Sustainable East Africa Research of Community Health (SEARCH) – Uganda and Kenya
UCSF:
Diane Havlir, MD (Co-Chair)
Edwin Charlebois, MPH, PhD (Vice Chair)
Craig Cohen, MD, MPH
Elvin Geng, MD, MPH
Gabriel Chamie, MD, MPH
Vivek Jain, MD, MAS
Tamara Clark, MHS
James G. Kahn, MD, MPH

UC Berkeley:
Maya L. Petersen, MD, PhD (Statistician)
Laura Balzer, MPhil
Mark van der Laan, PhD

University of North Carolina, Chapel Hill and World Bank:
Harsha Thirumurthy, PhD

Sustainable East Africa Research on Community Health (SEARCH) Collaboration was established in Vienna in 2010 to evaluate health and economic outcomes of bold community based health interventions for communicable and non-communicable diseases (NCD). The first initiative of the SEARCH collaboration is a community cluster randomized trial in Uganda and Kenya of widespread early community wide antiretroviral therapy (ART) vs. standard of care, where primary endpoints will include both community health and community economic status. An important strength of the SEARCH Collaboration is the partnership it has built with NIH, PEPFAR, WHO, and the World Bank to draw intellectual, financial, and policy support. From the inception the SEARCH collaboration has worked with Uganda and Kenya government agencies, community leaders, the US partner implementing agencies through Advisory Boards. Study implementation will coordinate with and compliment ongoing country activities.

Some of the achievements of SEARCH Collaboration so far:

  • SEARCH has held high level advisory board meetings 2-3 times/year (NIH, PEPFAR, WHO, World Bank, UNAIDS); annual in-country advisory board in both Uganda and Kenya (Ministry of Health (MOH), U.S. Government partners, community representatives, Implementing Partners (IP), local care organizations).
  • SEARCH has formal working relationships with implementing partners, health center supervisors, local community leaders at the proposed study sites; MOH has pledged support for post study ART.
  • Pilot studies done by the SEARCH team demonstrate the feasibility of the census, CHC, linkage and ART treatment and retention of high CD4 population included in the protocol. Data from these have been presented at major conferences and published in PLOS, Clinical Infectious Diseases, and AIDS.
  • SEARCH pilot work shows Community Health Campaigns (CHC) have high community acceptance, can provide HIV testing and linkage to care, malaria rapid diagnosis and treatment, deworming, hypertension and diabetes diagnosis and linkage to care in a high throughput setting with community workers using point of care fingerprick based technology.
  • SEARCH economic studies show adults with high CD4 counts have been found to have better economic status than those with low CD4 counts, suggesting the potential for the SEARCH intervention to help prevent employment and other economic outcomes from deteriorating.
  • In an ongoing pilot SEARCH study of early ART for high CD4, 97% of persons with high CD4 were interested and started ART; and retention and viral suppression exceeds 95% at 48 weeks. In our "streamlined" care model, wait times are dramatically reduced and there are and no concerning signals in safety.
  • HIV RNA can be collected and measured via a fingerprick, and assessments of percent of community members with viral load suppression and other key measures can be made in very rural areas.
  • In a test community where the CHC was repeated after one year, and ART was begun to be offered to all who tested HIV positive, an early look shows the percent of persons with undetectable HIV RNA has already increased from 37-55%.
  • The study team has a full IRB-approved protocol in Uganda, Kenya and UCSF for the first randomized trial. The protocol includes a detailed analytic plan for the health outcomes, economic and education outcomes and costing.
  • The SEARCH randomized trial is starting in Uganda in April, 2013; and in Kenya in September, 2013.