Frequently Asked Questions

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.
 
The overall goal of the SEARCH study is to quantify the health, economic and educational impact of a) early HIV diagnosis and immediate ART (antiretroviral therapy) using a streamlined care delivery system in rural communities in East Africa (Phase I) and b) targeted Pre-Exposure Prophylaxis (PrEP), targeted HIV testing and targeted care interventions on top of universal treatment and streamlined care (Phase II). The study intervention is 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.  

Why is private support vital to SEARCH’s mission?

SEARCH is funded by a variety of source including public and private oraginizations and individuals. In order to ensure the longevity of the SEARCH Orgainzation, private support is pivotal.

Who is leading SEARCH?

Dr.  Diane Havlir from University of California, San Francisco, HIV, ID and Global Medicine Division at San Francisco General Hospital, U.S.A. , Dr. Moses Kamya, Makerere University and Infectious Diseases Research Collaboration, Kampala, Uganda and Dr. Maya Petersen from University of California, Berkeley, U.S.A.

Who are the collaborators and advisors of SEARCH?

SEARCH is a multi-country, multidisciplinary consortium. The PEPFAR, NIH, UNAIDS, Gilead, World Bank, and WHO are members of the SEARCH Advisory Board. We have external advisory boards in Uganda and Kenya which include Ministry of Health, community members and leaders, HIV care organizations, the private sector, Ministry of Finance and World Bank.

What are the SEARCH study research questions?

The SEARCH study aims to address if an HIV test and treat strategy can ‘shut down’ new HIV infections; to show how it can best be done and its cost and cost savings. In Phase I, our hypothesis is that ART initiation at any CD4 count with streamlined delivery compared to current country guidelines will reduce cumulative HIV incidence and protect and improve health, economic and education outcomes in communities with annual HIV testing campaigns. In Phase II, our hypothesis is targeted PrEP, targeted HIV testing, and targeted care interventions on top of universal treatment and streamlined care, will reduce cumulative 3-year HIV incidence in men and women >15 years and improve other health and economic outcomes.

 

We will also be looking at the health-related and economic/education outcomes including: 1) mortality (overall, maternal, and infant mortality), 2) mother-to-child HIV transmission, 3) AIDS (WHO stage 4), 4) tuberculosis, 5) HIV drug resistance, 6) adult and child employment levels, 7) asset holdings, 8) school attendance levels, 9) programmatic costs, 10) health gains expressed in averted Disability Adjusted Life Years (DALY), and 11) cost effectiveness (e.g. cost per infection averted and per DALY averted).

 

You can learn more about the SEARCH study at Clinicaltrials.gov.

What is the SEARCH Study Design?

SEARCH is a cluster randomized community trial. In Phase I, community health campaigns were conducted in study communities offering HIV testing and multi-disease prevention and treatment services delivered in a streamlined approach for all HIV-infected adults and children. Components of streamlined care include ongoing HIV combination prevention strategies. HIV incidence will be measured using an efficient community cohort design (ECCO) comprised of three key elements: a) baseline household community level census, b) annual community health campaigns (CHC) that use unique identifiers to link individuals between successive waves of the intervention, and c) tracking and evaluation of individuals who do not participate in annual CHCs.  The intervention is annual and targeted HIV testing and ART independent of CD4 cell count delivered in a streamlined approach for all HIV infected adults and children. Components of streamlined care include ongoing HIV combination prevention strategies including male circumcision. Control communities will follow country guidelines for ART.

In Phase II, communities were re-randomized. A new baseline HIV negative cohort was established in each community following the community health campaign multi-disease testing. The intervention communities receive targeted PrEP, targeted HIV testing and targeted care interventions in addition to universal treatment and streamlined care. The control communities will receive universal treatment and streamlined care.

What is the sample size of the study and where will it take place?

Thirty-two communities with a population of approximately 10,000 persons each participate in the following three regions: 1) Western Uganda (n=10 communities), 2) Eastern Uganda (n=10 communities), and 3) Western Kenya (n=12 communities). Randomization to intervention vs. standard of care occurred in pairs of communities matched based on key health, geographic and ethnographic variables including: a) geographic region b) population density c) number of trading centres d) transportation index, and e) occupational mix in Phase I. Matching of those same communities for Phase II was based on the Phase I intervention arm, region, and other drivers of HIV incidence.

When did SEARCH study start?

The first community enumeration activities began in Western Uganda in April 2013. The first community health campaign took place in June 2013 and HIV programs began in July 2013.  Enrollment was completed in July 2014  with over 330,000 people enrolled.  

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Updated 21 August 2020