- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT03098654
Impact of Integrated HIV/NCD Screening on HIV Testing Uptake and Engagement in HIV Care In Kisarawe, Tanzania
Impact of Integrated HIV/NCD Screening on HIV Testing Uptake and Engagement in HIV Care: An RCT In Kisarawe, Tanzania
This study focuses on the integration of HIV and NCD screening and care. The investigators will conduct a randomized controlled trial examining the efficacy and cost-effectiveness of the intervention strategy in Kisarawe District, Tanzania, a rural area 40 KM southwest of Dar es Salaam. The study will match two similar HIV care and treatment centers (CTC) in the District, one of which will be randomized to receive the enhanced intervention which will integrate diabetes (DM) and hypertension (HTN) screening with the existing HIV testing program, and integrate care for DM and HTN into the HIV care program. Comparisons of the community HIV testing rates in the two communities, engagement in HIV care among those testing positive, and 24-month retention in HIV care will be assessed among a cohort of 107 newly enrolled patients per community.
Specifically, the aims are to determine:
- Whether integrating DM and HTN screening with HIV testing will increase the uptake of community-level HIV testing.
- If integrating DM/HTN care with HIV care enhances engagement in HIV care.
- Whether integration of DM/HTN care with HIV care enhances retention in HIV care for those newly enrolled in HIV care.
- The cost-effectiveness of integrating NCD screening and care with HIV screening and care with regard to the incremental cost per HIV infected client engaged in HIV care, and cost per newly enrolled HIV client retained in HIV care over 24-months.
Study Overview
Status
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
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Dar Es Salaam, Tanzania
- Muhimbili University of Health and Allied Sciences
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Eligibility Criteria for Screening:
• Be aged 18 years or above.
Inclusion Criteria for Intervention and Control Cohorts:
- Be aged 18 years or above.
- Recently enrolled in HIV care and treatment
Exclusion Criteria:
- Potentially vulnerable populations (incarcerated, under age of consent, unable to understand the procedures planned, etc.).
- Individuals under the influence of drugs or alcohol and anyone presenting with mental disability that would preclude ability to understand study procedure, risks, and benefits.
- Inability or unwillingness of subject to provide informed consent.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Enhanced Intervention
Members will have DM and HTN managed at the CTC together with their HIV care. Interventions include:
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Diabetes will be assessed using a 6-question risk assessment on a 10-point scale (based on a field-tested and culturally adapted International Diabetes Federation formula on DM risk factors and symptoms) and a random blood glucose test with a portable finger stick glucose monitor.
Those with either: (1) a risk score of 5 or more, or (2) a random blood glucose with a value greater than 140 mg/dl, will be asked to return after fasting for at least 8 hours to have a fasting glucose test taken.
Blood pressure will be assessed using a portable battery operated automatic BP cuff.
The BP test will include three values taken at least 5-minutes apart and the 3 will be averaged to determine the final value.
Other Names:
All participants with elevated glucose or BP will receive personalized lifestyle counseling by trained counselors informed by lab results and that includes education on diabetes, hypertension, dietary assessment and recommendations, advice on physical activity, and the need to regularly monitor their glucose, BP, and adjust their diet, activity level, as needed.
Personalized risk reduction plans will be negotiated with the client during their scheduled visits.
Subjects will receive DM or HTN medications prescribed by the CTC clinician as needed.
Other Names:
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No Intervention: Control
Members in the control arm will receive community-level rapid HIV testing at the CTCs, which is the standard of care.
HIV testing performed by the CTC is according to the National HIV Testing Algorithm (serial rapid testing using Determine HIV 1/2 and Uni-Gold HIV 1/2) which follows Tanzanian and international (WHO/CDC) standards for provision of HIV counseling and testing.
Those who test positive for HIV will be referred to the CTC for the standard Tanzanian level of HIV care, which includes counseling and ART medication managed at the CTCs.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Uptake of community-level HIV testing
Time Frame: 12 months
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Uptake of HIV testing will be measured as the annual cumulative number of unique persons receiving HIV testing as a proportion of the community size in each HIV CTC venue using clinic records from the government CTC.
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12 months
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Engagement in HIV care
Time Frame: 12 months
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Engagement will be measured as proportion of persons testing positive for HIV who advance to successful enrollment in HIV care at the CTC.
Persons will be documented with biometric fingerprint matching against those who tested for HIV in the study area.
Comparisons will be made across the enhanced and comparison CTCs.
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12 months
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Retention in HIV care
Time Frame: 24 months
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Retention in HIV care will be measured in several ways, including the Human Resources and Services Administration HIV/AIDS Bureau definition of 2 or more outpatient visits at least 3-months apart during each year, the number of missed clinic visits, and appointment adherence (number of completed visits/number of scheduled visits) during the study period.
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24 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Adherence to DM/HTN/ARV medication
Time Frame: 24 months
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Self-reported medication adherence questions adapted from our other NIH-funded study (Dyadic-Based Diagnosis, Care, and Prevention for HIV Discordant Couples) will be used to assess medication adherence.
The Self-Reported Medication Nonadherence Measurement tool will be used to assess reasons for nonadherence.
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24 months
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Adherence to physical activity intervention
Time Frame: 24 months
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Global Physical Activity Questionnaire (GPAQ) to assess DM / HTN lifestyle changes for NCD positive subjects in the intervention arm.
The GPAQ is a 12-item survey created by the World Health Organization to measure physical activity (intensity, duration, and frequency) and domains of performance (related to occupation, transportation, and leisure).
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24 months
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Adherence to dietary intervention
Time Frame: 24 months
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A food frequency questionnaire developed for use specifically in Tanzania and surrounding countries will be used to assess dietary changes.
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24 months
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Biological, Psychological, and Social adverse events associated with the study intervention
Time Frame: 24 months
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Self-reported and staff-reported adverse events (biological, psychological, or social) experienced as an outcome of receiving the intervention.
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24 months
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Cost-effectiveness of integrating NCD screening and care with HIV screening and care
Time Frame: 24 months
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Cost will be measured through regular cost worksheets that the investigators will collect throughout the duration of the study.
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24 months
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Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Michael D. Sweat, PhD, Medical University of South Carolina
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 (Actual)
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
- Glucose Metabolism Disorders
- Metabolic Diseases
- 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
- Endocrine System Diseases
- Diabetes Mellitus
- Slow Virus Diseases
- HIV Infections
- Diabetes Mellitus, Type 2
- Acquired Immunodeficiency Syndrome
- Immunologic Deficiency Syndromes
- Hypoglycemic Agents
- Physiological Effects of Drugs
- Metformin
Other Study ID Numbers
- Pro00064733
- 1R01MH111366-01 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
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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