LAUSR

OBJECTIVE Determine if patient-centered, streamlined HIV care achieves higher ART uptake and viral suppression than the standard treatment model for people with HIV (PWH) reporting hazardous alcohol use. DESIGN Community cluster-randomized trial. METHODS The SEARCH trial (NCT01864603) compared an intervention of annual population HIV testing, universal ART, and patient-centered care to a control of baseline population testing with ART by country standard in 32 Kenyan and Ugandan communities. Adults (≥15 years) completed a baseline Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) and were classified as no/non-hazardous (AUDIT-C 0-2 women/0-3 men) or hazardous alcohol use (≥3 women/≥4 men). We compared year 3 ART uptake and viral suppression of PWH reporting hazardous use between intervention and control arms. We compared alcohol use as a predictor of year 3 ART uptake and viral suppression among PWH, by arm. RESULTS Of 11,070 PWH with AUDIT-C measured, 1723 (16%) reported any alcohol use; 893 (8%) reported hazardous use. Among PWH reporting hazardous use, the intervention arm had higher ART uptake (96%) and suppression (87%) compared to control (74%, aRR=1.28, 95%CI:1.19-1.38; and 72%, aRR=1.20, 95%CI:1.10-1.31, respectively). Within arm, hazardous alcohol use predicted lower ART uptake in control (aRR=0.86, 95%CI:0.78-0.96), but not intervention (aRR=1.02, 95%CI:1.00-1.04); use was not predictive of suppression in either arm. CONCLUSION The SEARCH intervention improved ART uptake and viral suppression among PWH reporting hazardous alcohol use and eliminated gaps in ART uptake between PWH with hazardous and no/non-hazardous use. Patient-centered HIV care may decrease barriers to HIV care for PWH with hazardous alcohol use.