“We aim to pave the path to HIV elimination through the entry point of improving community health.”
Diane Havlir, MD,
SEARCH engages communities and local leadership in a multi-disease approach to improve health screening, care delivery and individual and community well-being.
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.
The SEARCH team is excited to announce the completion of Phase A in the SEARCH SAPPHIRE study. Phase B launch is expected for March 2023, with an extended trial within Phase A, introducing long-acting Cabotegravir (CAB-LA) as a dynamic prevention option, to continue until 2024. The newest addition to SEARCH, 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. The NIH-funded research program will 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. 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 Pennsylvania, and University College London.
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 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.
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.
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.
TB incidence reduction after SEARCH testing campaigns
At the 24th International AIDS Conference (AIDS 2022), Dr Carina Marquez of the University of California San Francisco presented results of an analysis of TB incidence in nine communities that participated in the SEARCH study in Uganda, where TB symptom screening was a component of the intervention. The study measured the incidence of TB after one year by looking at conversion from negative to positive tuberculin skin test (TST), indicating likely recent exposure to TB in the community. After one year, the incidence of TB was 27% lower in intervention communities. Sixteen per cent of participants in intervention communities tested positive for TB after one year compared to 22% in control group communities.
You can read the full article here
In early 2022, Dr. Florence Mwangwa and SEARCH team published results on youth living with HIV in the SEARCH communities in AIDS Care . The youth-focused study determined the association of recent significant life-events with HIV antiretroviral treatment (ART) initiation and HIV viral suppression in youth aged 15–24 years living with HIV in rural Kenya and Uganda. The research suggests that two or more recent life-events and alcohol use are key barriers to ART initiation and achievement of viral suppression among youth living with HIV in rural East Africa. The SEARCH consortium continues working with youth in finding new innovative interventions to impact HIV infection reduction in this population.
You can read the full article here
Simplified Isoniazid Preventive Therapy (IPT) Strategy to Reduce TB Burden
SEARCH Research has produced Over 80 peer-reviewed publications since 2014
SEARCH Program Highlights
Click on Article Title to Get PDF File of publication.
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
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.
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
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
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
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
Impacting HIV outcomes in Youth populations
The SEARCH collaboration conducted a cluster randomised trial in Uganda among district-level health managers. The study randomly assigned clusters of between four and seven managers in a 1:1 ratio to intervention or control groups. The intervention convened managers into mini-collaboratives facilitated by Ugandan experts in tuberculosis and HIV, and provided business leadership and management training, SMS platform access, and data feedback. In a recent publication from Dr. Ejiah Kakande, et al., in Lancet HIV, it was reported that after accounting for large increases in IPT from a 100-day push in both groups, the intervention led to significantly increased IPT rates, sustained after the push and during the COVID-19 pandemic. The findings suggest that interventions centred on mid-level health managers can improve IPT implementation on a large, subnational scale, and merit further exploration to address key public health challenges for which strong evidence exists but implementation remains suboptimal.
You can read the full article here
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