- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT01992887
Pre-ART Retention in Care in Tanzania (PARC)
Retention and Engagement in Care of Patients Prior to ART Initiation in the Kagera Region of Tanzania
Study Overview
Status
Detailed Description
Retention of patients in HIV care following diagnosis and enrollment is a chronic challenge in both resource rich and resource poor settings (Rosen, Fox et al. 2007; WHO 2009; Fox and Rosen 2010), and is critical to the long-term success of HIV care and treatment scale-up. Most research on retention in care has focused on persons who are eligible for or have initiated antiretroviral therapy (ART), generally examined only demographic and clinical determinants. However, a large proportion of patients enrolled in HIV care (e.g., 45%, according to our data from 722 sub-Saharan African clinics) have not been determined to be ART-eligible and have not yet initiated ART; among these individuals, even less is known about the magnitude and determinants of non-retention in care. Retention in HIV care prior to ART initiation is a pre-requisite to: 1) optimal prophylaxis, diagnosis, and treatment of opportunistic illnesses (OIs); 2) effective secondary prevention of HIV transmission, such as by patient counseling and education, earlier diagnosis of infected family members and sexual partners, and prevention of mother to child transmission (PMTCT); and 3) more timely ART initiation. Retention in care among patients at earlier disease stages is also increasingly important given the WHO-recommended expansion of ART eligibility guidelines in resource-limited settings (WHO 2009).
Objective: The goal of this study is to better understand barriers and enablers to retention and engagement in HIV care among adult patients who are enrolled in HIV care and are not yet eligible for ART. The specific objectives are:
- To describe themes in barriers and enablers to retention and engagement in HIV care;
- To conduct structured interviews to gather relevant baseline information on potential determinants of non-retention and non-engagement in HIV care;
- To estimate the incidence of short-term outcomes (missed visits and lost to follow-up (LTF)), including the rate and proportion of those LTF who are no longer engaged in HIV care; and
- To identify determinants of missed visits, LTF, and non-engagement in care among ART-ineligible patients.
Methods: This study will be conducted using qualitative and quantitative methods at four HIV care and treatment clinics (CTCs) in Kagera Region, Tanzania.
- Qualitative: in-depth interviews at two CTCs with up to 20 adult patients (ART naïve, and ineligible or indeterminate for ART) and about 4 health care workers; and focus group discussions (about 4 groups of about 6-10 persons/group) with adult patients (ART naïve, and ineligible or indeterminate for ART).
- Quantitative: 1) structured baseline interviews at four CTCs (n= approximately 900 adult patients who are ART naïve, and ineligible or indeterminate for ART); 2) prospective monitoring of these 900 patients using routine CTC patient data to assess missed visits and LTF; and 4) brief structured surveys of patients who become LTF and are reached through defaulter tracing efforts.
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
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Kagera
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Kamachumu, Kagera, Tanzania
- Ndolage District Hospital
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Mugana, Kagera, Tanzania
- Mugana District Hospital
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Nyakahanga, Kagera, Tanzania
- Nyakahanga District Hospital
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Rubya, Kagera, Tanzania
- Rubya District Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
QUALITATIVE COHORT
In-depth key informant interviews and focus groups will be conducted with patients that meet the following criteria:
ART-eligibility indeterminate patients (n= approximately 10 in-depth and up to 20 focus group participants, where half are from a rural site, Mugana District Hospital and half are from an urban site, Nyakahanga District Hospital)
i) Inclusion criteria:
- ≥18 years of age
- ART naïve (unless for prior PMTCT)
- made at least one clinic visit prior to study enrollment
- unknown ART eligibility,
- willing to give informed consent.
ii) Exclusion criteria:
- <18 years of age
- initiated ART other than PMTCT prior to enrollment
- have known ART eligibility or ineligibility
- not willing to give informed consent.
