The Kanyakla study: Randomized controlled trial of a microclinic social network intervention for promoting engagement and retention in HIV care in rural western Kenya.
<h4>Background</h4>Existing social relationships are a potential source of "social capital" that can enhance support for sustained retention in HIV care. A previous pilot study of a social network-based 'microclinic' intervention, including group health education and...
| Main Authors: | , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2021-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0255945 |
| _version_ | 1818735849391521792 |
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| author | Matthew D Hickey Gor B Ouma Brian Mattah Ben Pederson Nicholas R DesLauriers Pamela Mohamed Joyce Obanda Abdi Odhiambo Betty Njoroge Linda Otieno Daniel E Zoughbie Eric L Ding Kathryn J Fiorella Elizabeth A Bukusi Craig R Cohen Elvin H Geng Charles R Salmen |
| author_facet | Matthew D Hickey Gor B Ouma Brian Mattah Ben Pederson Nicholas R DesLauriers Pamela Mohamed Joyce Obanda Abdi Odhiambo Betty Njoroge Linda Otieno Daniel E Zoughbie Eric L Ding Kathryn J Fiorella Elizabeth A Bukusi Craig R Cohen Elvin H Geng Charles R Salmen |
| author_sort | Matthew D Hickey |
| collection | DOAJ |
| description | <h4>Background</h4>Existing social relationships are a potential source of "social capital" that can enhance support for sustained retention in HIV care. A previous pilot study of a social network-based 'microclinic' intervention, including group health education and facilitated HIV status disclosure, reduced disengagement from HIV care. We conducted a pragmatic randomized trial to evaluate microclinic effectiveness.<h4>Methods</h4>In nine rural health facilities in western Kenya, we randomized HIV-positive adults with a recent missed clinic visit to either participation in a microclinic or usual care (NCT02474992). We collected visit data at all clinics where participants accessed care and evaluated intervention effect on disengagement from care (≥90-day absence from care after a missed visit) and the proportion of time patients were adherent to clinic visits ('time-in-care'). We also evaluated changes in social support, HIV status disclosure, and HIV-associated stigma.<h4>Results</h4>Of 350 eligible patients, 304 (87%) enrolled, with 154 randomized to intervention and 150 to control. Over one year of follow-up, disengagement from care was similar in intervention and control (18% vs 17%, hazard ratio 1.03, 95% CI 0.61-1.75), as was time-in-care (risk difference -2.8%, 95% CI -10.0% to +4.5%). The intervention improved social support for attending clinic appointments (+0.4 units on 5-point scale, 95% CI 0.08-0.63), HIV status disclosure to close social supports (+0.3 persons, 95% CI 0.2-0.5), and reduced stigma (-0.3 units on 5-point scale, 95% CI -0.40 to -0.17).<h4>Conclusions</h4>The data from our pragmatic randomized trial in rural western Kenya are compatible with the null hypothesis of no difference in HIV care engagement between those who participated in a microclinic intervention and those who did not, despite improvements in proposed intervention mechanisms of action. However, some benefit or harm cannot be ruled out because the confidence intervals were wide. Results differ from a prior quasi-experimental pilot study, highlighting important implementation considerations when evaluating complex social interventions for HIV care.<h4>Trial registration</h4>Clinical trial number: NCT02474992. |
| first_indexed | 2024-12-18T00:27:47Z |
| format | Article |
| id | doaj.art-20a62fb5aec5441ab8a6a11806554d8e |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-18T00:27:47Z |
