Sustainable East Africa Research In Community Health | Search

“We aim to pave the path to HIV elimination through the entry point of improving community health.”

Diane Havlir, MD,

Principal Investigator

Mission

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.

What is SEARCH?

INFO

SEARCH team at AIDS 2018 conference in Amsterdam

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, including long-acting Cabotegravir, that will guide a global effort to end AIDS using a multi-disease, multi-sector approach.

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. 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.

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.

The results of SEARCH will help to guide the global effort to end AIDS.

SEARCH Research has produced Over 80 peer-reviewed publications since 2014

SEARCH Program Highlights

Click on Article Title to Get PDF File of publication.

IMPACT

SEARCH Science

PEOPLE

Leadership

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

Diane Havlir, MD

Co-Principal Investigator

Professor of Medicine and Chief, Division of HIV, Infectious Diseases, and Global Medicine at Zuckerberg San Francisco General Hospital, University of California, San Francisco

Moses Kamya, MBChB, MMed, MPH, PhD

Co-Principal Investigator

Professor of Medicine and past Dean of the School of Medicine at Makerere University College of Health Sciences and Director or the Infectious Diseases Research Collaboration in Kampala, Uganda

Maya Petersen, MD, PhD

Co-Principal Investigator

Professor of Epidemiology and Biostatistics

Co-Director of Joint Program in Computational Precision Health

Co-Director for Targeted Machine Learning and Causal Inference

at the School of Public Health, University of California, Berkeley

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

Investigative Team

Gabriel Chamie, MD, MPH

Study Vice Chair / Investigator

University of California, San Francisco

James Ayieko, MBChB, MPH, PhD

Investigator

Kenya Medical Research Institute

Laura Balzer, PhD

Study Statistician / Investigator

University of California, Berkeley

Elizabeth Bukusi, MBChB, MMed, MPH, PhD

Kenya Site PI / Investigator

Kenya Medical Research Institute

Carol Camlin, MPH, PhD

Investigator

University of California, San Francisco

Edwin Charlebois, MPH, PhD

Investigator

University of California, San Francisco

Tamara Clark, MHS

Executive Administrator /Investigator

University of California, San Francisco

Craig Cohen, MD, MPH

Investigator

University of California, San Francisco

Eric Goosby, MD

Investigator

University of California, San Francisco

Judy Hahn, MA, PhD

Investigator

University of California, San Francisco

Priscilla Hsue, MD

Investigator

University of California, San Francisco

Jane Kabami, MPH

Investigator

Infectious Diseases Research Collaboration, Uganda

Elijah Kakande, MBChB, MPH

Investigator

Infectious Diseases Research Collaboration

Catherine Koss, MD

Investigator

University of California, San Francisco

Florence Mwangwa, MBChB, MPH

Investigator

Infectious Diseases Research Collaboration

Marilyn Nyabuti, MBChB

Investigator

Kenya Medical Research Institute

Asiphas Owaraganise, MBChB, MMed

Investigator

Infectious Diseases Research Collaboration

Andrew Phillips, MSc, PhD

Modelling / Investigator

University College London

Theodore Ruel, MD

Investigator

University of California, San Francisco

Norton Sang, MA

Investigator

Kenya Medical Research Institute

Starley Shade, MPH, PhD

Investigator

University of California, San Francisco

Harsha Thurimurthy, PhD

Economist / Investigator

University of Pennsylvania

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

INFO

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

SEARCH SAPPHIRE RESULTS PRESENTED AT CROI 2023

At the 30th Conference on Retroviruses and Opportunistic Infections (CROI 2023), SEARCH researchers, including, Dr. Catherine Koss of University of San Francisco, Drs. Moses Kamya and Elijah Kakande (pictured above) of Infectious Disease Research Collaboration presented results of the Dynamic Choice Prevention (DCP) Intervention. The DCP intervention was comprised of three separate randomized controlled trials conducted using village health teams (VHT), antenatal clinics (ANC) and hospital outpatient departments (OPD), in which the intervention group utilized a dynamic, person-centered HIV prevention model, including choice of prevention product, service location, HIV-testing options, starter PEP packs, extended PrEP refills, and 24-hour phone access to clinicians. PrEP or PEP prevention coverage was up 28% in the VHT trial (compared to .5% in standard care); 70% in the ANC trial (compared to 29% in standard care); and 48% in the OPD trial (compared to 18% in standard care).

You can read the full article here

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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