The Intensified Treatment Monitoring Strategy to Prevent Accumulation of Drug Resistance (ITREMA) Trial (ITREMA)
Evaluation of an Intensified Treatment Monitoring Strategy to Prevent Accumulation and Spread of HIV-1 Drug Resistance in Low- and Middle-income Countries (ITREMA).
調査の概要
詳細な説明
This study will enroll adult HIV-1 infected patients who are about to initiate or have already initiated first-line ART. Patient enrollment and randomization will be performed at two different time points. Timing and criteria for enrollment and randomization are as follows:
- ART naïve patients: Patients are eligible for enrollment initiation of treatment with first-line ART. Randomization is performed after availability of the first routine viral load measurement, performed at month 6 of treatment.
- Patients on ART: Patients are eligible for enrollment after ≥ 1 year of virologically suppressive first-line ART and only if a last viral load with a result <1000 copies/mL was performed within the last 6 months. Randomization is performed 6 months after the last viral load (VL) result.
A total number of 600 patients will be randomized into two trial arms. The trial will be conducted on-site at one of the clinical facilities of Ndlovu Care Group (http://www.ndlovucaregroup.co.za/), one of the partners in the project. This facility, Ndlovu Medical Centre, is situated in the town of Elandsdoorn, Limpopo, South Africa, and provides medical service to local South African patients who are unable to pay medical insurance. The Ndlovu Care Group distributes antiretroviral medication in the framework of the South African Department of Health antiretroviral treatment programme. This clinic is currently providing ART to >3600 patients. Patients on ART return to the clinic monthly for collection of medication, pill count and adherence counselling, which allows intensification of monitoring without substantial change of the infrastructure or frequency of visits.
After randomisation, patients in both study arms will return for study follow-up visits on a three-monthly basis, at month 9, 12, 15, 18, 21 and 24 after start of ART or after the last VL measurement. In addition, patients will be called back for additional study visits (max. 2) in case of a detected viral load >1000 copies/ml during any of these visits. All visits in both arms, including aforementioned additional call back visits will coincide with standard of care medication collection visits to the clinic. In case of a switch to second-line therapy, patients in both arms will continue three-monthly follow-up visits in an observational manner, and guidelines for monitoring of second-line therapy are followed.
Control arm:
300 patients randomly assigned to this arm will be monitored in full concordance with current South African NDoH guidelines in use at the study site. Viral load measurements will be performed at month 12 and 24 after start of ART (for newly initiated patients) or at month 12 and 24 after the last viral load measurement (patients already on ART). If a viral load >1000 copies/ml is detected, the patient is called back for counseling for therapy adherence and repeat viral load measurement, 2 months after the initial viral load measurement. If the repeat viral load measurement is >1000 copies/ml after adherence counseling, this is taken to be indicative of therapy failure due to development of drug resistance and a switch to second line therapy is made, together with intensified adherence counseling, without verifying the cause of virological failure by performing drug level testing or drug resistance testing. If viral load drops to <1000 copies/ml after adherence counseling, the first line treatment is maintained.
Intervention arm:
300 patients randomly assigned to this arm will be monitored using the investigational intensified monitoring strategy. This strategy consists of 3-monthly viral load monitoring at month 9, 12, 15, 18, 21 and 24 (after start of ART in initiating patients or after the last viral load measurement in patients on ART). If a viral load measurement > 1000 copies/mL is detected, the patient will be called back for a follow-up study visit at the next monthly medication collection visit (4 weeks after detection of elevated viral load). Upon arrival drug level testing is performed, the viral load measurement is repeated, and a dried blood spot prepared and stored at room temperature. Procedures following this depend on the result of drug level testing:
- If drug levels are detected by drug level testing, the result of the viral load measurement is awaited. If the repeat viral load is >1000 copies/ml, the dried blood spot is shipped directly by courier to the World Health Organization (WHO) reference laboratory for drug resistance testing. The reference laboratory will provide feedback by means of a digital resistance report to the coordinating research physician. The patient will be called back for a second follow-up study visit at the next monthly medication visit (8 weeks after detection of elevated viral load), either for prescription of second-line therapy or continuation of first-line therapy, guided by the result of resistance testing.
- If drug level monitoring at the first follow-up visit indicates that drug levels are not detected, intensified counseling is performed at the same visit and first-line therapy will be maintained, regardless of the result of the repeat viral load measurement. The patient will not be called back and the next viral load will be performed at the next scheduled three-monthly time point. However, if the viral load result at this visit is again >1000 copies/ml, drug resistance testing will be performed regardless of the outcome of drug level testing.
