- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04341779
Simplifying Treatment and Monitoring for HIV (STREAM HIV)
Simplifying Treatment and Monitoring for HIV (STREAM HIV): Point-of-Care Urine Tenofovir Adherence and Viral Load Testing to Improve HIV Outcomes in South Africa
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
This study will be a two-arm, open-label, randomized controlled superiority trial at an HIV clinic in Durban. HIV-positive individuals aged 16 years and above, who are initiating a tenofovir-based, first-line ART will be randomized to receive POC VL testing and POC TFV adherence testing, versus standard-of-care (SoC) viral load testing. The schedule for VL testing and management of VL test results will follow South African guidelines for HIV VL testing after ART initiation. 540 participants will be randomized (1:1) at ART initiation into the intervention arm (routine POC TFV adherence testing with POC VL monitoring) or the standard-of-care (SoC) arm (no objective TFV adherence testing and SoC VL monitoring).
Participants will be followed to compare concentrations between study arms at 24 weeks after ART initiation and a composite outcome of VL suppression and retention in care between the study arms at 72 weeks after ART initiation. The study will use process evaluation data, interviews and focus groups with patients and staff to assess implementation of the POC assays. Micro-costing will be conducted to estimate intervention costs.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Zarna Marfatia
- Phone Number: +12065203800
- Email: zarnam@uw.edu
Study Locations
-
-
KwaZulu-Natal
-
Durban, KwaZulu-Natal, South Africa, 4013
- Recruiting
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal
-
Contact:
- Nigel Garrett, MBBS, PhD
- Phone Number: +27312604453
- Email: nigel.garrett@caprisa.org
-
Principal Investigator:
- Nigel Garrett, MBBS, PhD
-
Contact:
- Pedzisai Munatsi
- Phone Number: +27 (0)31 655 0604
- Email: pedzisai.manatsi@caprisa.org
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- HIV-positive
- ≥16 years old
- Initiating a TDF-based, first-line ART regimen
- Do not self-report being on an ART regimen in the prior month
- Willing/able to provide written informed consent
Exclusion Criteria:
- Does not plan to continue receiving HIV care at the CDC Clinic
- Per the decision or opinion of the PI (for example, a clinically significant acute or chronic medical condition or circumstances that would make the patient unsuitable for participation or jeopardize the safety or rights of the participant
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: Intervention arm
Point-of-care adherence testing and Point-of-care viral load testing
|
Point-of-care testing of HIV viral load and tenofovir, and providing same day results to participants
|
No Intervention: Standard-of-care arm
No adherence testing and lab-based viral load testing
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Mean tenofovir diphosphate concentration levels in dried blood spots
Time Frame: 24 weeks after ART initiation
|
We will measure tenofovir-diphosphate concentrations in 3mm dried blood spots using liquid chromatography/tandem mass spectrometry.
|
24 weeks after ART initiation
|
Combined measure of virological suppression and retention in care (binary)
Time Frame: 72 weeks after ART initiation
|
We will measure viral load by a laboratory-based reference assay, performed by the South African National Health Laboratory Services.
Viral suppression will be defined as a viral load <200 copies/mL.
Retention in care will be defined as having collected ART from the study clinic within 8 weeks of study exit.
|
72 weeks after ART initiation
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Combined measure of viral suppression and retention in care (binary)
Time Frame: 24 weeks after ART initiation
|
We will measure viral load by a laboratory-based reference assay, performed by the South African National Health Laboratory Services.
Viral suppression will be defined as a viral load <200 copies/mL.
Retention in care will be defined as having collected ART from the study clinic within 8 weeks of their 6-month study visit.
|
24 weeks after ART initiation
|
Tenofovir-diphosphate concentration in dried blood spots (continuous)
Time Frame: 72 weeks after ART initiation
|
We will measure tenofovir-diphosphate concentrations in 3mm dried blood spots using liquid chromatography/tandem mass spectrometry.
|
72 weeks after ART initiation
|
Acceptability of point-of-care tenofovir and viral load testing
Time Frame: 24 and 72 weeks after ART initiation
|
We will assess acceptability of point-of-care tenofovir and viral load testing by conducting semi-structured in-depth interviews and focus group discussions with study participants.
|
24 and 72 weeks after ART initiation
|
Cost-effectiveness of providing routine point-of-care tenofovir and viral load testing as compared to standard-of-care viral load monitoring
Time Frame: 24 and 72 weeks after ART initiation
|
We will conduct a micro-costing of the costs associated with point-of-care tenofovir and viral load testing and will estimate the cost-effectiveness of the intervention using an existing individual-based, stochastic HIV model for KwaZulu-Natal for simulating health and economic outcomes.
|
24 and 72 weeks after ART initiation
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Nigel Garett, MBBS, PHD, Centre for the AIDS Programme of Research in South Africa (CAPRISA)
- Principal Investigator: Paul Drain, MD, MPH, University of Washington
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- 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
- Urogenital Diseases
- Genital Diseases
- HIV Infections
- Acquired Immunodeficiency Syndrome
- Molecular Mechanisms of Pharmacological Action
- Anti-Infective Agents
- Antiviral Agents
- Reverse Transcriptase Inhibitors
- Nucleic Acid Synthesis Inhibitors
- Enzyme Inhibitors
- Anti-HIV Agents
- Anti-Retroviral Agents
- Tenofovir
Other Study ID Numbers
- STUDY00007544
- R01AI147752 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- ICF
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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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