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Background: The SEARCH Study (NCT01864683; first phase endpoint 2017) is a cluster randomized trial evaluating a “test and treat” HIV and multi-disease prevention strategy in rural Uganda and Kenya. We evaluated interim population-level HIV cascade coverage achieved over two years in the 16 SEARCH intervention communities.
Methods: We enumerated residents via baseline household census. HIV serostatus and plasma RNA were measured annually at multi-disease health campaigns followed by home-based testing for non-attendees. Streamlined ART (EFV/TDF/+FTC or 3TC), including patient-centered care and viral load counseling, was universally offered. At baseline, and after one and two years follow-up, we estimated (1) proportion of baseline HIV+ adult (≥15 years) stable (>6mo/past year) residents previously diagnosed; (2) of these, proportion ever on ART; (3) of these, proportion with viral suppression (RNA< 500 copies/ml). We estimated population viral suppression as a cascade product and via direct HIV RNA measurement, using inverse weights to adjust for missing measures.
Results: Of 77,773 baseline adult stable residents, 55% were women, 53% farmers, and 20% < 20 years. Baseline HIV prevalence was 9.9% (West Uganda: 6.3%; East Uganda: 3.3%; Kenya: 19.5%). We achieved high cascade coverage by follow up year 2 (Figure): (1) 97.4% (95%CI:97.3%,97.5%) were previously diagnosed; (2) 93.2% had received ART (95%CI:92.6%,93.9%); (3) 89.5% were suppressed (95%CI:88.6%,90.4%). Population viral suppression at year 2 was 81.3% (95%CI:80.3%,82.3%) based on the cascade product and 82.8% (95%CI:80.2%,85.3%) by adjusted direct measure. Coverage was high among men and mobile populations: 97.5% (95%CI:97.4%;97.7%;) of men and 97.1% (95%CI:96.8%,97.5%) of mobile populations tested at least once; among baseline HIV+, 80.3% (95%CI:78.4%,82.2%) of men and 81.7% (95%CI:78.3%,85.1%) of mobile populations had at least one suppressed RNA level.
Conclusions: Using a multi-disease community-based approach and patient-centered streamlined care, we increased population viral suppression from 45% to 81%, exceeding the UNAIDS 90-90-90 cascade target within 2 years in SEARCH intervention communities.

Cascade coverage and population-level viral suppression among baseline HIV+ adult stable residents of SEARCH Study intervention communities
[Cascade coverage and population-level viral suppression among baseline HIV+ adult stable residents of SEARCH Study intervention communities]