An Adaptive Strategy for Preventing and Treating Lapses of Retention in Adult HIV Care (AdaPT-R) in Nyanza, Kenya (AdaPT-R)
2021年3月11日 更新者：University of California, San Francisco
An Adaptive Strategy for Preventing and Treating Lapses of Retention in Adult HIV Care (AdaPT-R)
Retaining HIV-infected patients in care is critical, but loss to follow-up after enrolment often reaches 20%-40% by two years, placing millions of patients at risk of poor outcomes.
A strategy to optimize retention within resource constraints is urgently needed.
Sequential adaptive strategies - a novel class of public health approaches - may offer a solution.
A candidate sequential adaptive strategy would start with a less expensive intervention (e.g., SMS) in all patients and then apply a more costly and intensive one (e.g., navigator) only to patients who show early signs of poor retention.
This study involves a sequential multiple assignment randomized trial to evaluate a family of such strategies.
the investigators will randomize 1,800 adults newly initiating antiretroviral treatment (ART) at 4 HIV clinics in the Nyanza region of Kenya to (1) standard of care routine education and counselling (REC), (2) SMS text messages, or (3) transport vouchers.
Patients with early signs of weakening retention (defined as the first time a patient is 14 days late for an appointment) will be re-randomized to (1) a single episode of outreach (standard of care), (2) SMS combined with vouchers, or (3) a peer navigator.
Patients not successfully contacted by 28 days after missed visit (and not verified to have left the area or transferred to another clinic) will also be rerandomized to of one the same three re-engagement interventions.
Individuals randomized at first stage to SMS or voucher that do not miss a visit by at least 14 days in the first 12 months of follow up will be re-randomized at 12 months to stop first stage intervention or continue with that same intervention to 24 months.
The investigators primary objective is to assess the comparative effectiveness of sequenced intervention strategies to prevent initial lapses in retention and to treat those that occur.
The investigators primary endpoint is fraction of time retained in care two years after enrolment.
In addition, the investigators will assess the comparative effectiveness of first-stage strategies (REC, SMS, voucher) to prevent lapses in retention, and the comparative effectiveness of second stage strategies (outreach, SMS + voucher, navigator) to re-engage patients after initial lapse.
This study will also compare outcomes among patients who continue versus discontinue the SMS and voucher interventions, including a small complementarity component utilizing qualitative methods to examine the voucher approach and the effects of discontinuing this approach after success among a subset of participants.
At study conclusion the investigators output will be a menu of adaptive strategies for retention, accompanied by estimates of cost and effectiveness, which policy makers in different settings can use to advance the impact of HIV care and treatment programs in Africa.
調査の概要
状態
完了
条件
介入・治療
- 行動：REC; Outreach if Failure
- 行動：REC; SMS + Voucher if Failure
- 行動：REC; Navigator if Failure
- 行動：SMS; Outreach if Failure
- 行動：SMS; Outreach if Failure; Stop SMS if Success
- 行動：SMS; SMS+Voucher if Failure
- 行動：SMS; SMS+Voucher if Failure; Stop SMS if Success
- 行動：SMS; Navigator if Failure
- 行動：SMS; Navigator if Failure; Stop SMS if Success
- 行動：Voucher; Outreach if Failure
- 行動：Voucher; Outreach if Failure; Stop Voucher if Success
- 行動：Voucher; SMS+Voucher if Failure
- 行動：Voucher; SMS+Voucher if Failure; Stop Voucher if Success
- 行動：Voucher; Navigator if Failure
- 行動：Voucher; Navigator if Failure; Stop Voucher if Success
研究の種類
介入
入学 (実際)
1816
段階
- 適用できない
連絡先と場所
このセクションには、調査を実施する担当者の連絡先の詳細と、この調査が実施されている場所に関する情報が記載されています。
研究場所
-
-
Nyanza
-
Kisumu、Nyanza、ケニア
- Kenya Medical Research Institute
-
-
参加基準
研究者は、適格基準と呼ばれる特定の説明に適合する人を探します。これらの基準のいくつかの例は、人の一般的な健康状態または以前の治療です。
適格基準
就学可能な年齢
18年歳以上 (大人、高齢者)
健康ボランティアの受け入れ
いいえ
受講資格のある性別
全て
説明
Inclusion Criteria:
- HIV-infection
- 18 years old
- Planning to remain in the study area (Nyanza region) for the duration of the study, capable of informed consent
- Newly initiating ART (within past 90 days)
- Access to a cell phone
- Ability to read or be read SMS messages
- And willingness to be contacted by clinic upon missed appointment.
