- ICH GCP
- US Clinical Trials Registry
- Klinisk utprøving NCT05633056
En adaptiv randomisert kontrollert prøveversjon (ADAP-TIV)
Adaptiv evaluering av mHealth og konvensjonelle overholdelsesstøtteintervensjoner for å optimalisere resultatet med nye behandlingsregimer for medikamentresistent tuberkulose og HIV i Sør-Afrika
Studieoversikt
Status
Intervensjon / Behandling
Detaljert beskrivelse
Denne studien vil følge en 4-arm Bayesiansk, adaptiv prøvedesign. Etter hvert som pasienter blir registrert, vil de bli randomisert i en av de fire armene.
Studiet vil bli gjennomført innenfor en felles struktur for å muliggjøre effektiv påmelding og analyse. Den overordnede strukturen er en 4-arms adaptiv plattform av mHealth og psykososial adherensstøtteintervensjoner informert av en differensiert tjenestelevering (DSD) tilnærming.
Mål 1 er en adaptiv studie av mHealth og psykososial adherensstøtteintervensjoner ved å bruke et Bayesiansk adaptivt design for å tillate sammenligning av elementer av intervensjonen separat og i kombinasjon. Mål 1-deltakere vil bli randomisert til en av 4 armer og følges månedlig gjennom de 6 månedene med intervensjon, deretter gjennom slutten av behandlingen telefonisk, med et ekstra personlig besøk for å fastslå det primære resultatet. Primært utfall er et kombinert klinisk/biologisk utfall ved 12 måneder beskrevet nedenfor. Hypotese 1a bruker alle deltakerne mens 1b bare bruker de i mHealth intervensjonsarmer (3+4) siden granulær EDM-målt adherens er nødvendig.
Studietype
Registrering (Forventet)
Fase
- