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A Pilot Study of Pre-Exposure Prophylaxis (PrEP) to Evaluate Safety, Acceptability, and Adherence in At-risk Populations in Uganda, Africa

24 août 2011 mis à jour par: International AIDS Vaccine Initiative

This study will evaluate the safety and acceptability of intermittent and daily pre-exposure prophylaxis (PrEP) regimens with FTC/TDF (emtricitabine/tenofovir disoproxil fumarate) in HIV discordant couples, and it will directly compare adherence and intracellular drug levels in daily and intermittent PrEP recipients. It will also evaluate the relationship between drug adherence, sexual behavior and intracellular drug levels with an intermittent PrEP regimen. In addition it will evaluate the relationship between adherence to an intermittent PrEP regimen and timing of sexual activity in relation to PrEP dosing. The pilot will use objective medication event monitoring (MEMS) adherence measurement and evaluate the feasibility of newer adherence measurements such as hair sampling and plasma drug levels. This study will also evaluate the feasibility of using text messaging (SMS) to collect sexual activity data in an African setting. It will allow study teams and communities to prepare for potential subsequent larger trials of intermittent PrEP. The study is not sized to evaluate efficacy. If the intermittent PrEP regimen is safe, feasible in terms of adherence, and achieves intracellular drug levels similar to daily PrEP, the data could be used to design a larger phase 2 study with one or more intermittent PrEP regimens. The goal of such a larger trial would be to provide bridging data if daily PrEP regimens are found to be effective or to prepare for efficacy or non-inferiority trials of intermittent versus daily PrEP.

Investigation of immune responses associated with FTC/TDF will also be evaluated in the pilot study. The proportion of volunteers on FTC/TDF with HIV-specific immune responses, due to exposures that did not lead to established HIV infection, will be assessed at 2-3 time points and compared to responses in volunteers assigned to placebo. Immune responses may be correlated with risk behavior and host factors, such as human leukocyte antigen (HLA) type. As noted above, very few HIV infections are expected to occur during the study, so correlation of HIV-specific immune responses and protection from infection or attenuation of disease progression will not be possible until a larger study is conducted.

Aperçu de l'étude

Statut

Complété

Les conditions

Intervention / Traitement

Type d'étude

Interventionnel

Inscription (Anticipé)

72

Phase

  • Phase 2
  • La phase 1

Contacts et emplacements

Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.

Lieux d'étude

  • Ouganda
      • Entebbe, Ouganda
        • MRC-Entebbe

Critères de participation

Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.

Critère d'éligibilité

Âges éligibles pour étudier

18 ans à 49 ans (Adulte)

Accepte les volontaires sains

Oui

Sexes éligibles pour l'étude

Tout

La description

Inclusion Criteria (for HIV-uninfected volunteers):

  • Willing to comply with the protocol and available for follow-up for the study duration
  • Has understood the information provided and has provided written informed consent before any study-related procedures are performed
  • Willing to undergo couple HIV testing, sexually transmitted infection (STI) screening, HIV counseling and receive test results, and share results with partner
  • At risk for HIV infection as defined by: has an HIV-infected partner not using ART in the past 3 months and had episodes of unprotected sex with partner in the past 3 months

  • If a female of childbearing potential:

    • using an effective method of non-barrier contraception (hormonal contraceptive
    • intrauterine device (IUD)
    • surgical sterility) from 7 days prior to randomization until the end of the study
    • all female volunteers must be willing to undergo urine pregnancy tests
  • HIV-infected partner is willing and eligible to enroll in the study

Inclusion Criteria (for HIV-1 infected partner):

  • HIV-1 infected partner of an HIV-uninfected volunteer who meets study eligibility
  • Plan to remain in the relationship for the duration of the study period
  • Willing and able to provide written informed consent & locator information

Exclusion Criteria (for HIV-uninfected volunteer):

  • Confirmed HIV-1 or HIV-2 infection
  • Any clinically significant acute or chronic medical condition that is considered progressive, including severe infections requiring treatment such as tuberculosis, and alcohol or drug abuse

  • Any of the following abnormal lab parameters:

    • Haemoglobin < 9.0 g/dL
    • Creatinine clearance <80mL/min, as calculated by Cockcroft-Gault equation
    • AST: > 2.5 x ULN
    • ALT: > 2.5 x ULN
    • Total bilirubin > 1.5 x ULN
    • Serum amylase > 1.5 x ULN
    • Serum phosphorus < 2.4 mg/dL

    • Urinalysis: Two abnormal dipsticks showing any of the following:

      • blood = 2+ or more (not due to menses);
      • protein = 1+ or more
      • leucocytes = 2+ or more
      • glucose= 1+ or more
  • Confirmed diagnosis of chronic hepatitis B infection (HBsAg positive)
  • If female, pregnant or planning a pregnancy within 4 months after enrolment or lactating
  • Participation in another clinical study of a product currently, or within the 3 mo. prior to enrolment

Exclusion Criteria (for HIV-1 infected partner):

  • Current use of antiretroviral therapy
  • Concurrent enrollment in another HIV treatment trial

Plan d'étude

Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.

