Expanded PrEP Implementation in Communities in NSW (EPIC-NSW)
15. februar 2021 oppdatert av: Kirby Institute
Impact of the Rapid Expansion of Pre-exposure Prophylaxis (PrEP) on HIV Incidence, in a Setting With High HIV Testing and Antiretroviral Treatment Coverage, to Achieve the Virtual Elimination of HIV Transmission by 2020: a NSW HIV Strategy Implementation Project
A new NSW Ministry of Health HIV Strategy released on 1 December 2015 aims for the virtual elimination of HIV transmission in NSW by 2020. Critical to the new strategy's success is the population-based, targeted roll-out of HIV PrEP. PrEP involves taking one pill daily of co-formulated tenofovir disoproxil fumarate (TDF)/ emtricitabine (FTC). This large-scale study aims for the rapid roll-out of TDF/FTC to individuals at high risk of HIV, who will comprise mostly gay and bisexual men (GBM) but will also include small numbers of heterosexuals, injecting drug users, and transgender men and women. The drug will be used according to existing NSW Ministry of Health Guidelines. By rapidly rolling out this new intervention over a 12 month period, and following participants for two years on treatments, a reduction of about 50% in new HIV diagnoses in NSW is expected.
The study aims to assess the incidence of HIV among PrEP study participants and measure the population-level impact of the rapid roll-out of PrEP on HIV diagnoses among GBM in NSW over a two-year period.
It will also evaluate the rate of PrEP uptake among high risk GBM in NSW, assess the incidence of STI (gonorrhoea, chlamydia and infectious syphilis) among people prescribed PrEP and measure the effect of the rapid roll-out of PrEP on the overall number of notifications of gonorrhoea, chlamydia and infectious syphilis in NSW, describe patterns of PrEP use and medication adherence, and monitor behavioural risk practices among PrEP users.
The main population group will be more than 3700 gay men at high risk of HIV infection. All procedures of this study are guided by the NSW Guidelines on PrEP.
Protocol Co-Chairs Professor David Cooper, Professor Andrew Grulich. Project Manager: Barbara Yeung
Studieoversikt
Studietype
Intervensjonell
Registrering (Faktiske)
9733
Fase
- Fase 3
Kontakter og plasseringer
Denne delen inneholder kontaktinformasjon for de som utfører studien, og informasjon om hvor denne studien blir utført.
Studiesteder
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Australian Capital Territory
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Canberra, Australian Capital Territory, Australia, 2601
- Interchange General Practice
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Canberra, Australian Capital Territory, Australia, 2605
- Canberra Sexual Health Centre
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New South Wales
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Albury, New South Wales, Australia, 2640
- Albury Sexual Health Service
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Alexandria, New South Wales, Australia, 2015
- Fountain Street General Practice
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Byron Bay, New South Wales, Australia, 2481
- Holdsworth House Byron Bay
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Camperdown, New South Wales, Australia, 2050
- RPA Sexual Health
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Coffs harbour, New South Wales, Australia, 2450
- Coffs Harbour Sexual Health Clinic
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Darlinghurst, New South Wales, Australia, 2010
- St Vincent's Hospital HIV, Immunology and Infectious Disease Unit
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Dubbo, New South Wales, Australia, 2830
- Dubbo Sexual Health
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Enfield, New South Wales, Australia, 2136
- Dr Doong's Surgery
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Gosford, New South Wales, Australia, 2250
- Holden Street Gosford
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Illawarra, New South Wales, Australia, 2502
- Illawarra Shoalhaven Sexual Health
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Kogarah, New South Wales, Australia, 2217
- Short Street Clinic
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Lismore, New South Wales, Australia, 2480
- Lismore Sexual Health Clinic - Northen Rivers Area Health Service
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Liverpool, New South Wales, Australia, 2217
- Liverpool Sexual Health Clinic
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Newcastle, New South Wales, Australia, 2300
- Hunter New England Sexual Health Services
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North Sydney, New South Wales, Australia, 2065
- St Leonards Medical Centre
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Orange, New South Wales, Australia, 2800
- Orange Sexual Health
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Parramatta, New South Wales, Australia, 2150
- Western Sydney Sexual Health Centre
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Potts Point, New South Wales, Australia, 2011
- Macleay Street Medical Practice
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Surry Hills, New South Wales, Australia, 2010
- Crown Street Medical Centre
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Surry Hills, New South Wales, Australia, 2010
- The Albion Centre
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Sydney, New South Wales, Australia, 2010
- Holdsworth House Medical Practice
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Sydney, New South Wales, Australia, 2010
- Taylor Square Private Clinic
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Sydney, New South Wales, Australia, 1340
- Kirketon Road Centre
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Sydney, New South Wales, Australia, 2010
- East Sydney Doctors
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Sydney, New South Wales, Australia, 2000
- Sydney Sexual Health Centre
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Sydney, New South Wales, Australia, 2747
- Nepean Sexual Health and HIV Clinic
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Sydney, New South Wales, Australia, 2065
- Clinic 16, Royal North Shore Hospital
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Wagga Wagga, New South Wales, Australia, 2650
- Brookong Centre Sexual Health Centre
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Waterloo, New South Wales, Australia
- Green Square Health
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Deltakelseskriterier
Forskere ser etter personer som passer til en bestemt beskrivelse, kalt kvalifikasjonskriterier. Noen eksempler på disse kriteriene er en persons generelle helsetilstand eller tidligere behandlinger.
