outcomes. A randomized trial is needed to assess whether microfinance groups can improve clinical and socioeconomic outcomes among PLHIV in similar settings.