Evidence map›Paper›PMID 37541706›Full record

Trial reportThe lancet. HIV2023

A multilevel health system intervention for virological suppression in adolescents and young adults living with HIV in rural Kenya and Uganda (SEARCH-Youth): a cluster randomised trial.

Theodore Ruel, Florence Mwangwa, Laura B Balzer, James Ayieko, Marilyn Nyabuti, Wafula Erick Mugoma, Jane Kabami, Brian Kamugisha, Douglas Black, Bridget Nzarubara and 14 more

Registry-linked trialOpen access · hybridAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The lancet. HIV, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03848728 (Strategic Antiretroviral Therapy and HIV Testing for Youth in Rural Africa), which is not on this map. Cited by 20 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
20citing papers in PubMed, 4 pooled it
4.5field-weighted citation impact, top 4% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03848728 nacompletednot on this map

Strategic Antiretroviral Therapy and HIV Testing for Youth in Rural Africa

TypeinterventionalSponsorUniversity of California, San FranciscoRan2019 to 2023Enrolled1,988ConditionsHIVArmsSEARCH Youth combination intervention
3 · Its place in the literature

Who cites it

20 citing papers in PubMed, 4 syntheses or guidelines pooled it, 23 citations in OpenAlex.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

24 authors at 7 institutions in 3 countries.

Theodore RuelDepartment of Pediatrics, University of California, San Francisco, San Francisco, CA, USA. Electronic address: theodore.ruel@ucsf.edu.
Florence MwangwaInfectious Diseases Research Collaboration, Kampala, Uganda.
Laura B BalzerDivision of Biostatistics, School of Public Health, University of California, Berkeley, CA, USA.
James AyiekoKenya Medical Research Institute, Kisumu, Kenya.
Marilyn NyabutiKenya Medical Research Institute, Kisumu, Kenya.
Wafula Erick MugomaKenya Medical Research Institute, Kisumu, Kenya.
Jane KabamiInfectious Diseases Research Collaboration, Kampala, Uganda.
Brian KamugishaInfectious Diseases Research Collaboration, Kampala, Uganda.
Douglas BlackDivision of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Bridget NzarubaraInfectious Diseases Research Collaboration, Kampala, Uganda.
Fred OpelKenya Medical Research Institute, Kisumu, Kenya.
John SchromDivision of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
George AgengoKenya Medical Research Institute, Kisumu, Kenya.
Janet NakiguddeDepartment of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda.
Hellen N AtuhaireInfectious Diseases Research Collaboration, Kampala, Uganda.
Josh SchwabDivision of Biostatistics, School of Public Health, University of California, Berkeley, CA, USA.
James PengDepartment of Biostatistics, University of Washington, Seattle, WA, USA.
Carol CamlinDepartment of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
Starley B ShadeDepartment of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
Elizabeth BukusiKenya Medical Research Institute, Kisumu, Kenya.
Bill G KapogiannisEunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.
Edwin CharleboisDepartment of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
Moses R KamyaDepartment of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
Diane HavlirDivision of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA.
University of California, San Francisco · USKenya Medical Research Institute · KEInfectious Diseases Research Collaboration · UGMakerere University · UGUniversity of California, Berkeley · USEunice Kennedy Shriver National Institute of Child Health and Human Development · USUniversity of Washington · US

Funding

Ujima Mentoring ProgramP30MH062246 · NIMH · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI MALLORY O JOHNSON · 2001 to 2026
$57.4M
Strategic antiretroviral therapy and HIV testing for youth in rural AfricaUH3HD096915 · NICHD · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI HAVLIR, DIANE V · 2020 to 2022
$5.7M
Strategic antiretroviral therapy and HIV testing for youth in rural Africa (SATURN)UG3HD096915 · NICHD · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI HAVLIR, DIANE V · 2018 to 2019
$3.4M
NICHD NIH HHS UG3 HD096915NICHD NIH HHS UH3 HD096915NIMH NIH HHS P30 MH062246
6 · The paper itself

Abstract

backgroundSocial and cognitive developmental events can disrupt care and medication adherence among adolescents and young adults living with HIV in sub-Saharan Africa. We hypothesised that a dynamic multilevel health system intervention helping adolescents and young adults and their providers navigate life-stage related events would increase virological suppression compared with standard care.

methodsWe did a cluster randomised, open-label trial of young individuals aged 15-24 years with HIV and receiving care in eligible clinics (operated by the government and with ≥25 young people receiving care) in rural Kenya and Uganda. After clinic randomisation stratified by region, patient population, and previous participation in the SEARCH trial, participants in intervention clinics received life-stage-based assessment at routine visits, flexible clinic access, and rapid viral load feedback. Providers had a secure mobile platform for interprovider consultation. The control clinics followed standard practice. The primary, prespecified endpoint was virological suppression (HIV RNA <400 copies per mL) at 2 years of follow-up among participants who enrolled before Dec 1, 2019, and received care at the study clinics. This trial is registered with ClinicalTrials.gov, NCT03848728, and is closed to recruitment.

findings28 clinics were enrolled and randomly assigned (14 control, 14 intervention) in January, 2019. Between March 14, 2019, and Nov 26, 2020, we recruited 1988 participants at the clinics, of whom 1549 were included in the analysis (785 at intervention clinics and 764 at control clinics). The median participant age was 21 years (IQR 19-23) and 1248 (80·6%) of 1549 participants were female. The mean proportion of participants with virological suppression at 2 years was 88% (95% CI 85-92) for participants in intervention clinics and 80% (77-84) for participants in control clinics, equivalent to a 10% beneficial effect of the intervention (risk ratio [RR] 1·10, 95% CI 1·03-1·16; p=0·0019). The intervention resulted in increased virological suppression within all subgroups of sex, age, and care status at baseline, with greatest improvement among those re-engaging in care (RR 1·60, 95% CI 1·00-2·55; p=0·025).

interpretationRoutine and systematic life-stage-based assessment, prompt adherence support with rapid viral load testing, and patient-centred, flexible clinic access could help bring adolescents and young adults living with HIV closer towards a goal of universal virological suppression.

fundingEunice Kennedy Shriver National Institute of Child Health and Human Development, US National Institutes of Health.

Indexed as

Anti-HIV AgentsHIV InfectionsAdolescentChildFemaleHumansKenyaMaleRural PopulationUgandaViral LoadYoung AdultAnti-HIV Agents

Identifiers

PMID37541706
PMCPMC11158418
OpenAlexW4385487224

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.