Exclusion Criteria:
- Plans to move out of Nyanza region or acutely ill and requiring hospitalization.
- Hospitalized patients who later recover will be eligible for enrolment at the first post-hospitalization clinic visit during which eligibility criteria are met.
- No access to a cell phone.
- Involvement in studies with the potential to influence retention behaviors.
研究計画
このセクションでは、研究がどのように設計され、研究が何を測定しているかなど、研究計画の詳細を提供します。
研究はどのように設計されていますか？
デザインの詳細
- 主な目的：ヘルスサービス研究
- 割り当て：ランダム化
- 介入モデル：並列代入
- マスキング：なし（オープンラベル）
武器と介入
参加者グループ / アーム |
介入・治療 |
|---|---|
|
アクティブコンパレータ：REC; Outreach if Failure
|
Routine education and counseling (REC) services, delivered per Kenya Ministry of Health Guidelines; followed by standard of care (SOC) outreach to encourage return to clinic for patients 14 days late for a scheduled visit in year 1.
|
|
アクティブコンパレータ：REC; SMS + Voucher if Failure
|
Routine education and counseling services, delivered per Kenya Ministry of Health (MOH) Guidelines; followed by SMS text messages for patients and reimbursement at a fixed amount (KSH 400) for transport to the clinic for patients 14 days late for a scheduled visit in year 1.
|
|
アクティブコンパレータ：REC; Navigator if Failure
|
REC services, delivered per Kenya MOH Guidelines; followed by Peer Navigator (tailored outreach and support) for patients 14 days late for a scheduled visit
|
|
アクティブコンパレータ：SMS; Outreach if Failure
|
SMS text messages for patients; followed by SOC outreach for patients 14 days late for a scheduled visit
|
|
アクティブコンパレータ：SMS; Outreach if Failure; Stop SMS if Success
|
SMS text messages for patients, followed by SOC outreach for patients 14 days late for a scheduled visit, and discontinuation of SMS text messages if never 14 days late
|
|
アクティブコンパレータ：SMS; SMS+Voucher if Failure
|
SMS text messages for patients, followed by reimbursement at a fixed amount (KSH 400) for transport to the clinic for patients 14 days late for a scheduled visit in year 1.
|
|
アクティブコンパレータ：SMS; SMS+Voucher if Failure; Stop SMS if Success
|
SMS text messages for patients, followed by reimbursement at a fixed amount (KSH 400) for transport to the clinic for patients 14 days late for a scheduled visit in year 1, and discontinuation of SMS text messages if never 14 days late
|
|
アクティブコンパレータ：SMS; Navigator if Failure
|
SMS text messages for patents, followed by Peer Navigator (tailored outreach and support) for patients 14 days late for a scheduled visit
|
|
アクティブコンパレータ：SMS; Navigator if Failure; Stop SMS if Success
|
SMS text messages for patents, followed by Peer Navigator (tailored outreach and support) for patients 14 days late for a scheduled visit, and discontinuation of SMS text messages if never 14 days late
|
|
アクティブコンパレータ：Voucher; Outreach if Failure
|
Reimbursement at a fixed amount (KSH 400) for transport to the clinic for patients, followed by SOC outreach for patients 14 days late for a scheduled visit
|
|
アクティブコンパレータ：Voucher; Outreach if Failure; Stop Voucher if Success
|
Reimbursement at a fixed amount (KSH 400) for transport to the clinic for patients, followed by SOC outreach for patients 14 days late for a scheduled visit, and discontinuation of voucher for patients if never 14 days late
|
|
アクティブコンパレータ：Voucher; SMS+Voucher if Failure
|
Reimbursement at a fixed amount (KSH 400) for transport to the clinic for patients, followed by SMS text message and reimbursement (KSH 400) for transport to the clinic for patients 14 days late for a scheduled visit