| publishDate | 2021-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj.art-20a62fb5aec5441ab8a6a11806554d8e2022-12-21T21:27:12ZengPublic Library of Science (PLoS)PLoS ONE1932-62032021-01-01169e025594510.1371/journal.pone.0255945The Kanyakla study: Randomized controlled trial of a microclinic social network intervention for promoting engagement and retention in HIV care in rural western Kenya.Matthew D HickeyGor B OumaBrian MattahBen PedersonNicholas R DesLauriersPamela MohamedJoyce ObandaAbdi OdhiamboBetty NjorogeLinda OtienoDaniel E ZoughbieEric L DingKathryn J FiorellaElizabeth A BukusiCraig R CohenElvin H GengCharles R Salmen<h4>Background</h4>Existing social relationships are a potential source of "social capital" that can enhance support for sustained retention in HIV care. A previous pilot study of a social network-based 'microclinic' intervention, including group health education and facilitated HIV status disclosure, reduced disengagement from HIV care. We conducted a pragmatic randomized trial to evaluate microclinic effectiveness.<h4>Methods</h4>In nine rural health facilities in western Kenya, we randomized HIV-positive adults with a recent missed clinic visit to either participation in a microclinic or usual care (NCT02474992). We collected visit data at all clinics where participants accessed care and evaluated intervention effect on disengagement from care (≥90-day absence from care after a missed visit) and the proportion of time patients were adherent to clinic visits ('time-in-care'). We also evaluated changes in social support, HIV status disclosure, and HIV-associated stigma.<h4>Results</h4>Of 350 eligible patients, 304 (87%) enrolled, with 154 randomized to intervention and 150 to control. Over one year of follow-up, disengagement from care was similar in intervention and control (18% vs 17%, hazard ratio 1.03, 95% CI 0.61-1.75), as was time-in-care (risk difference -2.8%, 95% CI -10.0% to +4.5%). The intervention improved social support for attending clinic appointments (+0.4 units on 5-point scale, 95% CI 0.08-0.63), HIV status disclosure to close social supports (+0.3 persons, 95% CI 0.2-0.5), and reduced stigma (-0.3 units on 5-point scale, 95% CI -0.40 to -0.17).<h4>Conclusions</h4>The data from our pragmatic randomized trial in rural western Kenya are compatible with the null hypothesis of no difference in HIV care engagement between those who participated in a microclinic intervention and those who did not, despite improvements in proposed intervention mechanisms of action. However, some benefit or harm cannot be ruled out because the confidence intervals were wide. Results differ from a prior quasi-experimental pilot study, highlighting important implementation considerations when evaluating complex social interventions for HIV care.<h4>Trial registration</h4>Clinical trial number: NCT02474992.https://doi.org/10.1371/journal.pone.0255945 |
| spellingShingle | Matthew D Hickey Gor B Ouma Brian Mattah Ben Pederson Nicholas R DesLauriers Pamela Mohamed Joyce Obanda Abdi Odhiambo Betty Njoroge Linda Otieno Daniel E Zoughbie Eric L Ding Kathryn J Fiorella Elizabeth A Bukusi Craig R Cohen Elvin H Geng Charles R Salmen The Kanyakla study: Randomized controlled trial of a microclinic social network intervention for promoting engagement and retention in HIV care in rural western Kenya. PLoS ONE |
| title | The Kanyakla study: Randomized controlled trial of a microclinic social network intervention for promoting engagement and retention in HIV care in rural western Kenya. |
| title_full | The Kanyakla study: Randomized controlled trial of a microclinic social network intervention for promoting engagement and retention in HIV care in rural western Kenya. |
| title_fullStr | The Kanyakla study: Randomized controlled trial of a microclinic social network intervention for promoting engagement and retention in HIV care in rural western Kenya. |
| title_full_unstemmed | The Kanyakla study: Randomized controlled trial of a microclinic social network intervention for promoting engagement and retention in HIV care in rural western Kenya. |
| title_short | The Kanyakla study: Randomized controlled trial of a microclinic social network intervention for promoting engagement and retention in HIV care in rural western Kenya. |
| title_sort | kanyakla study randomized controlled trial of a microclinic social network intervention for promoting engagement and retention in hiv care in rural western kenya |
| url | https://doi.org/10.1371/journal.pone.0255945 |
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