Community health campaigns, such as this one in Rubirizi, Uganda, are the cornerstone of SEARCH activities.
Increased diagnoses of Human Immunodeficiency Virus (HIV) as well as viral suppression of adults in East Africa can be achieved with community-based testing and treatment, according to an analysis of interim data from an ongoing large-scale test-and-treat intervention led by UC researchers.The analysis was led by Maya Petersen, an associate professor of biostatistics and epidemiology in the UC Berkeley School of Public Health, and study results were published in June by JAMA.
The findings are promising, and signal the achievability of the so-called 90-90-90 mandate, an ambitious goal set forth by the United Nation’s Program on HIV/AIDS (UNAIDS) that calls for 90 percent of people infected with HIV to know their status, 90 percent of those diagnosed to be receiving antiretroviral therapy, and 90 percent of those receiving therapy to have suppressed HIV viral replication by 2020. Worldwide, only about half of people infected with HIV know their status.
“One of the most important and high priority public health interventions in the HIV response is to offer treatment to all persons living with HIV,” Petersen said. “Evidence from prior studies tells us that early diagnosis and immediate treatment that suppresses viral replication to an ‘undetectable’ level keeps a person with HIV healthy, reduces HIV-related death, and reduces HIV transmission by more than 95 percent.”
Researchers with Sustainable East Africa Research in Community Health Study (SEARCH), a multidisciplinary consortium co-led by Diane Havlir, of University of California, San Francisco (UCSF), Moses Kamya, of Makarere University, Uganda, and Petersen, observed more than 70,000 people 15 years and older living in 16 rural communities in Kenya and Uganda. The cohort participated in annual community-based multi-disease health campaigns that included HIV testing, followed by home-based testing for individuals who did not attend the campaigns. All HIV+ individuals were offered immediate initiation of antiretroviral therapy, and with streamlined patient-centered delivery.
“Instead of focusing only on HIV we took a community health approach,” Petersen said. “We worked side-by-side with the community and offered HIV testing in health fairs where community members received a variety of multi-disease services like hypertension, diabetes and malaria screenings. Individuals who screened positive were linked to their local community clinic for treatment.”
Petersen’s analysis found that through the initiative, the proportion of HIV-positive individuals with HIV viral suppression increased from 45 percent to 80 percent after 2 years, exceeding the UNAIDS target of 73% of HIV positive individuals with viral suppression within two years in communities in rural Uganda and Kenya, in regions where three to 20 of every 100 adults are HIV infected.
“These findings suggest that countries should embrace the challenge of achieving 90-90-90,” Petersen said. “Multi disease ‘test and treat’ approaches that are accessible to the community–such as health fairs–and that link diagnosis and screening to local clinic-based treatment can diagnose and successfully treat most HIV positive individuals.”
“We can and should redouble our commitment and investments to diagnose, treat, and virally suppress almost all HIV positive individuals globally,” she said.
By Brian M. Maxey