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The Impact of SEARCH Community Precision Health on HIV Incidence in Rural Kenya and Uganda
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CROI 2026 Feb 22-25 Denver
Program abstract
We conducted a cluster randomized controlled trial in rural Kenya and Uganda. We randomized 16 communities (N~80,000 adults) to a multi-component multi-disease intervention or usual care (control). The HIV intervention was:
1) home visits by trained existing government community health workers for HIV testing with prevention and treatment referrals;
2) training health center providers in person-centered HIV prevention for persons at-risk of HIV and care for persons with HIV (PWH) at risk of virologic failure;
3) an app/digital platform (MoH compatible) connecting community and clinic services. Biomedical prevention options were oral PrEP/PEP and DPV ring. The primary endpoint was HIV incidence by a recent infection testing algorithm (RITA) using the Sedia assay, measured on all adult residents in 2025, 2-years post-randomization. Secondary endpoints included biomedical prevention coverage (% of past 6 months with self-reported PrEP/PEP/ring use among adults without HIV) and HIV care cascades.
HIV incidence was lower (RR:0.30 [95%CI:0.14-0.61]; p=0.001) in intervention (0.06% [0.03-0.08]) vs control (0.19% [0.09-0.28]); incidence reduction was consistent across age, sex and country. In intervention vs control, biomedical prevention coverage was 4-fold higher on a population level (1.67% vs 0.41%; RR:4.04; p<0.001). Prevention coverage was significantly higher in intervention across age, sex and country. Among PWH in intervention and control: 91.2% and 88.7% knew their status (p=0.072), 98% of status-aware were on ART in both arms (p=0.64), and 93% and 94% of those on ART had VL<400 (p=0.652), respectively.
Conclusions: HIV incidence was reduced by 70% at a population-level using a multicomponent intervention that leveraged existing government infrastructure. The intervention bridged the gap between people and healthcare by pairing digital tools with tailored HIV services delivered by community health workers and clinicians.
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