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Microfinance Interventions and HIV Treatment Outcomes: A Synthesizing Conceptual Framework and Systematic Review

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Abstract

Background

Microfinance interventions have the potential to improve HIV treatment outcomes, but the mechanisms through which they operate are not entirely clear.

Objectives

To construct a synthesizing conceptual framework for the impact of microfinance interventions on HIV treatment outcomes using evidence from our systematic review.

Methods

We conducted a systematic review by searching electronic databases and journals from 1996 to 2018 to assess the effects of microfinance interventions on HIV treatment outcomes, including adherence, retention, viral suppression, and CD4 cell count.

Results

All studies in the review showed improved adherence, retention, and viral suppression, but varied in CD4 cell count following participation in microfinance interventions—overall supporting microfinance’s positive role in improving HIV treatment outcomes. Our synthesizing conceptual framework identifies potential mechanisms through which microfinance impacts HIV treatment outcomes through hypothesized intermediate outcomes.

Conclusion

Greater emphasis should be placed on assessing the effect mechanisms and intermediate behaviors to generate a sound theoretical basis for microfinance interventions.

Resumen

Antecedentes

 Las intervenciones de microfinanzas tienen el potencial de mejorar los resultados del tratamiento del VIH, pero los mecanismos a través de los cuales operan no están del todo claros.

Objetivos

Construir un marco conceptual de síntesis del impacto de las intervenciones de microfinanzas en los resultados del tratamiento del VIH utilizando evidencia de una revisión sistemática.

Métodos

Se llevó a cabo una revisión sistemática mediante búsquedas en bases de datos electrónicas y revistas desde 1996 hasta 2018 para evaluar los efectos de las intervenciones de microfinanzas en los resultados del tratamiento del VIH, incluida la adherencia, la retención, la supresión viral y el recuento de células CD4.

Resultados

Todos los estudios en la revisión mostraron una mejor adherencia, retención y supresión viral, pero variaron en el recuento de células CD4 luego de la participación en las intervenciones de microfinanzas, lo que respalda el papel positivo de las microfinanzas en la mejora de los resultados del tratamiento del VIH. El marco conceptual de síntesis propuesto identifica los mecanismos potenciales a través de los cuales las microfinanzas impactan los resultados del tratamiento del VIH a través de resultados intermedios hipotéticos.

Conclusión

Se debe poner mayor énfasis en evaluar los mecanismos de efecto y los comportamientos intermedios para generar una base teórica sólida para las intervenciones de microfinanzas.

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Acknowledgements

This paper was partially funded by the U.S. National Institutes of Health (NIH) Grants (R21-AI-118393; R34-MH-114664; K01MH099966; P2C-HD-041020). This work was facilitated by the Providence/Boston Center for AIDS Research, CFAR (P30-AI-042853).

Funding

This paper was partially funded by National Institutes of Health (NIH) Grants (R21-AI-118393; R34-MH-114664; K01MH099966).

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Authors and Affiliations

  1. Economics Department, Brown University, Providence, RI, USA

    Siddhi Nadkarni

  2. Epidemiology Department, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Becky Genberg

  3. Department of Health Services, Policy, and Practice, Brown University School of Public Health, 121 South Main Street, Box G-S121-2, Providence, RI, 02912, USA

    Becky Genberg & Omar Galárraga

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  1. Siddhi Nadkarni
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Correspondence to Omar Galárraga.

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Nadkarni, S., Genberg, B. & Galárraga, O. Microfinance Interventions and HIV Treatment Outcomes: A Synthesizing Conceptual Framework and Systematic Review. AIDS Behav 23, 2238–2252 (2019). https://doi.org/10.1007/s10461-019-02443-6

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