Point-of-care Viral Load Testing Among HIV-infected Adolescents in Haiti

This study is designed as an individual randomized trial among 150 HIV-infected adolescents aged 10-24 years who have been on ART for >6 months and will be randomized in a 1:1 fashion to one of two arms: 1) the intervention arm (POC) will receive a POC VL test with adherence counseling informed by the VL result the same day as testing vs. 2) the standard-of-care arm (SOC) will receive a standard laboratory-based test with adherence counseling informed by the VL result 1 month later. The study tests an intervention, POC VL testing, which reduces the time between sample collection and participant receipt of results, thus decreasing the number of steps in the HIV treatment cascade. This intervention was developed to addresses health systems-based barriers which delay clinic, laboratory, and data management processes for VL monitoring for HIV-infected adolescents. Our results will contribute to research on whether POC VL testing is a feasible testing method which could be incorporated into health systems in similar resource-limited settings and whether it can improve outcomes among HIV-infected adolescents.

Study Overview

Status

Completed

Conditions

Detailed Description

This study is designed as an individual randomized trial among 150 HIV-infected adolescents aged 10-24 years who have been on ART for >6 months and will be randomized in a 1:1 fashion to one of two arms: 1) the intervention arm (POC) - receiving a POC VL test with adherence counseling informed by the VL result the same day as testing vs. 2) the standard-of-care arm (SOC) - receiving a standard laboratory-based test with adherence counseling informed by the VL result 1 month later. The study tests an intervention, POC VL testing, which reduces the time between sample collection and participant receipt of results, thus decreasing the number of steps in the HIV treatment cascade. This intervention was developed to addresses health systems-based barriers which delay clinic, laboratory, and data management processes for VL monitoring for HIV-infected adolescents. The results will contribute to research on whether POC VL testing is a feasible testing method which could be incorporated into health systems in similar resource-limited settings and whether it can improve outcomes among HIV-infected adolescents. The two study arms are described below.

Standard-of-care (SOC): At the first visit after enrollment and randomization, participants in the SOC arm receive a standard laboratory-based VL test. Steps in the standard laboratory-based VL testing process include: sample collection at a phlebotomy clinic adjacent to the adolescent HIV clinic, labeling and daily storage, transportation (1 hr drive) to the central laboratory, arrival and intake at the laboratory, processing in the fully automated Abbott system, manual entry of the printed results into an excel spreadsheet by laboratory staff, and manual entry of results on the spreadsheet into the EMR by data management staff. This process - from sample collection to patient return of results - varies depending on the volume of samples collected each day and on laboratory and data management staffing. Average time from blood collection to availability of the result in the EMR is 2-3 weeks. Per standard clinical care at the adolescent HIV clinic, adolescents return for monthly visits, and the patient receives the VL result and adherence counseling which is informed by the VL result 1 month after providing the blood sample. The primary endpoint is return of the VL result within 6 weeks of sample collection to allow for a short time buffer for appointments that are not scheduled exactly 1 month from the previous visit for reasons related to school, work, family obligations, or holidays.

These standard laboratory procedures were developed to meet the high demand for VL testing when the Haitian national guidelines switched from recommending routine CD4 testing to routine VL testing. Since the Abbott systems are fully automated and can batch large quantities of samples together, this approach is appropriate for a routine nation-wide health system testing protocol. However, the need for transportation, cold-chain storage, and manual entry of thousands of results every year may not be the optimal structure for HIV-infected adolescents who are more likely to have high VL results and are more likely to be lost from care in between visits. This study will test the POC VL test vs. this standard laboratory-based test to determine if reducing the time between sample collection and patient receipt of results (removing a step in the HIV treatment cascade), can increase the impact of VL testing on clinical management and adolescent patient outcomes. The study will test if implementation of the POC VL test, in collaboration with clinicians and laboratory staff, and accompanied by patient education, can address many of the logistical barriers to laboratory-based VL testing in a resource-limited setting such as Haiti.

Study Type

Interventional

Enrollment (Actual)

150

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

      • Port-au-Prince, Haiti
        • GHESKIO

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

10 years to 24 years (Child, Adult)

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Aged 10-24 years
  • HIV-infected
  • On ART for > 6 months
  • Permanent residence in Port-au-Prince
  • Able to provide informed consent/assent

Exclusion Criteria:

  • Requires urgent VL test the day of enrollment/randomization
  • Requires ART regimen change
  • Currently pregnant
  • Co-infected with tuberculosis
  • Severe co-morbidities including cognitive impairment, bipolar disorder, psychosis, or current need for inpatient psychiatric hospitalization

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: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
No Intervention: Standard-of-care
Participants in the standard-of-care arm will receive a standard laboratory-based viral load test at baseline, 3, and 6 months.
Experimental: Point-of-care
Participants in the point-of-care arm will receive a point-of-care viral load test at baseline, 3, and 6 months.
A point-of-care viral load test returns viral load test results within 90 minutes.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
The number of steps in the HIV care cascade involved with viral load testing.
Time Frame: 1 day of clinic visit
The number of steps within the HIV care cascade involved with viral load testing will be measured comparing standard laboratory-based testing to POC testing.
1 day of clinic visit

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
The proportion of participants who demonstrate comprehension of the correlation between ART adherence and viral level
Time Frame: 1 month
The proportion of participants who demonstrate comprehension of the correlation between ART adherence and viral level 1 month after receiving their VL test result will be measured.
1 month
The proportion of participants who achieve or sustain a viral level <1000 cells/ml
Time Frame: 6 months
The proportion of participants who achieve or sustain a viral level <1000 cells/ml 6 months from the index VL test will be measured.
6 months

Collaborators and Investigators

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

Investigators

  • Principal Investigator: Daniel Fitzgerald, MD, Weill Medical College of Cornell 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)

May 3, 2018

Primary Completion (Actual)

January 30, 2020

Study Completion (Actual)

January 30, 2020

Study Registration Dates

First Submitted

September 13, 2017

First Submitted That Met QC Criteria

September 15, 2017

First Posted (Actual)

September 20, 2017

Study Record Updates

Last Update Posted (Actual)

July 29, 2020

Last Update Submitted That Met QC Criteria

July 28, 2020

Last Verified

July 1, 2020

More Information

Terms related to this study

Other Study ID Numbers

  • 1708018474

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

YES

IPD Plan Description

Data will be shared once the trial is complete

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.

Clinical Trials on HIV

Clinical Trials on point-of-care viral load test

3
Subscribe