- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04048629
Impact of Point-of-care (POC) Viral Load (VL) Testing During Pregnancy in Zimbabwe
Impact of Point-of-Care (POC) Viral Load (VL) Testing on Ensuring Appropriate Management of Viremia During Pregnancy to Prevent Vertical Transmission: an Observational Difference-in-difference Cohort Study
Study Overview
Status
Conditions
Detailed Description
Twenty public health facilities that offer HIV care to pregnant women and maternity services will be included in the study with half offering VL testing at the first antenatal care visit using the centralized VL system (standard of care cluster) and the other half offering onsite POC VL (POC cluster). The primary end-point will be the proportion of enrolled pregnant women who are virally suppressed at the time of delivery. Positivity rate will be measured as a secondary outcome. Primary and secondary outcomes will be compared between study arms. As well, a baseline assessment in each facility will be included to enable a difference in difference analysis within clusters, in which viral suppression rates at delivery and other outcomes are compared before and after the intervention.
The primary research question to be addressed by this study is: Does the availability of POC VL testing during ANC increase the proportion of women who are virally suppressed at the time of delivery?
The primary objective is to demonstrate the impact of POC VL on ensuring viral suppression at the time of delivery (defined as a viral load < 1,000 cpm within 2 weeks of delivery) for pregnant women living with HIV (PWLHIV) who are on ART in order to avert vertical transmission.
In addition, this study will:
- document the at-birth and 4-6 week EID positivity rate
- document proportion of women who have undetectable VL at the time of delivery (defined as below the limit of detection (LOD) of the VL test)
- document the baseline coverage of VL monitoring during the first ANC visit for WLHIV on ART ≥ 6 months
- compare the timeliness of VL result receipt by clinics (HCW) and clients between facilities with POC VL and those using centralized testing
- calculate the cost-effectiveness of POC VL for increasing the proportion of women who are virally suppressed at delivery
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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-
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Bulawayo, Zimbabwe
- Luveve Clinic
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Bulawayo, Zimbabwe
- Mpilo Central Hospital
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Bulawayo, Zimbabwe
- Nkulumane Clinic
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Bulawayo, Zimbabwe
- Pelandaba Clinic
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Bulawayo, Zimbabwe
- United Bulawayo Hospital
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Harare, Zimbabwe
- Budiriro PolyClinic
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Harare, Zimbabwe
- Chitungwiza Central Hospital
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Harare, Zimbabwe
- Gleview
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Harare, Zimbabwe
- Hatcliffe PolyClinic
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Harare, Zimbabwe
- Highfield PolyClinic
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Harare, Zimbabwe
- Kambuzuma
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Harare, Zimbabwe
- Kuwadzana PolyClinic
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Harare, Zimbabwe
- Mabvuku PolyClinic
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Harare, Zimbabwe
- Mbare polyclinic
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Harare, Zimbabwe
- Rujeko
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Harare, Zimbabwe
- Rutsanana PolyClinic
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Harare, Zimbabwe
- Seke South Clinic
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Harare, Zimbabwe
- St. Mary's Clinic
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Harare, Zimbabwe
- Warren Park PolyClinic
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Harare, Zimbabwe
- Zengeza Clinic
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Sites will be selected for inclusion in the study based on following criteria:
- Offer HIV testing and antiretroviral therapy (ART) services
- Offer prevention of mother-to-child transmission (PMTCT) and maternity services
- Offer Viral load monitoring either using POC or through referral
- Availability of Second line ART
- Located in 2 provinces in which VL testing labs are located
- Have historic monthly ANC cohorts of ≥ 6 pregnant women living with HIV (PWLHIV) already on ART
Patient Inclusion Criteria:
Baseline Cohort:
All women living with HIV on ART ≥7 months who deliver at the study facilities during the enrollment period, who do not meet the study criteria for the intervention cohort, were on ART at ANC1 and are of the age of consent (≥ 18 years old) will be offered participation. Informed consent will be obtained to collect a study-specific blood sample to perform a VL test in the central lab at the time of delivery. 7 months has been selected to be comparable to women in the intervention cohort who may present for ANC1 at 4 weeks prior to delivery who are on ART ≥ 6 months.
