DOI: 10.7272/q60v8b19
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

description: Background: 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 ("The Kanyakla
 Study"). Methods: 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.  Results: 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). 
 Conclusions: 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. Clinical Trial Number: NCT02474992
description: This data was collected as part of a randomized controlled trial
 evaluating a social network intervention to promote engagement in HIV
 care. The protocol and other details about the study can be found in the
 referenced open-access publication.
description: See attached data dictionary for descriptions and value labels
 for the variables in the dataset. All participants completed a baseline
 survey - baseline survey values are missing if the participant declined to
 answer a particular question or set of questions. End of study survey
 values are missing if the participant was not able to be located for the
 end of study survey, or if the participant declined to answer a particular
 question or set of questions. See referenced open-access publication for
 further details.