Assistant professor of biostatistics Laura Balzer is among an international team that recently received a five-year, $23 million National Institutes of Health (NIH) grant to extend the SEARCH (Sustainable East Africa Research in Community Health) study.
Since its inception in 2012, the SEARCH study has been designing and evaluating evidence-based interventions in rural Kenya and Uganda as part of the global effort to eliminate HIV and improve community health. The team uses multi-disease, community-based approaches to address more than HIV, including tuberculosis, hypertension, economic productivity and stigma.
Balzer is the Primary Statistician for the SEARCH consortium, led by Diane Havlir (University of California San Francisco), Moses Kamya (Makerere University in Kampala, Uganda) and Maya Petersen (University of California Berkeley). In the first phase of SEARCH (2013-2017), the team evaluated a community-based “Universal-HIV-Test-and-Treat” strategy — out-of-facility screening for multiple diseases, including HIV, followed by immediate treatment for persons with HIV—in 32 communities consisting of 350,000 persons in rural Uganda and Kenya. In the second phase (2017-2020), the team evaluated an additional intervention of targeted HIV prevention through Pre-Exposure Prophylaxis (PrEP) for all persons at elevated risk of HIV acquisition.
The new award will allow the team to launch the next phase in the study, SEARCH Sapphire: “A Multisectoral Strategy to Address Persistent Drivers of the HIV Epidemic in East Africa.” The new study will use multisectoral approaches and scalable interventions to reduce HIV incidence below 0.1%, while improving community health (e.g. reducing mortality, tuberculosis, uncontrolled hypertension, and heavy alcohol use).
“The first phase demonstrated how Universal-Test-and-Treat can improve population-level viral suppression, reducing HIV incidence and mortality,” says Balzer. “The second phase demonstrated the additional gains from targeted PrEP, especially among women. In SEARCH Sapphire, we hope to close the remaining gaps by offering dynamic choice prevention and dynamic choice treatment, tailored for the hardest-to-reach groups.”
Over the past decade, the SEARCH consortium has influenced policy for HIV prevention and treatment worldwide. To date, SEARCH has more than 70 publications, has been featured in an Emmy prize winning segment on PBS NewsHour and presented at numerous high-profile international conferences.
Balzer’s work on the project includes tackling pressing questions in both study design (e.g., pair-matching, multi-phase randomization, missing data) and analysis (e.g., machine learning for prediction, non-parametric inference, differential measurement, and complex dependence). She looks forward to continuing her work with the SEARCH team on the next phase of the study.