Sustainable East Africa Research In Community Health | Search

“We aim to pave the path to HIV elimination through the entry point of improving community health.”

Diane Havlir, MD,

Principal Investigator

Mission

The research study uses bold, new ideas—like multi-disease, community-based testing and treatment—to address more than HIV, including community health, economic productivity, and cultural stigma.

What is SEARCH?

INFO

SEARCH team at Working Retreat in Kampala 2023

The newest addition to SEARCH, SEARCH Sapphire: “A Multisectoral Strategy to Address Persistent drivers of the HIV epidemic in East Africa” aims to accelerate the path to HIV elimination with new innovative combination strategies for HIV prevention and treatment that are effective, efficient, scalable and reduce preventable infections and deaths. The NIH-funded research program will design and test evidence-based treatment and prevention interventions, including long-acting Cabotegravir, that will guide a global effort to end AIDS using a multi-disease, multi-sector approach using a community precision health model.

Community precision health is a new concept being introduced by the SEARCH team that builds on tenets of population health, implementation science, and precision medicine. It brings 21st century technology and data systems to reach the right persons with the right interventions. A central goal of our community precision health intervention is to build the capacity of community health workers to extend the reach of the Ministry of Health systems.

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. SEARCH currently is located in multiple communities in rural Uganda and Kenya. Collaborators for this study include Kenya Medical Research Institute in Kenya, Infectious Diseases Research Collaboration and Makerere University in Uganda, University of California Berkeley, University of Pennsylvania, and University College London.

Background

Despite effective treatments, in 2022, only 29 million of the 39 million people living with HIV globally receive treatment. This gap exists largely because health workers in developing countries struggle to reach HIV-infected individuals. SEARCH interventions are 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 will guide a global effort to end AIDS.

OPPORTUNITY

Now & the Future

SEARCH represents an opportunity to realize HIV elimination and to improve community health and productivity.

SEARCH Phase I (2013-2017) showed that multi-disease, community-based testing and treatment is effective and can reduce deaths and new HIV infections and increase workforce participation.

SEARCH Phase II (2017-2020) focused on new health and treatment models for adolescents and young adults; HIV Pre-Exposure Prophylaxis (PrEP); treatment models for tuberculosis; and novel electronic technologies for community health.

SEARCH SAPPHIRE (2021-2026) aims to accelerate the path to HIV elimination with new innovative combination strategies for HIV prevention and treatment that are effective, efficient, scalable and reduce preventable infections and deaths using a community precision health model.

The results of SEARCH will help to guide the global effort to end AIDS.

SEARCH Research has produced Over 120 peer-reviewed publications since 2014

SEARCH Program Highlights

Click on Article Title to Get PDF File of publication.

IMPACT

SEARCH Science

PEOPLE

Leadership

Diane Havlir, MD

Co-Principal Investigator

Professor of Medicine and Chief, Division of HIV, Infectious Diseases, and Global Medicine at Zuckerberg San Francisco General Hospital, University of California, San Francisco

Moses Kamya, MBChB, MMed, MPH, PhD

Co-Principal Investigator

Professor of Medicine and past Dean of the School of Medicine at Makerere University College of Health Sciences and Director or the Infectious Diseases Research Collaboration in Kampala, Uganda

