A New Community Approach to Testing and Treating HIV Improves Health in East Africa

The findings are the latest findings from the study on sustainable community health research in East Africa (SEARCH), an ongoing trial in which entire communities are randomized to either the United States or the United States. intervention either to a control group. The trial includes more than 350,000 adults and children in rural Kenya and Uganda to evaluate the effect of a "test-and-treat" strategy on HIV, community health and economic outcomes

year, and one million die from AIDS-related complications. Despite the wide availability of effective treatments, out of the 37 million people living with HIV worldwide, only 22 million are receiving treatment. This gap exists largely because health workers in developing countries are still struggling to reach people with HIV. Many people are unaware of their infection, have limited access to care or become ill. "The challenge is to find those who are not yet supported, and to adapt approaches to involve and keep them," said Diane Havlir, MD, head of the University of California, San Francisco & # 39; Division of HIV, Infectious Diseases and Global Medicine and Principal Investigator of SEARCH.

In 2014, the Joint United Nations Program on HIV / AIDS (UNAIDS) launched the "90-90-90" campaign, a call for 90% of people living with HIV to know their status, 90% all people diagnosed with HIV to receive antiretroviral therapy (ART), and 90 percent of people on antiretroviral therapy should be Viral suppression is the reduction of HIV in the blood of a patient to an undetectable level, which prevents him from being badually transmitted. If the goals of UNAIDS were met, 73 percent of people living with HIV would be killed by viruses. Globally, only 47% of people living with HIV are virally suppressed, well below the target.

In 2015, the World Health Organization recommended treating all HIV-positive people with antiretrovirals, regardless of the number of CD4 + T cells. Before that, patients had to wait for those immune cells, destroyed by HIV, to fall below a certain level.

To achieve the UN's goals, SEARCH researchers have devised a new approach offering comprehensive health care, including immediate treatment for anyone with HIV, to reduce new infections and prevent HIV infections. improve community health.

"We want to pave the way for the elimination of HIV by improving the health of the community," said Havlir, also a professor of medicine at UCSF

in the rural areas of Columbia. Uganda and Kenya where HIV is endemic. HIV care exists, including stigma and practical limitations of care, such as long waiting times for appointments. The SEARCH team wanted to offer respectful and attentive care to the desire for confidentiality of their patients. As a result, they treated various health conditions, as well as HIV testing and treatment, at health fairs that were accessible to villagers and had flexible schedules. They completed health fairs, which were not HIV-specific, with an HIV test at home for those who could not attend.

Thirty-two rural communities in Uganda and Kenya – including 150,395 people aged 15 years and older – were randomly badigned to the intervention group, which received HIV testing and treatment as well as HIV testing. Screening for other health problems, or the control group, who received the HIV test initially, followed by a standard HIV referral. treatment available in their country.

In the intervention communities, the SEARCH team organized two-week community-based mobile health fairs every year, including health education; screenings for HIV and diseases such as hypertension, diabetes and tuberculosis; and immediate or referral care for health problems.

After three years, improvements in community health were significant. Deaths among people living with HIV in intervention communities were 20 percent lower than in communities receiving standard care. New TB cases among HIV-infected people also decreased by 59% in the intervention community, while hypertension control increased by 26%.

"These findings suggest that a multi-disease community approach to testing and treating HIV on overall community health ranging from HIV to mortality, tuberculosis, and other important noncommunicable diseases," he said. said Edwin Charlebois, MPH, PhD, professor of medicine and vice-president of the UCSF's study

At the beginning of the study, researchers tested 90% of the population for HIV in intervention and control communities, of which 43% were virally removed prior to intervention.After three years, 80% of people living with HIV in the community Interventions were suppressed by viruses (exceeding the "90-90-90" target by 73% by 2020), compared with 68% in communities that received standard HIV care.

After three years, new cases of HIV infection have decreased by 32% in communities of all ages. But even though people in the intervention communities had a 12% higher rate of viral suppression, people in both groups were also likely to be infected with HIV. This may be due to the success of the original health fairs, which provided for HIV testing and referral to all participants, and the expansion of ART eligibility for people receiving HIV / AIDS. standard care, as provided for in the national guidelines at the beginning of the study

. The results of the study suggest a new and promising path in the ongoing struggle to eliminate HIV, and "can have a profound impact on how we test and treat large populations in East Africa" said Moses Kamya, MBChB, MMed, MPH, PhD, study co-principal investigator of the Infectious Diseases Research Collaboration (IDRC) and Makerere University in Uganda. "This will guide our global effort to end AIDS and improve community health."

Havlir and his team continue to collect data for the second phase of SEARCH, which develops pre-exposure prophylaxis, or PrEP, strategies for prevent HIV. acquisition in uninfected persons.

Learn more:
Community-Based Screening and Treatment Program for Enhancing Viral Suppression in HIV-Positive People