|
|
アクティブコンパレータ：Voucher; SMS+Voucher if Failure; Stop Voucher if Success
|
Reimbursement at a fixed amount (KSH 400) for transport to the clinic for patients, followed by SMS text message and reimbursement (KSH 400) for transport to the clinic for patients 14 days late for a scheduled visit, and discontinuation of voucher for patients if never 14 days late
|
|
アクティブコンパレータ：Voucher; Navigator if Failure
|
Reimbursement at a fixed amount (KSH 400) for transport to the clinic for patients, followed by Peer Navigator (tailored outreach and support) for patients 14 days late for a scheduled visit
|
|
アクティブコンパレータ：Voucher; Navigator if Failure; Stop Voucher if Success
|
Reimbursement at a fixed amount (KSH 400) for transport to the clinic for patients, followed by Peer Navigator (tailored outreach and support) for patients 14 days late for a scheduled visit, and discontinuation of voucher for patients if never 14 days late
|
この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Retention
時間枠：Up to two years after enrollment
|
Fraction of time in care
|
Up to two years after enrollment
|
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
Alive with suppressed HIV RNA level (<400 copies/ml)
時間枠：Two years after study enrollment
|
Number of subjects alive with suppressed HIV RNA levels (<400 copies/ml)
|
Two years after study enrollment
|
|
Time from second randomization to return to clinic after initial retention lapse
時間枠：Up to two years after enrollment
|
Time from second randomization to re-engagement; re-engagement is defined as first visit back to clinic
|
Up to two years after enrollment
|
|
Mean visit adherence (% visits made)
時間枠：Two years after study enrollment
|
Proportion of kept scheduled appointments (range=0-100%), with kept visits being those attended by the patient and with the denominator excluding canceled visits
|
Two years after study enrollment
|
|
Retention
時間枠：Two years after enrollment
|
Fraction of time in care
|
Two years after enrollment
|
|
Fraction on-time pharmacy pick-ups for antiretroviral drugs
時間枠：Two years after enrollment
|
Proportion of prescriptions filled and picked up by participants to prescriptions written
|
Two years after enrollment
|
|
Cost effectiveness
時間枠：After two years of enrollment
|
Cost per failure (virological failure (HIV RNA>=400 copies/ml) or death averted
|
After two years of enrollment
|
|
Patient-reported barriers to engagement
時間枠：At years one and two after study enrollment
|
Self-reported by questionnaire
|
At years one and two after study enrollment
|
協力者と研究者
ここでは、この調査に関係する人々や組織を見つけることができます。
協力者
捜査官
- 主任研究者：Elvin Geng, MD、University of California, San Francisco
- 主任研究者：Maya Petersen, MD, PhD、University of California, Berkeley
研究記録日
これらの日付は、ClinicalTrials.gov への研究記録と要約結果の提出の進捗状況を追跡します。研究記録と報告された結果は、国立医学図書館 (NLM) によって審査され、公開 Web サイトに掲載される前に、特定の品質管理基準を満たしていることが確認されます。
主要日程の研究
研究開始
2015年3月1日
一次修了 (実際)
2020年11月1日
研究の完了 (実際)
2020年11月1日
試験登録日
最初に提出
2014年12月11日
QC基準を満たした最初の提出物
2015年1月9日
最初の投稿 (見積もり)
2015年1月14日
学習記録の更新
投稿された最後の更新 (実際)
2021年3月16日
QC基準を満たした最後の更新が送信されました
2021年3月11日
最終確認日
2021年3月1日
詳しくは
本研究に関する用語
その他の研究ID番号
- 1R01MH104123-01 (米国 NIH グラント/契約)
医薬品およびデバイス情報、研究文書
米国FDA規制医薬品の研究
いいえ
米国FDA規制機器製品の研究
いいえ
米国で製造され、米国から輸出された製品。
いいえ
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。