Sustainable East Africa Research in Community Health

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Investigator: Diane V. Havlir, MD
Sponsor: Gilead Sciences, Inc.

Location(s): Kenya; Uganda

Description

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 will quantify the health, economic and educational impact of early HIV diagnosis and immediate anti-retroviral therapy (ART) treatment using a streamlined care delivery system in rural communities in East Africa. 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 would guide a global effort to end AIDS. 
SEARCH is a cluster randomized community trial. Annual community health campaigns will be conducted in all study communities and will offer 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 including male circumcision. Communities will receive annual testing campaigns and linked to care for future management. 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.

Thirty-two communities with a population of approximately 10,000 persons each will participate in the following three regions: 1) Western Uganda (n=10), 2) Eastern Uganda (n=10), and 3) Western Kenya (n=12). Randomization to intervention vs. standard of care will occur 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.

Annual community health campaigns will be conducted in all study communities and will offer HIV testing and multi-disease prevention and treatment services. The study intervention is provision of ART for all individuals at any CD4+ cell count. ART – the regimen of efavirenz, emtricitabine and tenofovir disoproxil fumurate – will be provided by the study for those who do not meet in-country guidelines to start ART.