{"doi":"10.1093/cid/ciaa1782","title":"SEARCH Human Immunodeficiency Virus (HIV) Streamlined Treatment Intervention Reduces Mortality at a Population Level in Men With Low CD4 Counts","abstract":"BACKGROUND: We tested the hypothesis that patient-centered, streamlined human immunodeficiency virus (HIV) care would achieve lower mortality than the standard treatment model for persons with HIV and CD4 ≤ 350/uL in the setting of population-wide HIV testing. METHODS: In the SEARCH (Sustainable East Africa Research in Community Health) Study (NCT01864603), 32 communities in rural Uganda and Kenya were randomized to country-guided antiretroviral therapy (ART) versus streamlined ART care that included rapid ART start, visit spacing, flexible clinic hours, and welcoming environment. We assessed persons with HIV and CD4 ≤ 350/uL, ART eligible in both arms, and estimated the effect of streamlined care on ART initiation and mortality at 3 years. Comparisons between study arms used a cluster-level analysis with survival estimates from Kaplan-Meier; estimates of ART start among ART-naive persons treated death as a competing risk. RESULTS: Among 13 266 adults with HIV, 2973 (22.4%) had CD4 ≤ 350/uL. Of these, 33% were new diagnoses, and 10% were diagnosed but ART-naive. Men with HIV were almost twice as likely as women with HIV to have CD4 ≤ 350/uL and be untreated (15% vs 8%, respectively). Streamlined care reduced mortality by 28% versus control (risk ratio [RR] = 0.72; 95% confidence interval [CI]: .56, .93; P = .02). Despite eligibility in both arms, persons with CD4 ≤ 350/uL started ART faster under streamlined care versus control (76% vs 43% by 12 months, respectively; P < .001). Mortality was reduced substantially more among men (RR = 0.61; 95% CI: .43, .86; P = .01) than among women (RR = 0.90; 95% CI: .62, 1.32; P = .58). CONCLUSIONS: After population-based HIV testing, streamlined care reduced population-level mortality among persons with HIV and CD4 ≤ 350/uL, particularly among men. Streamlined HIV care models may play a key role in global efforts to reduce AIDS deaths.","journal":"Clinical Infectious Diseases","year":2021,"id":187264,"datarank":0.8516483757308806,"base_score":2.9444389791664403,"endowment":2.9444389791664403,"self_citation_contribution":0.44166584687496613,"citation_network_contribution":0.4099825288559144,"self_endowment_contribution":0.44166584687496613,"citer_contribution":0.4099825288559144,"corpus_percentile":null,"corpus_rank":null,"citation_count":18,"citer_count":13,"citers_with_citation_signal":10,"citers_with_endowment":10,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9597,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT01864603"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":255295,"name":"Maya L. Petersen","orcid":"0000-0002-5505-153X","position":1,"is_corresponding":false},{"id":255277,"name":"Jane Kabami","orcid":"0000-0002-0265-3174","position":2,"is_corresponding":false},{"id":255275,"name":"James Ayieko","orcid":"0000-0002-0324-4006","position":3,"is_corresponding":false},{"id":746786,"name":"Dalsone Kwariisima","orcid":null,"position":4,"is_corresponding":false},{"id":255285,"name":"Norton Sang","orcid":"0000-0002-0092-7776","position":5,"is_corresponding":false},{"id":255292,"name":"Tamara D. Clark","orcid":"0000-0003-1109-6039","position":6,"is_corresponding":false},{"id":666904,"name":"Joshua Schwab","orcid":"0000-0002-9436-1805","position":7,"is_corresponding":false},{"id":255274,"name":"Edwin D. Charlebois","orcid":"0000-0001-7237-2119","position":8,"is_corresponding":false},{"id":255293,"name":"Craig R. Cohen","orcid":"0000-0001-8654-6634","position":9,"is_corresponding":false},{"id":255294,"name":"Elizabeth A. Bukusi","orcid":"0000-0002-2031-2808","position":10,"is_corresponding":false},{"id":255281,"name":"James Peng","orcid":"0000-0002-8245-8319","position":11,"is_corresponding":false},{"id":255284,"name":"Vivek Jain","orcid":"0000-0002-7835-1447","position":12,"is_corresponding":false},{"id":404146,"name":"Yea‐Hung Chen","orcid":"0000-0002-7949-0692","position":13,"is_corresponding":false},{"id":255283,"name":"Gabriel Chamie","orcid":"0000-0002-5860-8081","position":14,"is_corresponding":false},{"id":255278,"name":"Laura B. Balzer","orcid":"0000-0002-3730-410X","position":15,"is_corresponding":false},{"id":58746,"name":"Diane V. Havlir","orcid":"0000-0003-0761-3136","position":16,"is_corresponding":false},{"id":242453,"name":"Moses R. Kamya","orcid":"0000-0001-9106-4234","position":0,"is_corresponding":true}],"reference_count":32,"raw_metadata":null,"created_at":"2026-07-18T23:48:51.315888Z","pmid":"33783495","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}