A clinical study in a remote region of southwest Uganda has demonstrated the feasibility of using a health campaign to rapidly test a community for HIV and simultaneously offer prevention and diagnosis for a variety of other diseases in rural and resource-poor settings of sub-Saharan Africa.
At the XIX International AIDS Conference in Washington, D.C., the first results of this study, called the “Sustainable East Africa Research in Community Health (SEARCH) Collaboration,” will be described by doctors at the University of California, San Francisco (UCSF), San Francisco General Hospital and Trauma Center (SFGH) and Makerere University in Kampala, Uganda.
In this video, UCSF assistant professor Gabriel Chamie describes SEARCH and how it was designed to deal with multiple diseases:
“We wanted to increase testing rates… given the unmet need of people knowing their HIV status,” said Chamie, “But then to do that, we thought that broader testing and broader community health appeal would be needed, because not everybody thinks of HIV testing as their top priority — some people may not realize they are at risk and therefore may not access testing.”
The motivation for this work was the success of a comprehensive approach to addressing HIV/AIDS that was pioneered in San Francisco beginning in 2010. The strategy, known as “test and treat,” involves universal testing, linkage to care and early treatment. Mounting evidence shows that this approach keeps people healthier longer and reduces the spread of HIV within the community. The SEARCH study seeks to build on this approach and use “test and treat” as a platform for broader community health intervention in sub-Saharan Africa.
In the study, some 4,343 people were offered HIV testing, and 189 of them tested positive. Nearly half were new diagnoses — meaning that the other half were tested even though they knew they had the disease — and their CD4+ cell counts, on average, were in the mid-400s — indicating they were in the early stages of disease, before a decline towards AIDS. Often regional health centers in Uganda don’t identify new cases until a much more advanced stage of the disease.
The team also tested people for malaria, tuberculosis, diabetes and hypertension and offered counseling, treatment and prevention methods to address those conditions.
Addressing other diseases, like tuberculosis, is one of the issues identified in the official declaration of the conference, which states, “No more living with HIV but dying of TB.” Read about it in the Washington D.C. Declaration.
Gabriel Chamie, MD, MPH, is an assistant professor in the University of California, San Francisco (UCSF) Positive Health Program at San Francisco General Hospital and Trauma Center (SFGH)