Association of integrated community care and microfinance on mental health outcomes among adults with HIV in Kenya

Abstract We investigated associations between community-based care and microfinance with psychological distress among adults with HIV in Kenya. Using Harambee cluster-randomized trial data, we compared 18-month psychological distress symptom levels between microfinance participants randomized to integrated community-based care (MF+ICB) or usual facility-based care (MF+UC), and non-randomized matched facility-care patients (UC). Psychological distress symptoms were measured by Patient Health Questionnaire−4, Patient Health Questionnaire−2 (depression), and Generalized Anxiety Disorder-2 (anxiety). For within-group change analysis, we used linear mixed models with a random intercept; for between-arm comparisons, we used Poisson regression with cluster-robust errors for risk ratios. Participants in all arms reported a significant reduction in psychological distress symptoms, except for anxiety in UC. MF+ICB participants had significantly lower anxiety risk than MF+UC (RR=0.57, 95% CI: 0.36–0.90, p=0.016). Both MF arms showed better outcomes than UC. Community-based HIV care within microfinance groups may offer added anxiety-reduction benefits, though findings involving UC are exploratory.