An intervention has succeeded in raising the rate of HIV diagnosis, treatment and viral suppression in rural Ugandan and Kenyan communities above targets set by the Joint United Nations Programme on HIV and AIDS (UNAIDS). Researchers from the SEARCH study, a cluster randomized trial evaluating a test-and-treat intervention in those African communities presented findings at the 21st International AIDS Conference in Durban, South Africa (AIDS 2016).
UNAIDS has set a goal for nations to achieve the so-called 90-90-90 targets by 2020: getting 90 percent of their HIV populations diagnosed, 90 percent of that group on treatment for the virus and 90 percent of that group virally suppressed, for an overall viral suppression rate of 73 percent.
The researchers in the SEARCH study determined the local population in the areas researched through a household census. They tested for HIV antibodies and RNA annually through multi-disease health campaigns as well as home-based testing for those who did not attend. People who tested positive were offered Atripla (efavirenz/tenofovir disoproxil fumarate, or TDF/emtricitabine) or Truvada (TDF/emtricitabine) plus Epivir (lamivudine) along with viral load counseling and patient-centered care.
Out of 77,773 residents in the areas targeted by the intervention, 55 percent were women, 53 percent were farmers and 20 percent were younger than 20. At the beginning of the two-year study, 9.9 percent of the population was HIV positive, including 6.3 percent in the areas studied in West Uganda, 3.3 percent in the areas in East Uganda and 19.5 percent in the areas in Kenya. At that time, 45 percent of the overall HIV population had a fully suppressed viral load.
After two years, 97.4 percent of the HIV population was diagnosed, 93.2 percent had received ARVs and 89.5 percent were virally suppressed. This translated to an 81 percent viral suppression rate.
A total of 97.5 percent of men and 97.1 percent of the mobile population was tested for HIV at least once. At the outset of the study, 80.3 percent of men and 81.7 percent of the mobile population had had at least one undetectable viral load test result.