- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02796027
BRIDGE: Improving HIV Service Delivery for People Who Inject Drugs
May 26, 2022 updated by: Nabila El-Bassel, PhD, Columbia University
Scaling up integrated, cost-efficient HIV services for people who inject drugs (PWID) in Needle Syringe Programs (NSPs) is urgently needed in Kazakhstan, where only one-third of the estimated 19,000 HIV-positive PWID are ever linked to HIV care and only 10% initiate ART with 4% achieving viral suppression.
The study's aim is to evaluate the implementation, effectiveness, and sustainability of an integrated HIV service model in 24 NSPs located in 3 Kazakhstani city areas.
This model will employ highly effective strategies that will include peer-driven recruitment of PWID in NSPs using social network strategies (SNS), integrating rapid HIV testing in NSPs with HIV Care Clinic nurses, and linking HIV positive PWID in NSPs to HIV care using the ARTAS (Anti-Retroviral Treatment and Access to Services) case management model.
Findings will have important public health implications for improving HIV service delivery for PWID in the Central Asian region and other countries with injection driven epidemics.
Study Overview
Status
Completed
Intervention / Treatment
Detailed Description
The study is designed to evaluate the implementation and effectiveness of an enhanced HIV service integration package (BRIDGE) that may be scaled up in Kazakhstan's vast network of needle-syringe programs (NSPs) for PWID.
This package includes low threshold strategies of peer-driven recruitment, HIV counseling and rapid testing (HCT) in NSPs conducted by HIV care clinic nurses, and ARTAS, Centers for Disease Control and Prevention's highly effective case management strategies for linking PWID to HIV care.
BRIDGE is systematically designed to address specific service barriers to testing PWID for HIV, linking them to HIV care, and promoting ART (antiretroviral therapy) initiation.
This study will employ an innovative stepped wedge design to evaluate implementation and effectiveness of BRIDGE on increasing engagement in the HIV care continuum in 24 NSPs located in 3 geographically disparate Kazakhstani city areas using site-level data collected from NSPs and HIV clinics.
Investigators will conduct a longitudinal panel study with a random sample of HIV-positive PWID (N=600) from three regions in Kazakhstan using repeated assessments at baseline, 6-, and 12-months follow-up.
This study will employ mixed methods to identify multi-level structural, community, and organizational factors that influence the implementation and effectiveness of BRIDGE and the cost of BRIDGE, examining implications for cost-effectiveness, feasibility of expansion, and sustainability.
The study builds on the investigative team's extensive HIV intervention research among PWID in Kazakhstan in collaboration with the Republican AIDS Center over the past decade.
It addresses implementation research questions to improve and integrate HIV service delivery systems for PWID that are not only important to the region, but have relevance to other countries that have concurrent injection drug use and HIV epidemics.
Study Type
Interventional
Enrollment (Actual)
616
Phase
- Not Applicable
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
-
-
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Almaty, Kazakhstan
- Global Health Research Center of Central Asia
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-
-
-
New York
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New York, New York, United States, 10027
- Columbia University School of Social Work
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-
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
No
Genders Eligible for Study
All
Description
Inclusion Criteria:
- positive confirmatory HIV test;
- aged 18 or older;
- report injecting any drug in the past 30 days; and
- have had one or more contacts with NSP staff at one of the 24 NSPs
Exclusion Criteria:
- show evidence of significant psychiatric or cognitive impairment that would limit effective participation as confirmed during informed consent;
- are not fluent in Russian or Kazakh as determined during informed consent; or
- have been previously screened for or enrolled in the study confirmed by fingerprint scan
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: Health Services Research
- Allocation: Randomized
- Interventional Model: Crossover Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Experimental: BRIDGE
NSPs assigned to this arm would receive an integrated HIV service model
|
BRIDGE, enhanced HIV service integration package, has three components:
Other Names:
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No Intervention: Pre-implementation
NSPs assigned to this arm would receive standard care (treatment as usual) and would not be exposed to the integrated HIV service model.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of PWID who attend Needle Syringe Programs (NSPs) (Effectiveness Outcome)
Time Frame: 6 months
|
NSP attendance from electronic case records
|
6 months
|
Number of PWID who receive an HIV test (Effectiveness Outcome)
Time Frame: 6 months
|
HIV rapid testing
|
6 months
|
Number of HIV positive PWID who are referred to HIV care from NSPs (Effectiveness Outcome)
Time Frame: 6 months
|
HIV care linkage from electronic case records
|
6 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of HIV positive NSP clients who register at HIV care clinic (Effectiveness Outcome)
Time Frame: 6-months
|
Receipt of HIV care medical services confirmed by electronic health records
|
6-months
|
Number of HIV positive NSP clients who have a viral load <1500 (Effectiveness Outcome)
Time Frame: 6 months
|
Viral load suppression confirmed by electronic health records
|
6 months
|
Number of HIV positive NSP clients who initiate ART (Effectiveness Outcome)
Time Frame: 6 months
|
ART initiation confirmed by electronic health records
|
6 months
|
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Incremental cost per participant who receives HIV-related medical services (Cost-Effectiveness Outcome)
Time Frame: 6 months
|
Costs measured from staff time records, clinical and participant records, and overhead from standard program records/reports, multiplied by published labor rates and service charges
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6 months
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Implementation outcomes
Time Frame: 6 months
|
Fidelity
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6 months
|
Collaborators and Investigators
This is where you will find people and organizations involved with this study.
Sponsor
Collaborators
Investigators
- Principal Investigator: Nabila El-Bassel, PhD, Columbia University
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 (Actual)
February 1, 2017
Primary Completion (Actual)
August 1, 2020
Study Completion (Actual)
August 1, 2020
Study Registration Dates
First Submitted
June 7, 2016
First Submitted That Met QC Criteria
June 7, 2016
First Posted (Estimate)
June 10, 2016
Study Record Updates
Last Update Posted (Actual)
May 31, 2022
Last Update Submitted That Met QC Criteria
May 26, 2022
Last Verified
July 1, 2021
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Mental Disorders
- Chemically-Induced Disorders
- 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
- Substance-Related Disorders
- Substance Abuse, Intravenous
- HIV Infections
- Acquired Immunodeficiency Syndrome
Other Study ID Numbers
- AAAQ0952
- 1R01DA041063-01 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Undecided
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
No
Studies a U.S. FDA-regulated device product
No
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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