Improved Viral Suppression With Streamlined Care in the SEARCH Study

Abstract

Supplemental Digital Content is Available in the Text.

Universal HIV Testing and Treatment With Patient-Centered Care Improves ART Uptake and Viral Suppression Among Adults Reporting Hazardous Alcohol Use in Uganda and Kenya

“…32 Our findings add to the evidence demonstrating that the population health benefits gained by the SEARCH intervention extend to PWH reporting hazardous alcohol use, adding to the previously identified groups at high risk for poor HIV care outcomes, including pregnant and postpartum women, 33 men with low CD4 counts, 34 and treatment experienced patients with viremia. 28…”

“…32 Our findings add to the evidence demonstrating that the population health benefits gained by the SEARCH intervention extend to PWH reporting hazardous alcohol use, adding to the previously identified groups at high risk for poor HIV care outcomes, including pregnant and postpartum women, 33 men with low CD4 counts, 34 and treatment experienced patients with viremia. 28 There are several potential mechanisms for how the SEARCH intervention achieved a higher prevalence of ART uptake and viral suppression among PWH reporting hazardous alcohol use compared with control. First, and perhaps most importantly, patient-centered care focused on decreasing structural barriers, increasing care flexibility (ie, allowing extended clinic hours, late arrivals, and appointment flexibility), improving patient-clinician relationships, and enhancing patient and physician HIV/ART knowledge, which have been shown to predict retention in care.…”

“…27 This approach did not include any specific alcohol interventions and providers did not receive alcoholrelated treatment training; however, individual providers may have addressed alcohol use with patients using their clinical judgment or skills gained from patient-centered care training received for the intervention, as previously described. 27,28 In control communities, health campaigns were held at baseline only and ART was offered according to country guidelines. ART eligibility rapidly expanded during this study, from CD4 + # 350 cells/mm 3 at baseline to ,500 cells/mm 3 within 1 year, and subsequently to universal eligibility.…”

“…At baseline, across both arms, PWH reporting hazardous alcohol use were older (median [IQR] 38 years [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]) than those with no/nonhazardous use (35 years [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44]). A higher proportion of PWH reporting hazardous alcohol use vs. no/nonhazardous use were Ugandan (70% vs. 37%), male (74% vs. 33%), single (10% vs. 7%), educated at a secondary level or higher (21% vs. 13%), in the lowest wealth quintile (26% vs. 19%), and mobile (17% vs. 10%).…”

Effect of a patient-centered hypertension delivery strategy on all-cause mortality: Secondary analysis of SEARCH, a community-randomized trial in rural Kenya and Uganda

“…In the context of this population-wide screening, offered in both randomized arms at baseline, we found that a patient-centered chronic care delivery model improved hypertension control and reduced mortality among adults with uncontrolled hypertension beyond that of optimized standard care. We previously reported profound population-level health effects of this care delivery model among HIV-infected persons, including reduced mortality among those with prevalent HIV infection [ 17 ] and men with low CD4 counts [ 30 ], improved viral suppression among those with HIV viremia despite prior attempts at care engagement [ 31 ], reduced maternal-to-child transmission of HIV [ 32 ], and decreased incidence of tuberculosis [ 17 ]. Taken together, our findings support the value of integrated patient-centered chronic care models, when combined with multidisease community-based screening programs, for improving a wide range of population health outcomes.…”