Integrating Community-Based HIV and Non-Communicable Disease Care with Microfinance Groups: A Formative Study in Western Kenya

Abstract Background: The Harambee Study is a cluster randomized trial in western Kenya that tests the effect, mechanisms, and cost-effectiveness of integrating community-based HIV and non-communicable disease (NCD) care with group microfinance (MF) on HIV treatment outcomes. This paper documents the formative work to: (1) identify, enumerate, and characterize existing community-based microfinance groups to refine the study’s eligibility criteria, and (2) elicit support from multi-sectoral stakeholders in preparation for trial start. Methods: This mixed methods formative research took place between November 2019 and February 2020 in western Kenya. Surveys were administered to 115 group leaders of community-based MF groups. Field notes and GPS coordinates of group meeting locations and HIV healthcare facilities were also taken. A further 28 in-person meetings and two workshops involving stakeholders from multiple sectors of the health system took place throughout the formative phase. Quantitative survey data was analyzed using STATA IC/13. Longitude and latitude coordinates were mapped to County boundaries using Esri ArcMap. Qualitative data obtained from the meetings and field notes were analyzed thematically.Results: A total of 105 community-based microfinance groups were reached and 77 were eligible for the study. Of the eligible groups, we found differences in terms of definition of active membership, microfinance models, meeting location, and meeting frequency. Despite these differences, all the groups had an annual cycle period. Predominant themes emerging from the minutes and field notes revealed enthusiasm and support for the intervention among key stakeholders. Key stakeholders expressed a desire to have interventions integrated into the AMPATH care model for sustainability after the study period. Continuous engagement of various stakeholders, collaboration on various aspects of the study, identification of areas that could potentially lead to conflict, and overall increased transparency were identified as crucial to this integration.Conclusions: For randomized controlled trials (RCTs) conducted in rural communities, formative research is essential for pre-determining eligibility, mapping implementation sites and eliciting buy-in from community leaders. Adaptations identified from formative work should be addressed prior to study start.Trial registration: NCT04417127. Registered 4 June 2020 - Retrospectively registered, https:// www.clinicaltrials.gov/ct2/show/NCT04417127