The SEARCH study was designed to test whether offering HIV
testing alongside a larger community screening programme for non-communicable
diseases such as diabetes would increase demand for testing, whether a
streamlined linkage-to-care model improves treatment initiation, and whether
the sequence of enhanced linkage and person-centred treatment improved
retention and viral suppression. The campaigns were designed in consultation
with local communities in order to address a broad range of health needs.
randomised 32 communities in Uganda and Kenya, each with around 10,000
inhabitants, to receive either the intervention or standard of care according
to national guidelines. The intervention consisted of:
- A multi-disease prevention
campaign that included testing for HIV, diabetes and hypertension, with a
two-week health fair and household testing in each community.
- Linkage to care of anyone
who tested positive
- Immediate antiretroviral
therapy (ART), regardless of CD4 count
(Read more about the SEARCH study
the study period, which lasted from 2013 to 2016, treatment guidelines changed
so that eligibility for antiretroviral therapy in the standard-of-care arm
expanded from people with a CD4 cell count below 350 cells/mm3 to everyone with a CD4 cell count below 500 cells/mm3.
enrolled 186,354 adults in Uganda and Kenya, of whom 90.1% underwent HIV
testing. The study found higher HIV prevalence in Kenya (19.3%) than in the two
study regions in western and eastern Uganda (6.6 and 3.5% respectively). Prior
to the study, 57% of participants in the intervention and control group
communities knew their HIV status.
cent in the intervention communities and 17% in the control communities started
ART within six months of diagnosis; after two years, 80% in intervention
communities and 40% in control communities had started treatment.
the study found that by the end of year three, 79% of people with HIV in the
intervention communities had a fully suppressed viral load compared to 68% in
the control communities, an 11% difference (p < 0.001). However, viral
suppression was substantially lower in young people: only 55% had a fully
suppressed viral load by the end of year three.
effects of the multi-disease campaign went beyond viral suppression. People
with HIV in the intervention communities were 20% less likely to die during the
study than people with HIV in the control communities, and the mortality rate
was 11% lower among all people enrolled in the intervention communities
compared with the control communities.
prevention intervention had a significantly greater impact on non-HIV health
- TB incidence
was almost 60% lower in the intervention communities (RR 0.41, 95% CI
0.19-0.86, p = 0.02).
proportion of the population with hypertension who had controlled hypertension
was 26% higher in the intervention communities at year three (p < 0.01) and was
also higher in people with HIV. Findings were similar for diabetes but were not
presented at this meeting.
the total number of new HIV infections over three years did not differ
significantly between the two study arms: 0.8% of the population in each study
arm acquired HIV during the three-year trial. The investigators think that the
high rate of HIV testing and awareness of HIV diagnosis in both study arms may
partly explain the lack of difference in HIV incidence, but they also note that
new treatment guidelines introduced in the first year of the study mean that
both intervention and control communities were being offered immediate ART,
regardless of CD4 cell count.
at the three different regions in which the study took place, investigators
found that in intervention communities in Western Kenya – the area with the
highest incidence measured at baseline (0.7%) –
HIV incidence declined by 45% in intervention communities between
baseline and year three, with the greatest reduction in men. In comparison, annual
incidence did not change over the study period in Ugandan communities.