- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT06176859
Delivery Optimization for Pre-Exposure Prophylaxis (DO PrEP) Study
Delivery Optimization for Pre-Exposure Prophylaxis (DO PrEP) Study: A Prospective, Interventional, Randomized Study of Community-based PrEP Initiation, Delivery, and Monitoring in South Africa
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Optimizing pre-exposure prophylaxis (PrEP) delivery with a focus on priority populations is critical to realize the enormous potential of PrEP for HIV prevention. HIV incidence remains relentlessly high among young women and sexual minority men and primary prevention is critical to achieving control of the HIV epidemic. With effective and persistent use, oral pre-exposure prophylaxis (PrEP) for HIV prevents 75%-100% of HIV cases among cisgender women and men, gay and bisexual men, and transgender women. Despite the high efficacy, uptake throughout the PrEP prevention cascade remains low.
South Africa is expanding PrEP provision but requires evidence-based strategies on how to achieve access, effective use, and persistence. The current clinic-based requirement of PrEP to persons at risk for HIV acquisition requires that clients self-identify their exposure to HIV and visit the clinic regularly for initiation, monitoring and refills. Barriers to PrEP access include clinic level factors (i.e. staff training, brief visits) and individual level factors including logistics such as transportation for clinic visits. The priority is to determine how to deliver PrEP in a scalable way and achieve high PrEP access and effective, persistent use.
PrEP is a highly efficacious HIV prevention strategy but requires effective strategies that streamline delivery and engage users for scale-up. Community-based strategies for HIV testing, ART initiation, and monitoring successfully reach people living with HIV for treatment and have made marked improvements to viral suppression.
This protocol describes a randomized clinical study to test an end-to-end decentralized delivery service for PrEP. It aims to safely increase PrEP access and use among priority populations in South Africa. Participants will include 16-30 year old HIV negative women and sexual minority men at high risk for acquiring HIV. As a critical component of decentralized delivery, we will also evaluate the safety and efficacy of HIV self-testing compared to rapid diagnostic tests.
Study Type
Enrollment (Estimated)
Phase
- Not Applicable
Contacts and Locations
Study Contact
- Name: Francesca Caramazza
- Phone Number: 617-724-4160
- Email: IDCRU@mgh.harvard.edu
Study Locations
-
-
KwaZulu-Natal
-
Durban, KwaZulu-Natal, South Africa
- Recruiting
- Human Sciences Research Council
-
Contact:
- Zaynab Essack, PhD
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Aged 16 years - 30 years old,
- Men in serodifferent relationships or those reporting male to male sex,
- Heterosexual cis-gender females
- Interested in use of PrEP for HIV prevention
- Able and willing to provide informed consent for study procedures
Exclusion Criteria:
- HIV infection based on negative HIV rapid tests
- Clinically ineligible for PrEP
- The participant doesn't reside in the study community for the duration of follow-up
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: Home-based PrEP
In the home-based PrEP arm, participants will complete the HIV self-test at home with support received through telemedicine or over the phone.
Confirmation of HIV test result will be shared with the provider through a photograph of the test.
PrEP refills will be delivered to participants at home by courier.
|
To test an end-to-end decentralized delivery service for pre-exposure prophylaxis (PrEP) to safely increase PrEP access and use among priority populations in South Africa.
|
Active Comparator: Community-based PrEP
In the community-based PrEP arm, participants will be tested using rapid diagnostic tests (RDT) in person (at a community venue) or through telemedicine (at a community venue) where they will be linked by counsellor telephonically to nurse or clinician.
PrEP refills will be collected by participants at a community venue.
|
To test an end-to-end decentralized delivery service for pre-exposure prophylaxis (PrEP) to safely increase PrEP access and use among priority populations in South Africa.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The primary outcome is uptake of Pre-exposure prophylaxis of HIV (PrEP) .
Time Frame: 36 Months
|
The proportion of study participants who effectively accessed PrEP and continued use over a 12-month period.
|
36 Months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
The efficacy of rapid HIV testing kits in diagnosing HIV for PrEP initiation.
Time Frame: 36 Months
|
To compare the safety and efficacy of HIV self-testing (HIVST) to rapid diagnostic tests (RDT) by comparing the sensitivity and specificity of each diagnostic test.
|
36 Months
|
Persistent use of PrEP over a 12-month period.
Time Frame: 36 Months
|
The proportion of study participants in the home-monitored arm who accessed and effectively/persistently used PrEP over a 12-month period compared to the community-monitored arm.
|
36 Months
|
Cost effectiveness per HIV incident averted.
Time Frame: 36 Months
|
Estimate the incremental cost-per-person receiving community-based PrEP.
|
36 Months
|
Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Zaynab Essack, PhD, Human Sciences Research Council of South Africa
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 (Estimated)
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
Other Study ID Numbers
- 2022P003023
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.
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