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
18 år og eldre (Voksen, Eldre voksen)
Tar imot friske frivillige
Ja
Kjønn som er kvalifisert for studier
Mann
Beskrivelse
Inclusion Criteria:
- HIV negative at enrolment, with a negative HIV test result documented within seven days of initiating PrEP
- At high and ongoing risk for acquiring HIV infection through sexual exposure (as defined by Behavioural Eligibility criteria presented in Appendix II and online Risk Assessment Questionnaire in Appendix III), OR previously a PrELUDE study participant
- Aged 18 years or over
- Live in NSW or ACT or visit NSW or ACT enough to attend clinics for follow-up assessments
- Willing and able to provide informed consent
- Medicare ineligible individuals may be enrolled if the clinical service is able to cover the costs of monitoring of the patient
Exclusion Criteria:
- HIV-1 infected or has symptoms consistent with acute viral infection (If HIV positive status is not confirmed by testing, delay starting PrEP for at least one month and reconfirm negative HIV-1 status).
- Having an estimated creatinine clearance (glomerular filtration rate [GFR]) <60ml/min
- Having or developing clinical symptoms suggestive of lactic acidosis or pronounced hepatotoxicity (including nausea, vomiting, unusual or unexpected stomach discomfort, and weakness)
- Concurrently taking a nephrotoxic agent (e.g., high-dose non-steroidal anti-inflammatory drugs / NSAIDs)
- Allergic to TDF and/or FTC (based on self-report or recorded)
- Concurrently taking prescribed products containing FTC or TDF including ATRIPLA®, COMPLERA®, EMTRIVA, STRIBILD®, VIREAD, TAF (tenofovir alafenamide), GENVOYA, DESCOVY; other drugs containing lamivudine; HEPSERA
- Factors or conditions that may compromise a participant's access to health services for follow-up (incarceration or planned relocation and potential absence from NSW or ACT).
Behavioural eligibility criteria as per NSW PrEP guidelines.
Studieplan
Denne delen gir detaljer om studieplanen, inkludert hvordan studien er utformet og hva studien måler.
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Forebygging
- Tildeling: N/A
- Intervensjonsmodell: Enkeltgruppeoppdrag
- Masking: Ingen (Open Label)
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
|---|---|
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Eksperimentell: treatment
A single open-label arm.
All participants receive daily oral pill containing TDF/FTC
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one pill daily
Andre navn:
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Hva måler studien?
Primære resultatmål
Resultatmål |
Tidsramme |
|---|---|
|
Incidence of HIV infection per 100 person years among study participants
Tidsramme: 24 months of follow-up
|
24 months of follow-up
|
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Number of HIV diagnoses among gay and bisexual men notified to the NSW Ministry of Health.
Tidsramme: 24 months of follow-up
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24 months of follow-up
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Sekundære resultatmål
Resultatmål |
Tidsramme |
|---|---|
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Incidence of STI (gonorrhoea, chlamydia and infectious syphilis) per 100 person years among study participants
Tidsramme: 24 months of follow-up
|
24 months of follow-up
|
Samarbeidspartnere og etterforskere
Det er her du vil finne personer og organisasjoner som er involvert i denne studien.
Sponsor
Etterforskere
- Studiestol: David Cooper, MD, PhD, The Kirby Institute, UNSW Sydney
- Studiestol: Andrew Grulich, MD, PhD, The Kirby Institute, UNSW Sydney
Publikasjoner og nyttige lenker
Den som er ansvarlig for å legge inn informasjon om studien leverer frivillig disse publikasjonene. Disse kan handle om alt relatert til studiet.
