- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01710397
Rapid Initiation of Antiretroviral Therapy to Promote Early HIV/AIDS Treatment in South Africa (RapIT Study) (RapIT)
One of the most serious challenges facing antiretroviral therapy (ART) programs for HIV/AIDS in resource-constrained settings is the failure of ART-eligible patients to complete the steps required to initiate treatment. The high rate of loss to care of patients who are treatment-eligible at HIV diagnosis may be due in part to the large number of steps required between receiving an HIV diagnosis and obtaining the first dose of antiretrovirals (ARVs). In South Africa, these steps usually require approximately four clinic visits over a period of 2-8 weeks before a patient can start treatment. One strategy proposed for reducing losses among those eligible for ART is to simplify and condense the steps required for starting treatment. This is now possible because new, point-of-care (POC) tests for CD4 counts and tuberculosis (TB) diagnosis are available. These technologies can be combined with changes to clinic schedules to allow all steps required for ART initiation under South African guidelines (lab tests, physical exam, education) to take place on the day the patient presents for an HIV test.
This study is a randomized strategy evaluation of the feasibility, effectiveness, and cost-effectiveness of rapid ART initiation. Outpatient, non-pregnant, HIV-positive adults who come to a South African clinic for an HIV test, consent to study participation, and are eligible for ART will be randomized 1:1 to rapid ART initiation or to standard care. Those who are assigned to rapid ART initiation will have the possibility of receiving their first dose of ARVs as early as the same day, while those who are assigned to standard care will follow the clinic's usual procedures for starting ART. Rapid ART initiation for HIV-positive pregnant women, which has recently become the standard of care in South Africa, will also be assessed in a programmatic evaluation conducted alongside the randomized evaluation, with a retrospective comparison group. The primary study outcome for non-pregnant adults will be remaining alive, in care and virally suppressed 10 months after having a positive HIV test at the study site or making a first HIV-related visit. The primary study outcome for pregnant women will be adherence to ART until delivery. The cost effectiveness of the rapid initiation strategy will be assessed as the cost per patient achieving the primary outcome for each population.
Study Overview
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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-
Gauteng
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Johannesburg, Gauteng, South Africa, 2092
- Thuthukani Primary Health Clinic
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Johannesburg, Gauteng, South Africa
- Themba Lethu Clinic, Helen Joseph Hospital
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- Adult patients (>18 years)
- Tested HIV-positive at study site's outpatient testing service or antenatal clinic on day of study enrollment or previously tested HIV-positive but making first visit to study site for HIV-related care or antenatal care for the current pregnancy
- Eligible for antiretroviral therapy under prevailing South African guidelines
Exclusion Criteria:
- Currently or previously on ART (three-drug combination; previous PMTCT regimen exposure for an earlier pregnancy is not an exclusion criterion)
- Stated intention to seek further HIV or antenatal care at another site, not at the study site
- Not physically or emotionally able to participate in the study, in the opinion of the investigators
- Not willing or able to provide written informed consent to participate in the study
- Previously screened for the same study
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
No Intervention: Standard group, non-pregnant adults
Comparison group (prospective enrollment)
|
|
No Intervention: Standard group, pregnant women
Comparison group (retrospective record review)
|
|
Experimental: Rapid group, non-pregnant adults
Rapid ART initiation
|
Subjects offered the intervention who are eligible for antiretroviral therapy under South African guidelines will be offered the opportunity to initiate ART immediately, if possible on the same day as testing positive for HIV.
Rapid testing technologies and an accelerated schedule will be used to allow all steps required prior to initiating ART to take place in approximately a half-day period.
|
Experimental: Rapid group, pregnant women
Rapid ART initiation
|
Subjects offered the intervention who are eligible for antiretroviral therapy under South African guidelines will be offered the opportunity to initiate ART immediately, if possible on the same day as testing positive for HIV.
Rapid testing technologies and an accelerated schedule will be used to allow all steps required prior to initiating ART to take place in approximately a half-day period.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Proportion non-pregnant subjects virally suppressed at routine six-month viral load
Time Frame: 10 months after study enrollment
|
The primary outcome for non-pregnant adults is the proportion of subjects in each group alive, in care and virally suppressed at the routine six-month monitoring visit within 10 months of a positive HIV test or initial HIV care visit if previously diagnosed.
The analysis period will start at study enrollment and continue through the earlier of the patient's six-month viral load or 10 months after the patient's HIV test.
|
10 months after study enrollment
|
Proportion of pregnant subjects who adhere to ART or the prior PMTCT regimen until delivery
Time Frame: Up to 9 months after study enrollment
|
The primary outcome for pregnant women is the proportion of subjects in each group who adhere to ART or the prior prevention of mother-to-child transmission (PMTCT) regimen until delivery.
The number of weeks a pregnant woman is on ART before delivery is the most important predictor of perinatal HIV transmission7.
