- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04571684
Evaluating HITSystem 2.1 to Improve Viral Suppression in Kenya
Evaluating the HITSystem to Improve PMTCT Retention and Maternal Viral Suppression in Kenya
Study Overview
Status
Intervention / Treatment
Detailed Description
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Sarah Finocchario-Kessler, PhD, MPH
- Phone Number: 913-945-7077
- Email: skessler2@kumc.edu
Study Contact Backup
- Name: Catherine Wexler, MPH
- Email: cwexler@kumc.edu
Study Locations
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Siaya, Kenya
- Akala Subcounty Hospital
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Siaya, Kenya
- Siaya County Hospital
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Kilifi
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Mariakani, Kilifi, Kenya
- Mariakani Subcounty Hospital
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Mtwapa, Kilifi, Kenya
- Mtwapa Subcounty Hospital
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Vipingo, Kilifi, Kenya
- Vipingo Subcounty Hospital
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Mombasa
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Likoni, Mombasa, Kenya
- Likoni Subcounty Hospital
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Siaya
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Ambira, Siaya, Kenya
- Ambira Subcounty Hospital
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Bondo, Siaya, Kenya
- Bondo Subcounty Hospital
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Malanga, Siaya, Kenya
- Malanga Subcounty Hospital
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Sigomere, Siaya, Kenya
- Sigomere Health Center
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Ukwala, Siaya, Kenya
- Ukwala Subcounty Hospital
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Yala, Siaya, Kenya
- Yala Subcounty Hospital
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Pregnant women living with HIV who present for care at one of the study hospitals by 36 weeks gestation and provide written informed consent are eligible for enrollment in the study.
Exclusion Criteria:
- Pregnant women living with HIV will be excluded from study participation if she has any condition (including drug abuse, alcohol abuse, or psychiatric disorder) that study or hospital staff feel precludes her from providing informed consent.
- Women who transfer care from one study site to another during their PMTCT services will be ineligible for enrollment at their new facility.
Study Plan
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 |
---|---|
Experimental: Intervention Arm (HITSystem 2.1)
Participants enrolled at intervention sites will received HITSystem 2.1-supported PMTCT services through 6 months postpartum.
Interventions received will include: text messages to patients to support medication adherence, appointment attendance, and hospital delivery and algorithm-driven alerts to notify providers when follow up services are missed.
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HITSystem 2.1 is an intervention that tracks HIV+ pregnant women and their infants to improve the completeness and efficiency of PMTCT services.
Key intervention features include: (1) SMS messages sent to enrolled women and mothers to support essential PMTCT services, (2) automated, algorithm-driven alerts for providers when per-guidelines PMTCT services are missed, and (3) automatic enrollment of infants into early infant diagnosis (EID) and linkage with maternal PMTCT file at documentation of infant birth to improve the continuum of care for HIV+ mothers and HIV-exposed infants.
The HITSystem 2.1 intervention aims to facilitate complete PMTCT retention and viral load (VL) monitoring with prompt clinical action (adherence support, antiretroviral therapy (ART) regimen change) in the antenatal, delivery, and 6-month postpartum periods to increase viral suppression during windows critical for HIV prevention.
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No Intervention: Control Arm (Standard of care)
Participants enrolled at control sites will receive standard of care PMTCT services, with no HITSystem 2.1 tracking or follow up.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Proportion receiving complete PMTCT
Time Frame: 7-15 months (PMTCT enrollment date through 6 months postpartum)
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documented receipt of all of the following: maternal ART initiation, antenatal appointment attendance, facility delivery, EID linkage by 7 weeks of age, maternal viral load testing and clinical action per national guidelines through 6 months postpartum (Table 6).
Participants who receive all indicated services per guidelines will be coded as 1 or 'yes'.
Participants missing > 1 service will be coded as 0 or incomplete PMTCT services.
