PRe-Exposure Prophylaxis Acceptability & Readiness Assessments for Toronto gaY, Bisexual and Other Men Who Have Sex With Men-5 (PREP-5)

October 14, 2016 updated by: Unity Health Toronto

A Pilot Study of Daily TDF/FTC-based PrEP Among High-risk Toronto MSM:The PREPARATORY-5 Study

Canada continues to see an unrelenting stream of new HIV diagnoses, with a disproportionate burden among gay, bisexual, and other MSM in major centers such as Toronto. Pre-exposure prophylaxis (PrEP) with oral, daily tenofovir/emtricitabine (TDF/FTC, Truvada®) is a novel biomedical approach to HIV prevention shown in the iPrEx trial to be safe and efficacious in reducing HIV acquisition by 44% among MSM, when provided in a comprehensive package of HIV prevention interventions including counseling, testing/treatment of sexually transmitted infections (STIs), and condoms. There is now widespread mobilization to assess the feasibility of PrEP roll-out worldwide, with urgent calls for 'demonstration projects' addressing real-world PrEP implementation issues.

PREPARATORY-5 is Canada's first PrEP demonstration project, and will examine real-world PrEP implementation issues including acceptability, effectiveness, impact on sexually transmitted infections, and strategies for supporting adherence outside the clinical trial setting. The investigators have also established a comprehensive community-based research program investigating the role of community-based organizations in PrEP implementation and delivery.

Study Overview

Status

Completed

Intervention / Treatment

Study Type

Interventional

Enrollment (Actual)

52

Phase

  • Phase 4

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

    • Ontario
      • Toronto, Ontario, Canada, M5B 1W8
        • St. Michael's Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

Male

Description

Inclusion Criteria:

  • Self-identified man who has sex with men
  • Age 18 years or older
  • Able to communicate in both written and oral english
  • HIRI-MSM score greater than or equal to 10
  • At least one self-reported unprotected receptive anal sex act over the preceding 6 months
  • Creatinine clearance greater than or equal to 60mL/min by Modified Diet in Renal Disease (MDRD) formula
  • HIV un-infected at screening using standard ELISA and Western Blot testing

Exclusion Criteria:

  • Clinical signs or symptoms suggestive of an HIV seroconversion illness within the last 3 months in the opinion of the investigator
  • Use of pre- or post-exposure prophylaxis within the last 3 months
  • Use of concomitant nephrotoxic drugs
  • Use of concomitant immune modulatory drugs
  • Hepatitis B surface antigen positivity
  • Any condition or concomitant medication portending an increased risk of osteoporosis
  • Enrollment in any other HIV prevention program or trial

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Prevention
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Tenofovir/emtricitabine
MSM receiving once daily TDF/FTC-based (Truvada®) pre-exposure prophylaxis
Once daily Tenofovir/emtricitabine (Truvada®)
Other Names:
  • Truvada®

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Participants' self-reported overall acceptability of PrEP
Time Frame: 12 months
Participants' self-reported overall acceptability of PrEP over the full one-year follow-up period (including the use of the medication, clinic visits, and their impact on the participant's life) will be quantified using a Likert scale.
12 months
The level of community interest in PrEP
Time Frame: 12 months
The level of community interest in PrEP will be measured by quantifying the volume, rate and HIV risk levels of patient referrals to the PrEP clinic from each key referral source
12 months

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Adherence to daily TDF/FTC-based PrEP
Time Frame: 12 months
Adherence will be measured by self-report, pill count, and intra-RBC tenofovir diphosphate levels.
12 months
Time required by the patient, physician and research coordinator for each type of study visit.
Time Frame: 12 months
The time required by the patient, physician and research coordinator will be measured for each type of study visit.
12 months
HIV infection
Time Frame: 12 months
HIV infection will be detected using point-of-care tests, standard serology and HIV RNA testing.
12 months
Sexually transmitted infections
Time Frame: 12 months
Testing will be performed at each study visit to screen for gonorrhea, chlamydia and syphilis infection, including pharyngeal swab cultures, rectal swab cultures and urine NAAT tests.
12 months
Burden of syndemic health problems
Time Frame: 12 months
The burden of specific syndemic health problems (depression, social anxiety, substance abuse, sexual addiction, childhood sexual abuse, partner violence) will be quantified using standardized, validated psychometric tools.
12 months
Change in estimated glomerular filtration rate
Time Frame: 12 months
Estimated by the Modified Diet in Renal Disease (MDRD) formula
12 months
Percentage change in bone mineral density at the lumbar spine and total hip
Time Frame: 12 months
12 months
Adverse events
Time Frame: 12 months
Adverse events will be assessed at each visit via clinical assessment and laboratory monitoring (CBC, phosphate, urinalysis).
12 months
Pilot testing study instruments
Time Frame: 12 months
Outcomes related to pilot testing study instruments will include numbers of minutes required and participant-reported acceptability for each procedure
12 months

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

October 1, 2014

Primary Completion (Actual)

June 1, 2016

Study Completion (Actual)

June 1, 2016

Study Registration Dates

First Submitted

May 12, 2014

First Submitted That Met QC Criteria

May 23, 2014

First Posted (Estimate)

May 29, 2014

Study Record Updates

Last Update Posted (Estimate)

October 17, 2016

Last Update Submitted That Met QC Criteria

October 14, 2016

Last Verified

October 1, 2016

More Information

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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