Maya Petersen, MD, PhD

Co-Principal Investigator

Professor of Epidemiology and Biostatistics

Co-Director of Joint Program in Computational Precision Health

Co-Director for Targeted Machine Learning and Causal Inference

at the School of Public Health, University of California, Berkeley

Simplified Isoniazid Preventive Therapy (IPT) Strategy to Reduce TB Burden

Investigative Team

Gabriel Chamie, MD, MPH

Study Vice Chair / Investigator

University of California, San Francisco

James Ayieko, MBChB, MPH, PhD

Investigator

Kenya Medical Research Institute

Laura Balzer, PhD

Study Statistician / Investigator

University of California, Berkeley

Jane Kabami, MPH

Investigator

Infectious Diseases Research Collaboration, Uganda

Elijah Kakande, MBChB, MPH

Investigator

Infectious Diseases Research Collaboration

Carol Camlin, MPH, PhD

Investigator

University of California, San Francisco

Tamara Clark, MHS

Executive Administrator /Investigator

University of California, San Francisco

Eric Goosby, MD

Investigator

University of California, San Francisco

Judy Hahn, MA, PhD

Investigator

University of California, San Francisco

Priscilla Hsue, MD

Investigator

University of California, San Francisco

Catherine Koss, MD

Investigator

University of California, San Francisco

Florence Mwangwa, MBChB, MPH

Investigator

Infectious Diseases Research Collaboration

Marilyn Nyabuti, MBChB

Investigator

Kenya Medical Research Institute

Asiphas Owaraganise, MBChB, MMed

Investigator

Infectious Diseases Research Collaboration

Andrew Phillips, MSc, PhD

Modelling / Investigator

University College London

Theodore Ruel, MD

Investigator

University of California, San Francisco

Norton Sang, MA

Investigator

Kenya Medical Research Institute

Starley Shade, MPH, PhD

Investigator

University of California, San Francisco

Harsha Thurimurthy, PhD

Economist / Investigator

University of Pennsylvania

Elizabeth Bukusi, MBChB, MMed, MPH, PhD

Kenya Site PI / Investigator

Kenya Medical Research Institute

Edwin Charlebois, MPH, PhD

Investigator

University of California, San Francisco

Craig Cohen, MD, MPH

Investigator

University of California, San Francisco

The SEARCH collaboration conducted a cluster randomised trial in Uganda among district-level health managers. The study randomly assigned clusters of between four and seven managers in a 1:1 ratio to intervention or control groups. The intervention convened managers into mini-collaboratives facilitated by Ugandan experts in tuberculosis and HIV, and provided business leadership and management training, SMS platform access, and data feedback. In a recent publication from Dr. Ejiah Kakande, et al., in Lancet HIV, it was reported that after accounting for large increases in IPT from a 100-day push in both groups, the intervention led to significantly increased IPT rates, sustained after the push and during the COVID-19 pandemic. The findings suggest that interventions centred on mid-level health managers can improve IPT implementation on a large, subnational scale, and merit further exploration to address key public health challenges for which strong evidence exists but implementation remains suboptimal.

You can read the full article here

INFO

The association between social network characteristics and tuberculosis infection among adults in 9 rural Ugandan communities. Marquez et al. Clin Infect Dis. 2023 Feb 8;76(3):e902-e909. PMID: 35982635

HIV incidence after pre-exposure prophylaxis initiation among women and men at elevated HIV risk: A population-based study in rural Kenya and Uganda. Koss et al. PLOS Med. 2021 Feb 9;18(2):e1003492. PMID: 33561143 PMCID: PMC7872279

Dynamic choice HIV prevention intervention at outpatient departments in rural Kenya and Uganda: a randomized trial. Koss, et al. AIDS. 2023 Oct 20. PMID: 37861683.

Randomized trial of dynamic choice prevention at antenatal and postnatal care clinics in rural Uganda and Kenya.Kabami, et al. J Acquir Immune Defic Syndr. 2024 Apr 15; 95(5);447-455. PMID: 38489493; PMCID: PMC10927304.

A community-based dynamic choice model for HIV prevention improves PreP and PEP coverage in rural Uganda and Kenya: a cluster randomized trial. Kakande, et al. J Int AIDS Soc. 2023 Dec;26(12):e26195. PMID: 38054535; PMCID: PMC10698808.

HIV Testing and Treatment with the Use of a Community Health Approach in Rural Africa. Havlir et al. N Engl J Med. 2019 Jul 18; 381(3): 219-229. PMID: 31314966, PMCID: PMC6748325

Association of Implementation of a Universal Testing and Treatment Intervention With HIV Diagnosis, Receipt of Antiretroviral Therapy, and Viral Suppression in East Africa. Petersen et al. JAMA. 2017;317(21):2196-2206. PMID: 28586888, PMCID: PMC5734234

A hybrid mobile approach for population-wide HIV testing in rural east Africa: an observational study. Chamie et al. Lancet HIV. 2016 Mar: 3(3): e111-9: Epub 2016 Jan 26. PMID: 26939734; PMCID: PMC4780220

Highly Anticipated First Results of SEARCH SAPPHIRE “Dynamic Choice” intervention presented at CROI 2024

At the 31th Conference on Retroviruses and Opportunistic Infections (CROI 2024), SEARCH researchers, Professor Moses Kamya (pictured above) of Makerere University and Infectious Diseases Research Collaboration presented results of the second phase of the Dynamic Choice Prevention Intervention (Phase I Findings presented at CROI 2023 can be found here), which included the addition of Long-Acting Cabotegravir (CAB-LA), alongside oral PrEP and PEP. The SEARCH intervention increased the amount of time a person was taking a HIV product by five-fold and dramatically reduced the number of new HIV infections versus the standard of care.

SEARCH engages communities and local leadership in a multi-disease approach to improve health screening, care delivery and individual and community well-being.

Impacting HIV outcomes in Youth populations

SEARCH Severe Hypertension Telehealth Study Highlighted at CROI 2024

In early 2022, Dr. Florence Mwangwa and SEARCH team published results on youth living with HIV in the SEARCH communities in AIDS Care . The youth-focused study determined the association of recent significant life-events with HIV antiretroviral treatment (ART) initiation and HIV viral suppression in youth aged 15–24 years living with HIV in rural Kenya and Uganda. The research suggests that two or more recent life-events and alcohol use are key barriers to ART initiation and achievement of viral suppression among youth living with HIV in rural East Africa. The SEARCH consortium continues working with youth in finding new innovative interventions to impact HIV infection reduction in this population.

You can read the full article here

At the 31th Conference on Retroviruses and Opportunistic Infections (CROI 2024), Dr. Matt Hickey (pictured above) of the University of California San Francisco (UCSF) presented results of the Severe Hypertension Telehealth Study on behalf of the SEARCH team. The SEARCH Telehealth intervention for severe hypertension doubled the proportion of people with severe hypertension who had controlled blood pressure after 48 weeks compared to patient-centered clinic-based hypertension care. People with untreated severe hypertension are at high risk for heart attacks, strokes, and kidney failure, elevating the importance of care models that ensure early and sustained hypertension treatment.

SUPPORT THE CHILDREN

Collaborators, Sponsors & Advisors