The IMEA Project: An Intervention Based on Microfinance, Entrepreneurship, and Adherence to Treatment for Women With HIV/AIDS Living in Poverty

Abstract

A number of issues affect adherence to treatment and quality of life among women living with HIV/AIDS. In particular, women living in poverty have a higher risk of mortality due to their vulnerable conditions and socioeconomic exclusion. The objective of this study was to evaluate the effectiveness of an intervention that combines microfinance, entrepreneurship and adherence to treatment (IMEA) for women with HIV/AIDS and living in poverty in Cali, Colombia. A pre-post research design without a control was utilized, and 48 women were included in the study. The evaluation showed effectiveness of the program in the majority of the results (knowledge of HIV and treatment, adherence to treatment, self-efficacy, and the formation of a microenterprise) (p < 0.001); the global indicator increased from 28.3% to 85.5% (p < 0.001). The findings of this study demonstrate that the intervention was partially effective; the health outcomes showed beneficial effects. However, at the end of the study and throughout the follow-up phase, only one third of the participants were able to develop and maintain a legal operating business. It is concluded that the IMEA project should be tested in other contexts and that its consequent results should be analyzed; so it could be converted into a large scale public health program.

Does Economic Strengthening Improve Viral Suppression Among Adolescents Living with HIV? Results From a Cluster Randomized Trial in Uganda

“…Our findings contribute to the scientific literature examining the efficacy of economic interventions in improving HIV treatment adherence [18, 24–27], and expand this evidence base to an adolescent population. To our knowledge, this is the first study to utilize a randomized experimental design to assess the longitudinal effects of an economic intervention on HIV viral suppression among adolescents.…”

“…The published literature has largely focused on poor adults who are living with HIV and includes strategies relating to financial and economic incentives [18, 24], food assistance [18, 25], medication vouchers and subsidies [26, 27], as well as microfinance [26] and entrepreneurial education [27]. By and large, these studies have found significant improvements in treatment adherence among HIV-infected adults.…”

Economic strengthening for retention in HIV care and adherence to antiretroviral therapy: a review of the evidence

“…The preceding feasibility study was not powered to detect significant differences in CD4 counts but found positive trends (Pandit et al, 2010). Two studies that combined ART adherence support and HES, including microcredit, yielded positive findings in relation to self-reported adherence (Arrivillaga et al, 2014), Support with access to school was not a significant predictor of ART adherence.…”

“…interventions aimed at supporting ART adherence. One, conducted with females in Colombia, found that self-reported adherence improved over the intervention period (Arrivillaga et al, 2014); the other found entrepreneurial training was independently associated with lower LTFU and reduced mortality among adult PLHIV in Uganda (Talisuna-Alamo et al, 2012). Similarly, participants in an intervention in Ethiopia which included entrepreneurial training and other HES support, reported better adherence than a comparison group (Bezabih, 2016).…”

Microfinance, retention in care, and mortality among patients enrolled in HIV care in East Africa

“…Although medical record data captured important sociodemographic factors associated with group microfinance participation (e.g. wealth proxies, household conditions), it is still possible that imbalances exist between the comparison groups in terms of unmeasured covariates, such as treatment adherence [10,12], group cohesion [12,41], or spousal support [12,41]. If these unmeasured covariates are confounders, then the matching methods could potentially exacerbate bias in treatment effect estimates.…”