“We aim to pave the path to HIV elimination through the entry point of improving community health.”
Diane Havlir, MD,
Principal Investigator
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INFO
Mission
SEARCH engages communities and local leadership in a multi-disease approach to improve health screening, care delivery and individual and community well-being.
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The research study uses bold, new ideas—like multi-disease, community-based testing and treatment—to address more than HIV, including community health, economic productivity, and cultural stigma.
SEARCH SAPPHIRE
The SEARCH team is excited to announce a new 5-year NIH-funded research program designed to design and test evidence based treatment and prevention interventions that will guide a global effort to end AIDS using a multi-disease, multi-sector approach. The new program, SEARCH Sapphire: “A Multisectoral Strategy to Address Persistent drivers of the HIV epidemic in East Africa” aims to accelerate the path to HIV elimination with new innovative combination strategies for HIV prevention and treatment that are effective, efficient, scalable and reduce preventable infections and deaths. Collaborators for this study include Kenya Medical Research Institute in Kenya, Infectious Diseases Research Collaboration and Makerere University in Uganda, University of California Berkeley, University of Massachusetts Amherst, University of Pennsylvania, and University College London and will start in early 2021!
SEARCH team at AIDS 2018 conference in Amsterdam
What is SEARCH?
SEARCH (Sustainable East Africa Research in Community Health) is a multinational, multidisciplinary consortium assembled to conduct research that evaluates bold health interventions at the community level that inform policy makers and funding agencies through the inclusion of health, economic and education parameters and through innovative, efficient study designs. SEARCH currently is located in multiple communities in rural Uganda and Kenya.
The study is considering the health, economic and educational impact of new approaches in community HIV testing, treatment, care and prevention. In the first phase of SEARCH (2013-2017), the research team worked with local communities to host mobile, community-wide health fairs that included health education; screenings for HIV and diseases like hypertension, diabetes, and tuberculosis; and immediate care or referral for any health problems. In the second phase (2017-2020), the team used targeted HIV prevention (i.e., PrEP, or Pre-Exposure Prophylaxis), targeted HIV testing, and targeted care interventions on top of universal treatment and streamlined care. In the upcoming SAPPHIRE study, the team aims to accelerate the path to HIV elimination with new innovative combination strategies for HIV prevention and treatment that are effective, efficient, scalable and reduce preventable infections and deaths.
The results of SEARCH will help to guide the global effort to end AIDS.
Background
Despite effective treatments, in 2018, only 24.5 million of the 38 million people living with HIV globally receive treatment. This gap exists largely because health workers in developing countries struggle to reach HIV-infected individuals. SEARCH interventions are designed to improve the entire continuum of care, to reduce structural barriers for all populations including those most “at risk” and build upon evidence based prevention interventions. This information will guide a global effort to end AIDS.
OPPORTUNITY
Now & the Future
SEARCH represents an opportunity to realize HIV elimination and to improve community health and productivity.
SEARCH Phase I (2013-2017) showed that multi-disease, community-based testing and treatment is effective and can reduce deaths and new HIV infections and increase workforce participation.
SEARCH Phase II (2017-2020) focused on new health and treatment models for adolescents and young adults; HIV Pre-Exposure Prophylaxis (PrEP); treatment models for tuberculosis; and novel electronic technologies for community health.
SEARCH SAPPHIRE (2021-2026) aims to accelerate the path to HIV elimination with new innovative combination strategies for HIV prevention and treatment that are effective, efficient, scalable and reduce preventable infections and deaths.
IMPACT
SEARCH Science
Dr. Catherine Koss of University of California, San Francisco presented at the 2020 AIDS Conference in San Francisco on behalf of the SEARCH team on SEARCH trial Phase II interim results.The results show that population-level PrEP offer (2016-2019) in 16 communities in rural Uganda and Kenya was associated with lower HIV incidence among PrEP initiators with follow-up HIV testing than among recent (2015-2017) matched controls in the absence of PrEP.
Scientific Abstract and Presentation: https://cattendee.abstractsonline.com/meeting/9289/presentation/202
SEARCH Phase I Main Findings Published in New England Journal of Medicine
The SEARCH Collaboration published its Phase I findings "HIV Testing and Treatment with the Use of a Community Health Approach" in the prestigious New England Journal of Medicine. In conjunction with two other published studies, we now know that a Universal Test and Treat strategy can significantly reduce HIV incidence. SEARCH showed that a multi-disease approach adds community health benefits of reducing tuberculosis and mortality along with reductions in new HIV infections. We also know that we will need more than test and treat alone to eliminate HIV and that is why we continue important work in the SEARCH study.
See SEARCH profiled in the Emmy-winning episode of the PBS Newshour click below
SEARCH study exceeds U.N. 'test and treat' goal for ending HIV pandemic
SEARCH Research has produced Over 70 peer-reviewed publications since 2014
SEARCH Program Highlights
Click on Article Title to Get PDF File of publication.
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HIV incidence after pre-exposure prophylaxis initiation among women and men at elevated HIV risk: A population-based study in rural Kenya and Uganda. Koss et al. PLOS Med. 2021 Feb 9;18(2):e1003492. PMID: 33561143 PMCID: PMC7872279
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Uptake, engagement, and adherence to pre-exposure prophylaxis offered after population HIV testing in rural Kenya and Uganda: 72-week interim analysis of observational data from the SEARCH study. Koss et al. Lancet HIV. 2020 Apr; 7(4): e249–e261. PMID: 32087152, PMCID: PMC7208546.
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HIV Testing and Treatment with the Use of a Community Health Approach in Rural Africa. Havlir et al. N Engl J Med. 2019 Jul 18; 381(3): 219-229. PMID: 31314966, PMCID: PMC6748325
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Association of Implementation of a Universal Testing and Treatment Intervention With HIV Diagnosis, Receipt of Antiretroviral Therapy, and Viral Suppression in East Africa. Petersen et al. JAMA. 2017;317(21):2196-2206. PMID: 28586888, PMCID: PMC5734234
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A hybrid mobile approach for population-wide HIV testing in rural east Africa: an observational study. Chamie et al. Lancet HIV. 2016 Mar: 3(3): e111-9: Epub 2016 Jan 26. PMID: 26939734; PMCID: PMC4780220
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Implementation and Operational Research: Cost and Efficiency of a Hybrid Mobile Multidisease Testing Approach With High HIV Testing Coverage in East Africa. Chang et al. J Acquir Immune Defic Syndr. 2016 Nov 1;73(3):e39-e45. PMID:27741031, PMCID: PMC5089839
The SEARCH Collaboration published important Phase II findings "HIV incidence after pre-exposure prophylaxis initiation among women and men at elevated HIV risk: A population-based study in rural Kenya and Uganda" in the prestigious PLoSMed journal. SEARCH found that population-level offer of oral pre-exposure prophylaxis (PrEP) with rapid start and flexible service delivery was associated with 74% lower HIV incidence. HIV infections were significantly lower among women who started PrEP. Universal HIV testing with linkage to treatment and prevention, including PrEP, is a promising approach to accelerate reductions in new infections.
You can read the full article here.
SEARCH Phase II Findings Published in PLoS Med
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