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Simplified HCV Integrated Management Model in Methadone Clinics in Ukraine (SHIM)

28. april 2026 opdateret af: Ukrainian Institute on Public Health Policy

The goal of this pragmatic, quasi-experimental cluster trial is to evaluate whether simplified, onsite hepatitis C virus (HCV) treatment integrated into opioid agonist maintenance therapy (OAMT) clinics improves cure rates compared with referral-based care in Ukraine . The study includes adults (18 years and older) receiving OAMT with confirmed chronic HCV infection and no prior HCV treatment.

The main questions it aims to answer are:

  • Does onsite Simplified HCV Integrated Management (SHIM) increase the proportion of patients achieving sustained virologic response 12 weeks after treatment completion (SVR12) compared with case management and referral (CMR) to specialist clinics?
  • Does adding provider pay-for-performance (P4P) incentives to SHIM further improve progression along the HCV treatment cascade and SVR12 rates?

Researchers compared three models of care across 13 OAMT clinics in 12 Ukrainian cities:

  • Case Management and Referral (CMR): structured referral to off-site specialist clinics for HCV treatment
  • SHIM: simplified onsite HCV testing, evaluation, treatment, and follow-up delivered by OAMT physicians
  • SHIM + P4P: SHIM with provider incentives linked to completion of key cascade milestones All SHIM clinics were supported by Project ECHO telementoring to strengthen clinician capacity . The study used nationally procured direct-acting antivirals (DAAs) under routine program conditions and did not reimburse diagnostic costs.

Between February 2023 and December 2024, 616 eligible patients were enrolled .

Participants:

  • Completed confirmatory HCV RNA testing
  • Underwent simplified pretreatment clinical and laboratory assessment
  • Received 12 weeks of pan-genotypic DAA treatment either onsite (SHIM arms) or at specialist clinics (CMR arm)
  • Attended follow-up visits during treatment for adherence assessment and counseling
  • Were prescribed HCV RNA testing 12 weeks after treatment completion to confirm cure (SVR12) The primary outcome was SVR12. Secondary outcomes included completion of pretreatment evaluation, treatment initiation, treatment completion, and completion of SVR assessment.

This study evaluates HCV care under real-world conditions during ongoing national treatment scale-up in Ukraine. The findings inform whether integrating simplified HCV treatment into OAMT clinics-and aligning provider incentives-can improve cure rates and accelerate progress toward HCV elimination in high-burden populations.

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

616

Fase

  • Ikke anvendelig

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

  • Ukraine
      • Kyiv, Ukraine, 01054
        • Ukrainian Institute on Public Health Policy

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

  • Voksen
  • Ældre voksen

Tager imod sunde frivillige

Ingen

Beskrivelse

Inclusion Criteria:

  • currently receiving treatment at the selected OAT site (implying a diagnosis of opioid dependence according to ICD 10);
  • aged 18 years or older;
  • residing within the study catchment area; and
  • having a positive HCV antibody test documented in the medical chart

Exclusion Criteria:

  • previous HCV treatment history;
  • active tuberculosis (assessed using 4-item screening questionnaire and confirmed according to the current national protocol);
  • pregnant or planning pregnancy in the next 6 months;
  • planning to move to another city in the next 6 months;
  • unwillingness to undergo confirmatory HCV RNA PCR test at their own expense and treat HCV

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Sundhedstjenesteforskning
  • Tildeling: Ikke-randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Aktiv komparator: Case Management and Referral
structured referral to off-site specialist clinics for HCV treatment
Andet: Case Management and Referral
structured referral to off-site specialist clinics for HCV treatment
Eksperimentel: Simplified HCV Integrated Management
simplified onsite HCV testing, evaluation, treatment, and follow-up delivered by OAMT physicians
Andet: Simplified HCV Integrated Management
simplified onsite HCV testing, evaluation, treatment, and follow-up delivered by OAMT physicians
Eksperimentel: Simplified HCV Integrated Management + Pay-for-performance
simplified onsite HCV testing, evaluation, treatment, and follow-up delivered by OAMT physicians with provider incentives linked to completion of key cascade milestones
Andet: Simplified HCV Integrated Management
simplified onsite HCV testing, evaluation, treatment, and follow-up delivered by OAMT physicians
Andet: Pay-for-performance
provider incentives linked to completion of key cascade milestones

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Sustained virologic response
Tidsramme: Up to 24 weeks after treatment completion
Number of participants who have HCV RNA below the limit of quantitation (≤50 IU/mL) based on clinical records
Up to 24 weeks after treatment completion

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Completion of all pretreatment diagnostic assessments
Tidsramme: Through study completion, an average of 2 weeks after baseline
Number of participants who complete all pretreatment diagnostic assessments according to the SHIM algorithm (complete blood count, basic metabolic panel (including creatinine), hepatic function panel, fibrosis assessment, and HBsAg testing) based on clinical records
Through study completion, an average of 2 weeks after baseline
Treatment initiation
Tidsramme: Through study completion, an average of 4 weeks after baseline
Number of participants who are prescribed treatment for HCV infection based on clinical records
Through study completion, an average of 4 weeks after baseline
Treatment completion
Tidsramme: Through study completion, an average of 14 weeks after baseline
Number of participants who complete the full course of HCV treatment as prescribed based on clinical records
Through study completion, an average of 14 weeks after baseline
SVR assessment completion
Tidsramme: Up to 24 weeks after treatment completion
Number of participants who complete HCV RNA testing for SVR confirmation based on clinical records
Up to 24 weeks after treatment completion
HCV reinfection
Tidsramme: 12 months after treatment completion
Number of participants who receive a positive result of HCV RNA test at 12 months after treatment completion, based on clinical records
12 months after treatment completion

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Ukrainian Institute on Public Health Policy

Samarbejdspartnere

The Western-Eastern European Partnership Initiative on HIV, Viral Hepatitis and TB

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

4. marts 2023

Primær færdiggørelse (Faktiske)

31. oktober 2025

Studieafslutning (Faktiske)

31. december 2025

Datoer for studieregistrering

Først indsendt

27. februar 2026

Først indsendt, der opfyldte QC-kriterier

28. april 2026

Først opslået (Faktiske)

6. maj 2026

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

6. maj 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

28. april 2026

Sidst verificeret

1. april 2026

Mere information

Begreber relateret til denne undersøgelse

Nøgleord

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • 127-2022

Plan for individuelle deltagerdata (IPD)

Planlægger du at dele individuelle deltagerdata (IPD)?

JA

IPD-delingstidsramme

January 1, 2026 - June 30, 2029

IPD-delingsadgangskriterier

Reasonable request to the principal investigator

IPD-deling Understøttende informationstype

  • STUDY_PROTOCOL
  • ICF

Studiedata/dokumenter

  1. Studieprotokol
  2. Formular til informeret samtykke

Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter

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Ingen

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Kliniske forsøg med Opioidbrugsforstyrrelse

Kliniske forsøg med Case Management and Referral

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