- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02808507
Comparative Effectiveness/Implementation of TB Case Finding in Rural South Africa (Kharitode TB)
Study Overview
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Limpopo
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Louis Trichardt, Limpopo, South Africa
- Vhembe health subdistrict
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Mokopane, Limpopo, South Africa
- Waterberg health subdistrict
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
Facility-based screening arm
- Age 0-99 years
- Informed consent provided (or assent plus parent/guardian consent)
- Attending any of the study 28 study clinics in the facility-based screening arm
Contact tracing arm- Index Case
- Age 0-99 years
- Informed consent provided (or assent plus parent/guardian consent)
- Newly diagnosed (last 2 months) with TB at any of the 28 study clinics in the contact tracing arm
Contact tracing arm- Household Contact
- Age 0-99 years
- Informed consent provided (or assent plus parent/guardian consent)
- Living in the same household as an enrolled Index case (see above)
Contact tracing arm- Non-household Close Contact
- Age 0-99 years
- Informed consent provided (or assent plus parent/guardian consent)
- Referred to the study as a close contact of an enrolled Index case (see above)
Exclusion Criteria (all arms):
- Unable to provide informed consent.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Diagnostic
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Facility-based screening
This strategy will be implemented at all clinics (n=28) within this arm for 18 months.
Study staff will encourage providers at each of the clinics to screen all consenting patients attending the clinic, regardless of the original reason for clinic presentation.
Upon presenting for care (e.g., while waiting for their healthcare provider), patients will be informed about the study and screened for cough of any duration, fever, weight loss, or night sweats.
Participants who are symptomatic and provide a sputum specimen (according to the clinic standard of care) will be given a study flyer informing them that they may be contacted by study staff, and a brief summary of the study.
Per standard of care, all sputum samples will be sent to the local National Health Laboratory Service laboratory for Xpert testing.
|
Active TB case finding (ACF) refers to any number of strategies used to identify individuals with active TB disease, outside of passive case finding.
In passive case finding, individuals with symptoms present at health centers for diagnosis.
In active case finding, the health system makes an effort to identify TB cases before they present passively.
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Experimental: Contact screening
This arm is comprised of two sub-arms: In the household contact screening sub-arm, a mobile field team visits the household of each consenting newly diagnosed pulmonary TB index case. Each visit consists of a household census, consent of all eligible household members for TB screening, administration of a brief questionnaire, sputum collection for testing with Xpert Mycobacterium tuberculosis (MTB)/rifampin (RIF) and the offer of HIV testing. In the incentive-based contact screening sub-arm, all consenting newly diagnosed active TB cases are provided with 10 coupons for free TB screening to give to close contacts. When a contact presents at clinic with a coupon, they and the index case each receive a small amount of money. If the contact is diagnosed with active TB and starts treatment, the index case receives an additional larger amount of money. Each contact receives a brief questionnaire, TB symptom screen, optional HIV testing, and sputum sample collection for Xpert MTB/RIF. |
Active TB case finding (ACF) refers to any number of strategies used to identify individuals with active TB disease, outside of passive case finding.
In passive case finding, individuals with symptoms present at health centers for diagnosis.
In active case finding, the health system makes an effort to identify TB cases before they present passively.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Treatment Initiation Ratio in Facility Versus Contact Investigation Clinics
Time Frame: 18 months
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The primary analysis was based on the facility- level rate ratio, and we first calculated an unadjusted ratio of the treatment initiation rates between the two arms and the corresponding 95% confidence interval (CI).
We then adjusted for any residual confounding by district stratification and the historical annual number of people started on TB following a two-stage approach.
The first step of this approach fits a Poisson regression to the facility-level counts and the district and historical volume covariates irrespective of study arm.
The residuals ratios, calculated as the ratio of the observed over the expected counts, are then used in the second stage to estimate the between-arm rate ratio and the corresponding 95% CI.
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18 months
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Comparative Treatment Initiation Ratio in the Incentive-based Versus Household-based Contact Investigation Arms
Time Frame: 36 months
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The primary outcome of the study was the comparative number of people with incident TB diagnosed and started on treatment at study clinics in the two contact tracing arms, excluding the six-month washout period.
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36 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Comparative Costs and Cost-effectiveness of Active TB Case Finding Strategies
Time Frame: 3.5 years
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The primary outcome for this analysis will be the incremental cost-effectiveness ratio, defined as (cost of ACF strategy 2 - cost of ACF strategy 1 [or no ACF])/(effectiveness of ACF strategy 2 - effectiveness of ACF strategy 1 [or no ACF]), where effectiveness is modeled as the number of disability-adjusted life years (DALYs) averted by the intervention.
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3.5 years
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Comparative Number of Secondary TB Cases Identified in Incentive-based Versus Household-based Contact Tracing
Time Frame: 36 months
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The pre-specified secondary study outcome was the number of Xpert-based TB diagnoses made among enrolled contacts ("secondary cases") by arm.
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36 months
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Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: David Dowdy, MD, PhD, Johns Hopkins Bloomberg School of Public Health
Publications and helpful links
General Publications
- Baik Y, Hanrahan CF, Mmolawa L, Nonyane BAS, Albaugh NW, Lebina L, Siwelana T, Martinson N, Dowdy DW. Conditional Cash Transfers to Incentivize Tuberculosis Screening: Description of a Novel Strategy for Contact Investigation in Rural South Africa. Clin Infect Dis. 2022 Mar 23;74(6):957-964. doi: 10.1093/cid/ciab601.
- Hanrahan CF, Nonyane BAS, Mmolawa L, West NS, Siwelana T, Lebina L, Martinson N, Dowdy DW. Contact tracing versus facility-based screening for active TB case finding in rural South Africa: A pragmatic cluster-randomized trial (Kharitode TB). PLoS Med. 2019 Apr 30;16(4):e1002796. doi: 10.1371/journal.pmed.1002796. eCollection 2019 Apr.
- Kerrigan D, West N, Tudor C, Hanrahan CF, Lebina L, Msandiwa R, Mmolawa L, Martinson N, Dowdy D. Improving active case finding for tuberculosis in South Africa: informing innovative implementation approaches in the context of the Kharitode trial through formative research. Health Res Policy Syst. 2017 May 30;15(1):42. doi: 10.1186/s12961-017-0206-8.
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 (Estimated)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 15-0005
- R01AI116787-02 (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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