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Improved Viral Suppression With Streamlined Care in the SEARCH Study.

Matthew D Hickey1, James Ayieko2, Dalsone Kwarisiima3

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Streamlined HIV care models improved viral suppression for patients with viremia in resource-limited settings. This approach enhanced treatment outcomes in rural Uganda and Kenya.

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Area of Science:

  • Public Health
  • Infectious Diseases
  • Clinical Medicine

Background:

  • Differentiated Service Delivery (DSD) models are expanding for stable HIV patients in resource-limited areas.
  • Outcomes of DSD for HIV patients with viremia are less understood.
  • The study evaluated a streamlined care DSD model within the SEARCH trial.

Purpose of the Study:

  • To assess the impact of a streamlined care DSD model on viral suppression (VS) in HIV-infected adults.
  • To determine if DSD models are effective for patients with viremia.
  • To compare VS rates between intervention and control groups in rural Uganda and Kenya.

Main Methods:

  • A randomized trial (SEARCH) involving 16 intervention and 16 control communities.
  • Included HIV-infected adults eligible for antiretroviral therapy (ART) at baseline (2013).
  • Streamlined care involved patient-centered approaches, spaced appointments, improved access, and reminders.

Main Results:

  • Overall year 3 VS was 90% in the intervention arm and 87% in the control arm.
  • Streamlined care significantly increased VS among ART-experienced patients with baseline viremia (67% vs 47%).
  • VS was not significantly different for ART-naïve patients or those already virally suppressed.

Conclusions:

  • Streamlined care DSD models show promise for improving viral suppression in specific HIV patient groups.
  • The model was particularly effective for ART-experienced patients with viremia.
  • Further research can optimize DSD for diverse HIV patient populations.