title: "Wan Kanyakla" (We are together): Community transformations in Kenya following a social network intervention for HIV care.
abstract: BACKGROUND
  In sub-Saharan Africa, failure to initiate and sustain HIV treatment contributes to significant health, psychosocial, and economic impacts that burden not only infected individuals but diverse members of their social networks. Yet, due to intense stigma, the responsibility for managing lifelong HIV treatment rests solely, and often secretly, with infected individuals. We introduce the concept of "HIV risk induction" to suggest that social networks of infected individuals share a vested interest in improving long-term engagement with HIV care, and may represent an underutilized resource for improving HIV/AIDS outcomes within high prevalence populations.
  
  
  METHODS
  In 2012, we implemented a 'microclinic' intervention to promote social network engagement in HIV/AIDS care and treatment. A microclinic is a therapy management collective comprised of a small group of neighbors, relatives, and friends who are trained as a team to provide psychosocial and adherence support for HIV-infected members. Our study population included 369 patients on ART and members of their social networks on Mfangano Island, Kenya, where HIV prevalence approaches 30%. Here we report qualitative data from 18 focus group discussions conducted with microclinic participants (n = 82), community health workers (n = 40), and local program staff (n = 39).
  
  
  RESULTS
  Participants reported widespread acceptability and enthusiasm for the microclinic intervention. Responses highlight four overlapping community transformations regarding HIV care and treatment, namely (1) enhanced HIV treatment literacy (2) reduction in HIV stigma, (3) improved atmosphere for HIV status disclosure and (4) improved material and psychosocial support for HIV-infected patients. Despite challenges, participants describe an emerging sense of "collective responsibility" for treatment among HIV-infected and HIV-uninfected members of social networks.
  
  
  CONCLUSIONS
  The lived experiences and community transformations highlighted by participants enrolled in this social network intervention in Western Kenya suggest opportunities to reframe the continuum of HIV care from a secretive individual journey into a network-oriented cycle of engagement.
authors.affiliation: The Mfangano Research Department, Organic Health Response (OHR), P.O. Box 224, Mbita 40305, Kenya; Microclinic International (MCI), 388 Market St. Suite 1300, San Francisco, CA 94111, USA; Department of Family and Community Medicine, University of Minnesota, 420 Delaware St. SE, Minneapolis, MN 55455, USA. Electronic address: csalmen@organichealthresponse.org.
authors.forename: Charles R
authors.initials: CR
authors.lastname: Salmen
authors.affiliation: The Mfangano Research Department, Organic Health Response (OHR), P.O. Box 224, Mbita 40305, Kenya; Global Health Department, University of California-San Francisco, 513 Parnassus Ave, San Francisco, CA 94143-0410, USA; Microclinic International (MCI), 388 Market St. Suite 1300, San Francisco, CA 94111, USA. Electronic address: matt.hickey@ucsf.edu.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Hickey
authors.affiliation: The Mfangano Research Department, Organic Health Response (OHR), P.O. Box 224, Mbita 40305, Kenya; Department of Environmental Science, Policy & Management, 130 Mulford Hall, University of California, Berkeley, Berkeley, CA 94720-3114, USA. Electronic address: kfiorella@gmail.com.
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Fiorella
authors.affiliation: The Mfangano Research Department, Organic Health Response (OHR), P.O. Box 224, Mbita 40305, Kenya. Electronic address: danodomany@yahoo.com.
authors.forename: Dan
authors.initials: D
authors.lastname: Omollo
authors.affiliation: The Mfangano Research Department, Organic Health Response (OHR), P.O. Box 224, Mbita 40305, Kenya. Electronic address: benogor@gmail.com.
authors.forename: Gor
authors.initials: G
authors.lastname: Ouma
authors.affiliation: Microclinic International (MCI), 388 Market St. Suite 1300, San Francisco, CA 94111, USA. Electronic address: danielzoughbie@microclinics.org.
authors.forename: Daniel
authors.initials: D
authors.lastname: Zoughbie
authors.affiliation: The Mfangano Research Department, Organic Health Response (OHR), P.O. Box 224, Mbita 40305, Kenya. Electronic address: marco.salmen@gmail.com.
authors.forename: Marcus R
authors.initials: MR
authors.lastname: Salmen
authors.affiliation: The Mfangano Research Department, Organic Health Response (OHR), P.O. Box 224, Mbita 40305, Kenya.
authors.forename: Richard
authors.initials: R
authors.lastname: Magerenge
authors.affiliation: UCSF East Bay Department of Surgery, Alameda County Hospital, 1411 East 31st Street, Oakland, CA 94602, USA. Electronic address: robert.tessler@gmail.com.
authors.forename: Robert
authors.initials: R
authors.lastname: Tessler
authors.affiliation: The Mfangano Research Department, Organic Health Response (OHR), P.O. Box 224, Mbita 40305, Kenya; Microclinic International (MCI), 388 Market St. Suite 1300, San Francisco, CA 94111, USA. Electronic address: halobocampbell@gmail.com.
authors.forename: Harold
authors.initials: H
authors.lastname: Campbell
authors.affiliation: Division of HIV/AIDS, San Francisco General Hospital, Department of Medicine, UCSF, 995 Potrero Ave, San Francisco, CA 94110, USA. Electronic address: geng@php.ucsf.edu.
authors.forename: Elvin
authors.initials: E
authors.lastname: Geng
authors.affiliation: Division of HIV/AIDS, San Francisco General Hospital, Department of Medicine, UCSF, 995 Potrero Ave, San Francisco, CA 94110, USA. Electronic address: monica.gandhi@ucsf.edu.
authors.forename: Monica
authors.initials: M
authors.lastname: Gandhi
authors.affiliation: Kenya Medical Research Institute, Box 19464, Post Code 00202 Nairobi, Kenya. Electronic address: ebukusi@kemri.org.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.affiliation: Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA 94158-2549, USA. Electronic address: ccohen@globalhealth.ucsf.edu.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use; D003256:Community Participation; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D011203:Poverty / Q000523:psychology; D057545:Social Stigma; D012944:Social Support; D012959:Socioeconomic Factors; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents
keywords: ART adherence; Continuum of care; Disclosure; HIV/AIDS; Kenya; Microclinics; Social networks; Social support