研究の種類
入学 (実際)
段階
- 適用できない
連絡先と場所
研究場所
-
-
Limpopo
-
Elandsdoorn、Limpopo、南アフリカ、0485
- Ndlovu Medical Centre
-
-
参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- HIV-1 infected male or female patients
- For ART Naïve patients: Eligible for and intending to initiate ART at the clinical site
- For patients on ART: On ART ≥1 year. Last VL <6 months ago and <1000 copies/mL
- ≥18 years of age
- Able to understand and willing to give informed consent
Exclusion Criteria:
- Any serious unstable medical condition at study baseline
- Any criteria that in the opinion of the investigator indicate that the patient is unable to participate in the full study.
研究計画
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:他の
- 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:Control
Standard of Care monitoring
|
Standard-of-care virological monitoring during first-line ART as described by WHO and South African National Department of Health ART guidelines, consisting of viral load monitoring at month 6 and 12 of ART and annually thereafter, followed-up by a repeat measurement within 3 months after a viral load >1000 copies/mL, during first-line antiretroviral treatment (ART) for HIV-1 infection as prescribed by South African national guidelines.
|
実験的:Intervention
Intensified monitoring
|
Intensified virological monitoring during first-line ART with viral load monitoring at month 6 of ART and 3-monthly thereafter, followed-up consecutively by point-of-care qualitative drug level testing and drug resistance testing in case of a viral load >1000 copies/mL, during first-line antiretroviral treatment (ART) for HIV-1 infection as prescribed by South African national guidelines.
|
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 |
---|---|---|
Drug resistance
時間枠:week 48
|
Prevalence of drug resistance in patients with therapy failure in each arm
|
week 48
|
Drug resistance
時間枠:week 96
|
Prevalence of drug resistance in patients with therapy failure in each arm
|
week 96
|
Unnecessary treatment switches
時間枠:week 48
|
Number of virological failure cases without drug resistance in the intervention arm (averted unnecessary treatment switches) versus in the control arm (unnecessary treatment switches)
|
week 48
|
Unnecessary treatment switches
時間枠:week 96
|
Number of virological failure cases without drug resistance in the intervention arm (averted unnecessary treatment switches) versus in the control arm (unnecessary treatment switches)
|
week 96
|
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
---|---|---|
Time on failing regimen
時間枠:week 96
|
Time during which viremia > 1000 copies/mL is maintained after the first instance of a viral load >1000 copies/ml
|
week 96
|
Loss of second line therapeutic options over time
時間枠:week 96
|
The loss of second line therapeutic options over time due to accumulation of resistance mutations in the presence of a failing regimen.
|
week 96
|
Influence of genotypic resistance testing
時間枠:week 96
|
Influence of genotypic resistance testing on the choice for a second line regimen by comparing chosen regimens in the intervention and control groups.
|
week 96
|
協力者と研究者
スポンサー
協力者
捜査官
- 主任研究者:Annemarie MJ Wensing, MD, PhD、UMC Utrecht
出版物と役立つリンク
研究記録日
主要日程の研究
研究開始 (実際)
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (実際)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
追加の関連 MeSH 用語
その他の研究ID番号
- 69/2015
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
米国FDA規制機器製品の研究
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。
HIV/エイズの臨床試験
-
Massachusetts General HospitalNational Institute of Allergy and Infectious Diseases (NIAID); Emory University; University of... と他の協力者完了
-
University of California, San Diego完了
-
University of California, San DiegoJanssen Research & Development, LLC完了
-
Elizabeth Glaser Pediatric AIDS FoundationPopulation Council; Ministry of Health, Tanzania完了
-
Medical College of WisconsinNational Institute of Mental Health (NIMH)完了
-
Centers for Disease Control and PreventionJohns Hopkins University; Columbia University; University of Pittsburgh; RTI International; US Department...完了HIV | AIDS
-
Kristine Patterson, MDMerck Sharp & Dohme LLC完了
-
University of California, San DiegoNational Institute of Allergy and Infectious Diseases (NIAID)完了
Standard of care monitoringの臨床試験
-
Compedica IncProfessional Education and Research Institute募集
-
DeRoyal Industries, Inc.Lincoln Memorial University完了皮膚感作 | 機械的、熱的、および放射線刺激に対する皮膚反応アメリカ
-
University of PittsburghShadyside Hospital Foundation完了
-
Saint-Joseph University完了
-
Johns Hopkins UniversityJuvenile Diabetes Research Foundation; National Eye Institute (NEI)募集
-
Johns Hopkins UniversityNational Eye Institute (NEI)完了