小额信贷项目的参与情况与HIV患者的病毒载量抑制有关吗?来自肯尼亚西部的证据。
Is membership in microfinance initiatives associated with viral load suppression among HIV patients? Evidence from western Kenya.
作者信息
Thapa Bishnu Bahadur, Genberg Becky, Wachira Juddy, Steingrimsson Jon, Galarraga Omar
机构信息
Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI, USA.
Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
出版信息
BMC Glob Public Health. 2025 Jun 25;3(1):55. doi: 10.1186/s44263-025-00170-w.
BACKGROUND
Social and economic factors have considerable influence on the lives of people living with HIV (PLHIV). These factors shape their health behaviors, willingness to engage with other members of their communities for support, and ability to seek appropriate and timely treatment options. Evidence has shown that microfinance initiatives, by providing access to credit and social networks, have the potential to help PLHIV overcome some of these barriers. The objective of this study was to understand the association between microfinance membership and viral load suppression among HIV patients.
METHODS
We used data from the Academic Model Providing Access to Healthcare (AMPATH)-Kenya's Group Integrated Savings for Health Empowerment (GISHE), a microfinance initiative (MFI), to study the association between GISHE participation and viral load suppression. Our longitudinal dataset consisted of a matched group of 3609 HIV patients. We examined the association between GISHE membership and viral load suppression by addressing the missing data problem with respect to the viral load count via multiple imputation.
RESULTS
Our study revealed that GISHE membership was associated with increased viral load suppression (adjusted odds ratio (AOR) = 1.15; 95% confidence interval (CI), 1.03-1.29). Further, the study found that male patients were less likely to be virally suppressed (AOR = 0.85; 95% CI, 0.74-0.97), as were the patients in the most advanced disease stage (AOR = 0.71; 95% CI, 0.52-0.95). The finding that GISHE participation was associated with a greater likelihood of viral load suppression held even after addressing the missing data problem.
CONCLUSIONS
We conclude that GISHE-type programs hold promise as scalable interventions to combat HIV/AIDS in Kenya and other countries where the disease is a generalized epidemic.
背景
社会和经济因素对艾滋病毒感染者(PLHIV)的生活有相当大的影响。这些因素塑造了他们的健康行为、与社区其他成员寻求支持的意愿以及寻求适当和及时治疗方案的能力。有证据表明,小额融资举措通过提供信贷和社交网络,有可能帮助艾滋病毒感染者克服其中一些障碍。本研究的目的是了解小额融资成员资格与艾滋病毒患者病毒载量抑制之间的关联。
方法
我们使用了学术医疗获取模式(AMPATH)-肯尼亚的健康赋权团体综合储蓄(GISHE)(一项小额融资举措)的数据,来研究参与GISHE与病毒载量抑制之间的关联。我们的纵向数据集由3609名匹配的艾滋病毒患者组成。我们通过多重插补解决病毒载量计数方面的缺失数据问题,研究了GISHE成员资格与病毒载量抑制之间的关联。
结果
我们的研究表明,GISHE成员资格与病毒载量抑制增加相关(调整后的优势比(AOR)=1.15;95%置信区间(CI),1.03 - 1.29)。此外,研究发现男性患者病毒载量被抑制的可能性较小(AOR = 0.85;95% CI,0.74 - 0.97),疾病最晚期的患者也是如此(AOR = 0.71;95% CI,0.52 - 0.95)。即使在解决了缺失数据问题之后,GISHE参与与病毒载量抑制可能性更大之间的关联仍然成立。
结论
我们得出结论,GISHE类型的项目有望作为可扩展的干预措施,在肯尼亚和其他该疾病呈广泛流行的国家抗击艾滋病毒/艾滋病。