Generelle publikasjoner
- Amin J, Vaccher S, Templeton DJ, Bavinton B, Jin F, Zablotska I, Matthews G, Ogilvie E, Yeung B, Ooi C, Dharan N, Baker DA, Read P, Guy R, Grulich AE. Low Prior Exposure and Incidence of Hepatitis C in Human Immunodeficiency Virus-Negative Gay and Bisexual Men Taking Preexposure Prophylaxis (PrEP): Findings From the Expanded PrEP Implementation in Communities-New South Wales Prospective Implementation Study. Clin Infect Dis. 2022 Oct 29;75(9):1497-1502. doi: 10.1093/cid/ciac231.
- Grulich AE, Jin F, Bavinton BR, Yeung B, Hammoud MA, Amin J, Cabrera G, Clackett S, Ogilvie E, Vaccher S, Vickers T, McNulty A, Smith DJ, Dharan NJ, Selvey C, Power C, Price K, Zablotska I, Baker DA, Bloch M, Brown K, Carmody CJ, Carr A, Chanisheff D, Doong N, Finlayson R, Lewis DA, Lusk J, Martin S, Ooi C, Read P, Ryder N, Smith D, Tuck Meng Soo C, Templeton DJ, Vlahakis E, Guy R; Expanded PrEP Implementation in Communities New South Wales (EPIC-NSW) research group. Long-term protection from HIV infection with oral HIV pre-exposure prophylaxis in gay and bisexual men: findings from the expanded and extended EPIC-NSW prospective implementation study. Lancet HIV. 2021 Aug;8(8):e486-e494. doi: 10.1016/S2352-3018(21)00074-6. Epub 2021 Jul 1.
- Grulich AE, Guy R, Amin J, Jin F, Selvey C, Holden J, Schmidt HA, Zablotska I, Price K, Whittaker B, Chant K, Cooper C, McGill S, Telfer B, Yeung B, Levitt G, Ogilvie EE, Dharan NJ, Hammoud MA, Vaccher S, Watchirs-Smith L, McNulty A, Smith DJ, Allen DM, Baker D, Bloch M, Bopage RI, Brown K, Carr A, Carmody CJ, Collins KL, Finlayson R, Foster R, Jackson EY, Lewis DA, Lusk J, O'Connor CC, Ryder N, Vlahakis E, Read P, Cooper DA; Expanded PrEP Implementation in Communities New South Wales (EPIC-NSW) research group. Population-level effectiveness of rapid, targeted, high-coverage roll-out of HIV pre-exposure prophylaxis in men who have sex with men: the EPIC-NSW prospective cohort study. Lancet HIV. 2018 Nov;5(11):e629-e637. doi: 10.1016/S2352-3018(18)30215-7. Epub 2018 Oct 17.
- Zablotska IB, Selvey C, Guy R, Price K, Holden J, Schmidt HM, McNulty A, Smith D, Jin F, Amin J, Cooper DA, Grulich AE; EPIC-NSW study group. Expanded HIV pre-exposure prophylaxis (PrEP) implementation in communities in New South Wales, Australia (EPIC-NSW): design of an open label, single arm implementation trial. BMC Public Health. 2018 Feb 2;18(1):210. doi: 10.1186/s12889-017-5018-9. Erratum In: BMC Public Health. 2018 Feb 28;18(1):297.
Studierekorddatoer
Disse datoene sporer fremdriften for innsending av studieposter og sammendragsresultater til ClinicalTrials.gov. Studieposter og rapporterte resultater gjennomgås av National Library of Medicine (NLM) for å sikre at de oppfyller spesifikke kvalitetskontrollstandarder før de legges ut på det offentlige nettstedet.
Studer hoveddatoer
Studiestart (Faktiske)
1. mars 2016
Primær fullføring (Faktiske)
1. mars 2019
Studiet fullført (Faktiske)
1. oktober 2020
Datoer for studieregistrering
Først innsendt
14. august 2016
Først innsendt som oppfylte QC-kriteriene
14. august 2016
Først lagt ut (Anslag)
17. august 2016
Oppdateringer av studieposter
Sist oppdatering lagt ut (Faktiske)
17. februar 2021
Siste oppdatering sendt inn som oppfylte QC-kriteriene
15. februar 2021
Sist bekreftet
1. februar 2021
Mer informasjon
Begreper knyttet til denne studien
Ytterligere relevante MeSH-vilkår
Andre studie-ID-numre
- HEPP1511
Denne informasjonen ble hentet direkte fra nettstedet clinicaltrials.gov uten noen endringer. Hvis du har noen forespørsler om å endre, fjerne eller oppdatere studiedetaljene dine, vennligst kontakt register@clinicaltrials.gov. Så snart en endring er implementert på clinicaltrials.gov, vil denne også bli oppdatert automatisk på nettstedet vårt. .