ART-ineligible patients (n= approximately 10 in-depth and up to 20 focus group participants, where half are from a rural site, Mugana District Hospital and half are from an urban site, Nyakahanga District Hospital)
i) Inclusion criteria:
- ≥18 years of age
- ART naïve (unless for prior PMTCT)
- made at least one clinic visit prior to study enrollment
- known ART ineligibility
- willing to give informed consent.
ii) Exclusion criteria:
- <18 years of age
- initiated ART other than PMTCT prior to enrollment
- have known ART eligibility
- not willing to give informed consent
Health care workers will be purposefully selected for participation according to the following criteria:
i) Inclusion criteria:
- ≥18 years of age
- have worked at that HIV clinic more than any other post within the hospital for at least 6 months
- medical officer, clinical officer or nurse
- willing to give informed consent.
ii) Exclusion criteria:
- <18 years of age
- primarily posted at another clinic (just part-time or tempory assignment to HIV clinic)
- not willing to give informed consent
PROSPECTIVE COHORT
Patients that meet the following criteria will be included in the prospective study cohort:
i) Inclusion criteria:
- ≥18 years of age
- ART naïve (unless for prior PMTCT)
- enrolled in the study CTC
- ART-ineligible or of indeterminate ART eligibility
- willing to provide written informed consent,contact information and accept a home visit to verify outcomes if they become LTF.
ii) Exclusion criteria:
- <18 years of age
- initiated ART other than PMTCT prior to study enrollment
- ART eligible
- and/ or not willing to provide written informed consent, contact information or accept a home visit if LTF.
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
---|
In-depth Interview
Up to 20 in-depth interviews will be conducted among adult ART naïve patients, balanced by gender, site and reason for ART naiveté (determined ineligible or eligibility not yet determined) as much as possible.
Up to 4 in-depth interviews will be conducted with health care providers.
|
Focus Group Participants
Up to 40 patients ineligible or not yet eligible for ART will be invited to join a focus group discussion.
Patients will be eligible for selection for either in-depth interviews or focus group discussions if they have made at least one prior visit to the clinic.
Selected patients will be balanced as much as possible by gender and by pre-ART status (e.g.
roughly half pre-ART eligibility determined, and roughly half pre-ART eligibility indeterminate).
|
Prospective Cohort
Based on historical patient data from the four study CTCs, we expect that approximately 1,000 patients will enroll in HIV care at these clinics during the study period and be determined not eligible for ART or of unknown eligibility.
Assuming a 10% refusal rate, approximately 900 patients would then enroll in this study and complete baseline interviews.
These 900 patients will be prospectively monitored using routinely collected patient care data for up to 24 months.
Outreach workers will attempt to trace all of the enrolled patients who are observed to be LTF during the study period, and complete a defaulter tracing survey.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Proportion of those lost to follow-up (LTF) who are no longer engaged in HIV care
Time Frame: 24 months
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24 months
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Batya Elul, PhD, MSc, ICAP-NY, Columbia University
Publications and helpful links
General Publications
- Fox MP, Rosen S. Patient retention in antiretroviral therapy programs up to three years on treatment in sub-Saharan Africa, 2007-2009: systematic review. Trop Med Int Health. 2010 Jun;15 Suppl 1(s1):1-15. doi: 10.1111/j.1365-3156.2010.02508.x.
- Rosen S, Fox MP, Gill CJ. Patient retention in antiretroviral therapy programs in sub-Saharan Africa: a systematic review. PLoS Med. 2007 Oct 16;4(10):e298. doi: 10.1371/journal.pmed.0040298.
- WHO (2009). Rapid advice: antiretroviral therapy for HIV infection in adults and adolescents - November 2009. Geneva, World Health Organization.
- WHO (2009). Towards Universal Access: Scaling up priority HIV/AIDS Interventions in the Health Sector: Progress report 2009. Geneva, WHO.
Study record dates
Study Major Dates
Study Start
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 (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
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
- Immune System Diseases
- Slow Virus Diseases
- HIV Infections
- Acquired Immunodeficiency Syndrome
- Immunologic Deficiency Syndromes
Other Study ID Numbers
- AAAI0251
- 3R01MH089831 (U.S. NIH Grant/Contract)
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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