The guideline change to immediate ART initiation for pregnant women is likely to lead to earlier initiation for most pregnant women, but the intervention will be effective only if patients adhere to ART through the duration of pregnancy.
Adherence will be measured as making monthly medication pickups to allow a continuous supply of ARVs through delivery.
The analysis period for the primary outcome will start on the day of study enrollment, which is the date of a positive HIV test or the first antenatal visit of the current pregnancy, for women previously diagnosed, and end at the actual or estimated delivery date.
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Up to 9 months after study enrollment
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Average cost per non-pregnant patient who is alive, in care, and virally suppressed within 10 months of study enrollment
Time Frame: 10 months after study enrollment
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10 months after study enrollment
|
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Average cost per pregnant patient who initiates ART within 4 weeks
Time Frame: 3 months after study enrollment
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3 months after study enrollment
|
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Proportion virally suppressed at six-month intervals and final date of data censoring
Time Frame: 24 months after enrollment
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Proportion of subjects in each track and group alive, on ART, and virally suppressed at six-month intervals and the final date of data censoring
|
24 months after enrollment
|
Average time to ART initiation
Time Frame: 24 months after enrollment
|
24 months after enrollment
|
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Average gestational age at ART initiation and average duration on ART prior to delivery
Time Frame: 3 months after study enrollment
|
3 months after study enrollment
|
|
Patient-level predictors of treatment uptake, retention in care, and viral suppression
Time Frame: 10 months after enrollment
|
10 months after enrollment
|
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Prevalence of TB symptoms, confirmed TB, time to initiation of TB treatment, and time to initiation of ART among patients with TB
Time Frame: 10 months after enrollment
|
10 months after enrollment
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Acceptance of rapid initiation strategy
Time Frame: 10 months after enrollment
|
Acceptance of rapid initiation strategy (% of patients offered rapid initiation who accept)
|
10 months after enrollment
|
Time from HIV test to treatment
Time Frame: 10 months after enrollment
|
Average time elapsed (days) between HIV test and dispensing of first dose of ARVs
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10 months after enrollment
|
Cost to patients
Time Frame: 10 months after enrollment
|
Average cost to patients of initiating treatment, including travel and other out-of-pocket costs and time spent in clinic
|
10 months after enrollment
|
Collaborators and Investigators
Publications and helpful links
General Publications
- Rosen S, Maskew M, Fox MP, Nyoni C, Mongwenyana C, Malete G, Sanne I, Rohr JK, Long L. Rapid ART initiation reduces loss between HIV testing and treatment: the RapIT trial. Abstract 1091, 21st Conference on Retroviruses and Opportunistic Infections (CROI 2015), Seattle, February 23-26, 2015.
- Rosen S, Maskew M, Fox MP, Nyoni C, Mongwenyana C, Malete G, Sanne I, Bokaba D, Sauls C, Rohr J, Long L. Initiating Antiretroviral Therapy for HIV at a Patient's First Clinic Visit: The RapIT Randomized Controlled Trial. PLoS Med. 2016 May 10;13(5):e1002015. doi: 10.1371/journal.pmed.1002015. eCollection 2016 May. Erratum In: PLoS Med. 2016 Jun;13(6):e1002050.
- Rosen S, Maskew M, Fox MP, Nyoni C, Mongwenyana C, Malete G, Sanne I, Bokaba D, Sauls C, Rohr R, Long L. Initiating antiretroviral therapy for HIV at a patient's first clinic visit: the RapIT randomized controlled trial. Conference on Retroviruses and Opportunistic Infections (CROI) 2016, Boston, Feb 22-25 2016.
- Long LC, Maskew M, Brennan AT, Mongwenyana C, Nyoni C, Malete G, Sanne I, Fox MP, Rosen S. Initiating antiretroviral therapy for HIV at a patient's first clinic visit: a cost-effectiveness analysis of the rapid initiation of treatment randomized controlled trial. AIDS. 2017 Jul 17;31(11):1611-1619. doi: 10.1097/QAD.0000000000001528.
- Maskew M, Jamieson L, Mohomi G, Long L, Mongwenyana C, Nyoni C, Mokaba D, Fox MP, Sanne I, Rosen S. Implementation of Option B and a fixed-dose combination antiretroviral regimen for prevention of mother-to-child transmission of HIV in South Africa: A model of uptake and adherence to care. PLoS One. 2018 Aug 30;13(8):e0201955. doi: 10.1371/journal.pone.0201955. eCollection 2018.
Helpful Links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- RNA Virus Infections
- Virus Diseases
- Infections
- Blood-Borne Infections
- Communicable Diseases
- Sexually Transmitted Diseases, Viral
- Sexually Transmitted Diseases
- Lentivirus Infections
- Retroviridae Infections
- Immunologic Deficiency Syndromes
- Immune System Diseases
- Slow Virus Diseases
- HIV Infections
- Acquired Immunodeficiency Syndrome
Other Study ID Numbers
- H-31880
- 1U01AI100015-01 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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