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7-15 months (PMTCT enrollment date through 6 months postpartum)
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Viral suppression
Time Frame: 1-15 months, (first VL test and followed through 6 months postpartum)
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the proportion of clients with a suppressed viral load(<1000 copies/mL) at delivery and within 6 months postpartum
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1-15 months, (first VL test and followed through 6 months postpartum)
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Cost-effectiveness
Time Frame: Years 2 and 4
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Quality of Life Years Saved for infants and mothers
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Years 2 and 4
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
PMTCT retention duration (weeks)
Time Frame: 7-15 months (PMTCT enrollment date through 6 months postpartum)
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The number of weeks women were engaged in PMTCT serves
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7-15 months (PMTCT enrollment date through 6 months postpartum)
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Antiretroviral therapy (ART) adherence
Time Frame: 7-15 months (PMTCT enrollment date through 6 months postpartum)
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The proportion with ART adherence > 95%
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7-15 months (PMTCT enrollment date through 6 months postpartum)
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Viral load test coverage
Time Frame: 7-15 months (PMTCT enrollment date through 6 months postpartum)
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The proportion of women receiving baseline and repeat viral load tests per guidelines.
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7-15 months (PMTCT enrollment date through 6 months postpartum)
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Viral load test utility
Time Frame: 7-15 months (PMTCT enrollment date through 6 months postpartum)
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Proportion of detectable viral load results with clinical action per guidelines, such as: intensified adherence counseling and/or ARV regimen change
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7-15 months (PMTCT enrollment date through 6 months postpartum)
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Turnaround time of viral load results and patient notification
Time Frame: 7-15 months (PMTCT enrollment date through 6 months postpartum)
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The number of weeks from the date of sample collection to results
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7-15 months (PMTCT enrollment date through 6 months postpartum)
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Turnaround time of viral load patient notification
Time Frame: 7-15 months (PMTCT enrollment date through 6 months postpartum)
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The number of weeks from the date of results to the date of patient notification
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7-15 months (PMTCT enrollment date through 6 months postpartum)
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Moderators of HITSystem 2.1 effectiveness
Time Frame: Baseline, delivery, 6 months postpartum (participants), Pre and post study implementation (provider and facility assessment)
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Identify potential patient factors (age, education, income, disclosure, PMTCT knowledge, motivation to engage and complete PMTCT, perceived partner support, depression [modified Edinburgh postnatal scale]) and/or provider factors (gender, age, knowledge of PMTCT guidelines, perceived complexity of guidelines, motivation to provide guideline adherent care, workload, perception of the quality of patient care), and facility factors (resource level, patient volume, number of providers), that moderate the primary outcomes of complete PMTCT retention and viral load suppression.
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Baseline, delivery, 6 months postpartum (participants), Pre and post study implementation (provider and facility assessment)
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Mediators of HITSystem 2.1 effectiveness
Time Frame: Baseline, delivery, 6 months postpartum (participants), Pre and Post study implementation (providers)
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Identify potential patient factors (disclosure status, PMTCT knowledge, motivation to engage and complete PMTCT, perceived partner support, depression (modified Edinburgh postnatal scale) and/or provider factors (knowledge of PMTCT guidelines, perceived complexity of guidelines, motivation to provide guideline adherent care, workload, perception of the quality of patient care) that mediate the primary outcomes of complete PMTCT retention and viral load suppression.
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Baseline, delivery, 6 months postpartum (participants), Pre and Post study implementation (providers)
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Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Sarah Finocchario-Kessler, PhD, MPH, University of Kansas Medical Center
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 (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Other Study ID Numbers
- R01MH121245 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
The investigators will make data collected for aims 1 & 2 available only upon request from users who can show proof of human subject's training and only under a data-sharing agreement that provides for: (1) use of the data only for research purposes, (2) exclusion of any identifying or potentially identifying information in shared analyses, publications, reports, etc., (3) appropriate storage and securing of the data to prevent authorized persons from accessing it, (4) a commitment to destroy or return the data after analyses are completed.
Data from aim 3 includes costing data for PMTCT services. These data will be shared openly at the dissemination meetings planned at the end of the study, which will include county and national health personnel. Furthermore, these data will be placed in a readily accessible public database.
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ICF
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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