Comment l'étude est-elle conçue ?

Détails de conception

  • Objectif principal: La prévention
  • Répartition: Randomisé
  • Modèle interventionnel: Affectation parallèle
  • Masquage: Quadruple

Armes et Interventions

Groupe de participants / Bras
Intervention / Traitement
Expérimental: FTC/TDF Daily
Daily dosing
Médicament: FTC/TDF
emtricitabine/tenofovir disoproxil fumarate
Expérimental: FTC/TDF Intermittent
Dosed intermittently
Médicament: FTC/TDF
emtricitabine/tenofovir disoproxil fumarate
Comparateur placebo: Placebo Daily
Placebo dosed daily
Médicament: Placebo
Placebo
Comparateur placebo: Placebo Intermittent
Placebo dosed intermittently, orally.
Médicament: Placebo
Placebo

Que mesure l'étude ?

Principaux critères de jugement

Mesure des résultats
Délai
Safety and tolerability: volunteers with moderate and greater severity clinical adverse events, renal toxicities, and other moderate and severe laboratory abnormalities.
Délai: 6 months
6 months
Acceptability: proportion of volunteers who report willingness to use the study regimen; the acceptability to the HIV-infected partner of their partner using the investigational product
Délai: 6 months
6 months
Intracellular drug concentrations: the mean intracellular drug concentration for each group assigned to FTC/TDF
Délai: 6 months
6 months
Adherence: proportion of vol. who took, by MEMS data, at least 80% of doses; vol. assigned to FTC/TDF with detectable drug plasma levels within 48 hrs of use; relationship between intracellular drug levels and adherence in vol. assigned to FTC/TDF
Délai: 6 months
6 months
Behavioral: reported number of steady and casual sex partners; frequency of unprotected vaginal intercourse; substance use prior to or during sex
Délai: 6 months
6 months

Mesures de résultats secondaires

Mesure des résultats
Délai
The proportion of study days with missing SMS sexual activity data
Délai: 6 months
6 months
The proportion of volunteers who report sharing medications
Délai: 6 months
6 months
The proportion of volunteers assigned to placebo who have detectable intracellular drug levels
Délai: 6 months
6 months
The proportion of volunteers with HIV-specific immune responses as measured by analysis of cellular or humoral immune response, or changes in gene regulation as measured by microarray or proteomic techniques
Délai: 6 months
6 months
The proportion of volunteers who report somewhat high or high levels of burden in using electronic medication monitoring to measure adherence, and using cell phone communication to measure sexual activity
Délai: 6 months
6 months
The proportion of HIV-infected partners in discordant couples not on ART with detectable drug levels
Délai: 6 months
6 months

Collaborateurs et enquêteurs

C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.

Parrainer

International AIDS Vaccine Initiative

Les enquêteurs

  • Chaise d'étude: Heiner Grosskurth, MD, MRC Entebbe
  • Chercheur principal: Anatoli Kamali, MD, MRC Entebbe

Publications et liens utiles

La personne responsable de la saisie des informations sur l'étude fournit volontairement ces publications. Il peut s'agir de tout ce qui concerne l'étude.

Publications générales

Liens utiles

Dates d'enregistrement des études

Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.

Dates principales de l'étude

Début de l'étude

1 octobre 2009

Achèvement primaire (Réel)

1 octobre 2010

Achèvement de l'étude (Réel)

1 octobre 2010

Dates d'inscription aux études

Première soumission

29 juin 2009

Première soumission répondant aux critères de contrôle qualité

30 juin 2009

Première publication (Estimation)

2 juillet 2009

Mises à jour des dossiers d'étude

Dernière mise à jour publiée (Estimation)

25 août 2011

Dernière mise à jour soumise répondant aux critères de contrôle qualité

24 août 2011

Dernière vérification

1 août 2011

Plus d'information

Termes liés à cette étude

Mots clés

Termes MeSH pertinents supplémentaires

Autres numéros d'identification d'étude

  • IAVI E002

Ces informations ont été extraites directement du site Web clinicaltrials.gov sans aucune modification. Si vous avez des demandes de modification, de suppression ou de mise à jour des détails de votre étude, veuillez contacter register@clinicaltrials.gov. Dès qu'un changement est mis en œuvre sur clinicaltrials.gov, il sera également mis à jour automatiquement sur notre site Web .

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