# Harambee: Integrated Community-Based HIV/NCD Care & Microfinance Groups in Kenya

> **NIH NIH R01** · BROWN UNIVERSITY · 2021 · $541,608

## Abstract

PROJECT SUMMARY/ABSTRACT
Sustained viral suppression (VS) continues to present major challenges to HIV treatment and prevention.
Retention in care is a particularly challenging issue for persons living with HIV (PLHIV) because of lack of
convenient access and issues related to economic stability. Our long-term goal is to help achieve the 90-90-90
goals through improved care delivery based on rigorous implementation research. The objective of this project
is to demonstrate the effectiveness and longer-term sustainability of a differentiated care delivery model for
improving HIV treatment outcomes. The central hypothesis is that the integration of HIV care delivery and
community-based primary care with group-based microfinance will improve retention and rates of VS among
PLHIV in Kenya via two mechanisms: improved household economic status and easier access to care. Thus,
the specific aims are as follows: (1) To evaluate the extent to which integrated community-based HIV care with
group microfinance affects retention in care and VS among PLHIV in rural western Kenya using a cluster
randomized intervention design of existing (fully HIV+) microfinance groups to receive either: (A) integrated
community-based HIV care, or (B) standard care. We will also augment trial data with a matched
contemporaneous control group of patients in standard care (group C) comparing outcomes in groups A, B and
C; (2) To identify specific mechanisms through which microfinance and integrated community-based care impact
VS: Using a mixed methods approach, we will characterize the mechanisms of effect on patient outcomes. We
will conduct quantitative mediation analysis to examine two main mediating pathways (household economic
conditions and easier access to care), as well as exploratory mechanisms (food security, social support, HIV-
related stigma). We will also use qualitative methods and multi-stakeholder panels to contextualize the
implementation of the intervention; and (3) To assess the cost-effectiveness of microfinance and integrated
community-based care delivery to maximize future policy and practice relevance of this promising intervention
strategy. Our working hypothesis is that the differentiated model will be cost-effective in terms of cost per HIV
suppressed person-time, cost per patient retained in care, and cost per disability-adjusted life year saved. This
project is part of the Academic Model Providing Access to Healthcare (AMPATH) program in western Kenya
which cares for more than 150,000 PLHIV at over 500 sites in western Kenya since 2001. The main expected
outcomes will be rigorous evidence of effectiveness, mechanisms and cost-effectiveness of a differentiated
model for achieving the last key step in the HIV care continuum. These results are expected to have an important
positive impact in terms of improved, high-quality services that address known individual and structural barriers
to care and promote long-term sustainability of care for PLHIV in rura...

## Key facts

- **NIH application ID:** 10148816
- **Project number:** 5R01MH118075-03
- **Recipient organization:** BROWN UNIVERSITY
- **Principal Investigator:** Omar Galarraga
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $541,608
- **Award type:** 5
- **Project period:** 2019-07-05 → 2024-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10148816

## Citation

> US National Institutes of Health, RePORTER application 10148816, Harambee: Integrated Community-Based HIV/NCD Care & Microfinance Groups in Kenya (5R01MH118075-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10148816. Licensed CC0.

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