Expectations about future health and longevity in Kenyan and Ugandan communities receiving a universal test-and-treat intervention in the SEARCH trial

Abstract

Expectations about future health and longevity are important determinants of individuals’ decisions to invest in physical and human capital. Few population-level studies have measured subjective expectations and examined how they are affected by scale-up of antiretroviral therapy (ART). We assessed these expectations in communities receiving annual HIV testing and universal ART. Longitudinal data on expectations were collected at baseline and one year later in 16 intervention communities participating in the Sustainable East Africa Research in Community Health (SEARCH) trial of the test and treat strategy in Kenya and Uganda (NCT01864603). A random sample of households with and without an HIV-positive adult was selected after baseline HIV testing. Individuals’ expectations about survival to 50, 60, 70, and 80 years of age, as well as future health status and economic well-being, were measured using a Likert scale. Primary outcomes were binary variables indicating participants who reported being very likely or almost certain to survive to advanced ages. Logistic regression analyses were used to examine trends in expectations as well as associations with HIV status and viral load for HIV-positive individuals. Data were obtained from 3126 adults at baseline and 3977 adults in year 1, with 2926 adults participating in both waves. HIV-negative adults were more likely to have favorable expectations about survival to 60 years than HIV-positive adults with detectable viral load (adjusted odds ratio [AOR] 1.87, 95% CI 1.53–2.30), as were HIV-positive adults with undetectable viral load (AOR 1.41, 95% CI 1.13–1.77). Favorable expectations about survival to 60 years were more likely for all groups in year 1 compared to baseline (AOR 1.53, 95% CI 1.31–1.77). These findings are consistent with the hypothesis that universal ART leads to improved population-level expectations about future health and well-being. Future research from the SEARCH trial will help determine whether these changes are causally driven by the provision of universal ART.

Comparative assessment of five trials of universal HIV testing and treatment in sub‐Saharan Africa

“…Besides characterizing the trial populations with standard socio‐demographic information, these trials also collect experiences and perceptions of a sample of trial participants, community members and services providers. Such qualitative research provides evidence to understand the acceptability of the UTT strategies by the general population 29, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69. Overall, the analysis of the various themes addressed within these five trials will contribute to understanding the impact of UTT strategies in various contexts as well as inform the generalization of such a strategy to new contexts.…”

“…The average follow-up refers to the average time a study participant was observed in the context of the trial. strategies by the general population [29,[53][54][55][56][57][58][59][60][61][62][63][64][65][66][67][68][69]. Overall, the analysis of the various themes addressed within these five trials will contribute to understanding the impact of UTT strategies in various contexts as well as inform the generalization of such a strategy to new contexts.…”

Delayed Antiretroviral Therapy (ART) Initiation among Hospitalized Adults in a Resource-Limited Settings: A Challenge to the Global Target of ART for 90% of HIV-Infected Individuals

“…A study in Tanzania showed that less than 1% of HIV-infected patients initiated cART during hospitalization [26]. Despite advances in national guidelines to include the WHO “test and treat” guidelines for initiating cART among HIV-infected adults irrespective of CD4 counts [6], which is largely adhered to in ambulatory clinics and community programs [4], hospital settings continue to present the challenge of advanced untreated HIV disease that is associated with a high postdischarge mortality rate. In addition to scale up the “test and treat” strategy to meet the 90-90-90 targets for 2020, there is a need to fast-track cART initiation among hospitalized patients who continue to present with advanced untreated HIV disease.…”

The epidemiology of chronic kidney disease (CKD) in rural East Africa: A population-based study

“…To estimate the prevalence of CKD and understand its risk factors in rural East Africa, we conducted a home-based sub-study (named SEARCH-CKD) during parent study year 3 (2016-2017). We utilized a sampling framework (established by the parent study in 2013) where 100 households with at least one HIV-positive adult and 100 households without any HIV-positive adults were randomly selected to participate in each study community [19]. For the SEARCH-CKD sub-study, one HIV-positive adult was randomly selected from HIVpositive households, and one HIV-negative adult was randomly selected from HIV-negative households.…”