Intervention Cohort:
Pregnant women who are known to be living with HIV and on ART for ≥ 6 months and attend the study facilities for ANC services and have an anticipated due date ≥ 4 weeks, will be offered participation in the study. It is expected that a woman who is on ART < 6 months may not yet have achieved viral suppression (using current NNRTI-containing regimens) and therefore conducting a VL at this time is not currently standard. According to Zimbabwe guidelines and consistent with normative guidance from the World Health Organization (WHO), any infant born to a woman living with HIV who is on ART for less than 4 weeks is considered at high risk of HIV transmission. Therefore, for this study the first ANC visit must be ≥ 4 weeks prior to delivery. Women must be at least the age of adult consent (≥ 18 years old) in Zimbabwe. If consent is obtained, a sample will be collected at ANC1 for VL testing.
Patient Exclusion Criteria:
Baseline Cohort
- PWLHIV not on ART at ANC1 or on ART < 7 months at time of delivery
- Women who have enrolled in or are eligible for the intervention cohort
- Women who are not HIV positive
- Pregnant women who are newly diagnosed as HIV positive during pregnancy
- Women who cannot or do not provide informed consent
Intervention Cohort
- Pregnant women who are newly diagnosed as HIV positive during pregnancy
- PWLHIV not on ART or on ART < 6 months at their first ANC visit
- Women who are not HIV positive
- Women who cannot or do not provide informed consent
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Diagnostic
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Point-of-care (POC)
All facilities will receive a refresher training on Zimbabwe's 2018 Guidelines.
At POC facilities, at the first antenatal visit (ANC1), all women enrolled in the intervention cohort will have a blood sample collected for VL which will be tested onsite using an existing POC device.
If a woman is virally unsuppressed (VL ≥1000 cpm), she will be given adherence counseling and, if necessary, a treatment regimen switch/infant prophylaxis per national guidelines.
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VL testing at the first antenatal care visit will occur using POC VL testing in pregnant women, and a refresher training on Zimbabwe's guidelines will be provided at all facilities
Other Names:
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Active Comparator: Standard of care (SOC)
All facilities will receive a refresher training on Zimbabwe's 2018 Guidelines.
At SOC facilities, at ANC1, all women enrolled in the intervention cohort will have a blood sample collected for VL which will be sent to centralized labs for testing.
If a woman is virally unsuppressed (VL ≥1000 cpm), she will be given adherence counseling and, if necessary, a treatment regimen switch/infant prophylaxis per national guidelines.
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VL testing at the first antenatal care visit will occur using central laboratory VL testing in pregnant women, and a refresher training on Zimbabwe's guidelines will be provided at all facilities
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Viral suppression at delivery
Time Frame: Within 2 weeks after delivery
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The proportion of enrolled PWLHIV on ART ≥ 6 months at their first ANC visit who are virally suppressed at delivery
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Within 2 weeks after delivery
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Viral suppression at delivery among those with an unsuppressed viral load at first antenatal care visit
Time Frame: Within 2 weeks after delivery
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The proportion of enrolled PWLHIV identified as having unsuppressed VL at first ANC who suppress at delivery
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Within 2 weeks after delivery
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Infant HIV infection
Time Frame: Within 6 weeks of birth
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The proportion of infants who test HIV positive at birth and/or 4-6 weeks using an early infant diagnosis (EID) test
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Within 6 weeks of birth
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Turnaround time to VL results available at facility
Time Frame: Through end of the study, approximately 1 year
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The time between VL sample collection and result receipt by health care provider
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Through end of the study, approximately 1 year
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Turnaround time to VL results available to patient
Time Frame: Through end of the study, approximately 1 year
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The time between VL sample collection and result receipt by pregnant woman living with HIV
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Through end of the study, approximately 1 year
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Costing of POC VL
Time Frame: Through end of the study, approximately 1 year
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The commodity costs of VL testing at ANC1 on the POC platform will be calculated ($USD per patient) and compared to the commodity costs of VL testing using the central laboratory given any differences in the primary and secondary endpoints by group
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Through end of the study, approximately 1 year
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Acceptability of POC VL
Time Frame: End of the study, approximately 1 year after study start
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The acceptability to healthcare workers of offering POC VL testing at the first ANC visit, based on a survey
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End of the study, approximately 1 year after study start
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Collaborators and Investigators
Collaborators
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
Other Study ID Numbers
- POC VL during pregnancy
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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