title: Implementation and Operational Research: Pulling the Network Together: Quasiexperimental Trial of a Patient-Defined Support Network Intervention for Promoting Engagement in HIV Care and Medication Adherence on Mfangano Island, Kenya.
abstract: BACKGROUND
  Despite progress in the global scale-up of antiretroviral therapy, sustained engagement in HIV care remains challenging. Social capital is an important factor for sustained engagement, but interventions designed to harness this powerful social force are uncommon.
  
  
  METHODS
  We conducted a quasiexperimental study evaluating the impact of the Microclinic Social Network intervention on engagement in HIV care and medication adherence on Mfangano Island, Kenya. The intervention was introduced into 1 of 4 similar communities served by this clinic; comparisons were made between communities using an intention-to-treat analysis. Microclinics, composed of patient-defined support networks, participated in 10 biweekly discussion sessions covering topics ranging from HIV biology to group support and group HIV status disclosure. Nevirapine concentrations in hair were measured before and after study.
  
  
  RESULTS
  One hundred thirteen (74%) intervention community participants joined a microclinic group, 86% of whom participated in group HIV status disclosure. Over 22-month follow-up, intervention community participants experienced one-half the rate of ≥ 90-day clinic absence as those in control communities (adjusted hazard ratio: 0.48; 95% confidence interval: 0.25 to 0.92). Nevirapine hair levels declined in both study arms; in adjusted linear regression analysis, the decline was 6.7 ng/mg less severe in the intervention arm than control arm (95% confidence interval: -2.7 to 16.1).
  
  
  CONCLUSIONS
  The microclinic intervention is a promising and feasible community-based strategy to improve long-term engagement in HIV care and possibly medication adherence. Reducing treatment interruptions using a social network approach has important implications for individual patient virologic suppression, morbidity, and mortality and for broader community empowerment and engagement in healthcare.
authors.affiliation: *Division of Internal Medicine, Department of Medicine, San Francisco General Hospital, University of California, San Francisco (UCSF), San Fransisco, CA; †Mfangano Island Research Group, Organic Health Response, Homa Bay, Kenya; ‡Microclinic International (MCI), San Francisco, CA; §Department of Family and Community Medicine, University of Minnesota, Minneapolis, MN; ‖Department of Environmental Science, Policy and Management, University of California, Berkeley, Berkeley, CA; ¶Department of Medicine, Division of HIV/AIDS, University of California, San Francisco (UCSF), San Francisco, CA; #Department of Epidemiology and Biostatistics, University of California, San Francisco (UCSF), San Francisco, CA; **Department of Surgery, University of California, San Francisco (UCSF) East Bay, Oakland, CA; ††Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco (UCSF), San Francisco, CA; ‡‡Centre for Microbial Research, Kenya Medical Research Institute, Nairobi, Kenya; and §§Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, CA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Hickey
authors.forename: Charles R
authors.initials: CR
authors.lastname: Salmen
authors.forename: Dan
authors.initials: D
authors.lastname: Omollo
authors.forename: Brian
authors.initials: B
authors.lastname: Mattah
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Fiorella
authors.forename: Elvin H
authors.initials: EH
authors.lastname: Geng
authors.forename: Peter
authors.initials: P
authors.lastname: Bacchetti
authors.forename: Cinthia
authors.initials: C
authors.lastname: Blat
authors.forename: Gor B
authors.initials: GB
authors.lastname: Ouma
authors.forename: Daniel
authors.initials: D
authors.lastname: Zoughbie
authors.forename: Robert A
authors.initials: RA
authors.lastname: Tessler
authors.forename: Marcus R
authors.initials: MR
authors.lastname: Salmen
authors.forename: Harold
authors.initials: H
authors.lastname: Campbell
authors.forename: Monica
authors.initials: M
authors.lastname: Gandhi
authors.forename: Starley
authors.initials: S
authors.lastname: Shade
authors.forename: Betty
authors.initials: B
authors.lastname: Njoroge
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000627:therapeutic use*; D003153:Community Health Services; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D008962:Models, Theoretical; D012944:Social Support
chemical_list: D019380:Anti-HIV Agents