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Reaching 90–90–90 in rural communities in East Africa: lessons from the Sustainable East Africa Research in Community Health Trial

Reaching 90–90–90 in rural communities in East Africa: lessons from the Sustainable East Africa... Purpose of review There is an urgent need to understand new population-level approaches that achieve high levels of treatment and viral suppression for persons living with HIV. Recent findings The SEARCH Universal test and treat (UTT) trial conducted in Kenya and Uganda aimed to reduce HIV incidence and improve community health. SEARCH offered HIV and multidisease testing at health fairs followed by home testing for nonparticipants in 32 communities, each with approximately 10 000 persons. In the 16 intervention communities, UNAIDS 90–90–90 targets were achieved within 3 years, reaching ‘92–95–90’ and 79% population-level viral suppression. HIV incidence declined by 32% between year 1 and 3 of follow-up. Key principles of SEARCH's approach included community engagement, integration of HIV with multidisease services, rapid ART start upon HIV diagnosis, and patient-centered, streamlined care. SEARCH's community health approach also reduced HIV mortality, annual TB incidence, and uncontrolled hypertension compared with a country standard of care. Population-level viral suppression increased beyond the UNAIDS 73% target in women and men and reached levels well above recent country estimates across much of sub-Saharan Africa. Summary SEARCH provides one example of how to rapidly surpass UNAIDS 90–90–90 targets while addressing community health on the path to HIV epidemic control. aDivision of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, California, USA bDepartment of Medicine, Makerere University College of Health Sciences, Kampala, Uganda cDivision of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, California, USA Correspondence to Gabriel Chamie, MD, MPH, Associate Professor of Medicine, Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, University of California, San Francisco, UCSF Box 0874, San Francisco, CA 94143-0874, USA. Tel: +1 415 476 4082 x445; e-mail: Gabriel.Chamie@ucsf.edu This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Current Opinion in HIV and Aids Wolters Kluwer Health

Reaching 90–90–90 in rural communities in East Africa: lessons from the Sustainable East Africa Research in Community Health Trial

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References (24)

Publisher
Wolters Kluwer Health
ISSN
1746-630X
eISSN
1746-6318
DOI
10.1097/COH.0000000000000585
Publisher site
See Article on Publisher Site

Abstract

Purpose of review There is an urgent need to understand new population-level approaches that achieve high levels of treatment and viral suppression for persons living with HIV. Recent findings The SEARCH Universal test and treat (UTT) trial conducted in Kenya and Uganda aimed to reduce HIV incidence and improve community health. SEARCH offered HIV and multidisease testing at health fairs followed by home testing for nonparticipants in 32 communities, each with approximately 10 000 persons. In the 16 intervention communities, UNAIDS 90–90–90 targets were achieved within 3 years, reaching ‘92–95–90’ and 79% population-level viral suppression. HIV incidence declined by 32% between year 1 and 3 of follow-up. Key principles of SEARCH's approach included community engagement, integration of HIV with multidisease services, rapid ART start upon HIV diagnosis, and patient-centered, streamlined care. SEARCH's community health approach also reduced HIV mortality, annual TB incidence, and uncontrolled hypertension compared with a country standard of care. Population-level viral suppression increased beyond the UNAIDS 73% target in women and men and reached levels well above recent country estimates across much of sub-Saharan Africa. Summary SEARCH provides one example of how to rapidly surpass UNAIDS 90–90–90 targets while addressing community health on the path to HIV epidemic control. aDivision of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, California, USA bDepartment of Medicine, Makerere University College of Health Sciences, Kampala, Uganda cDivision of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, California, USA Correspondence to Gabriel Chamie, MD, MPH, Associate Professor of Medicine, Division of HIV, Infectious Diseases and Global Medicine, San Francisco General Hospital, University of California, San Francisco, UCSF Box 0874, San Francisco, CA 94143-0874, USA. Tel: +1 415 476 4082 x445; e-mail: Gabriel.Chamie@ucsf.edu This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

Journal

Current Opinion in HIV and AidsWolters Kluwer Health

Published: Nov 1, 2019

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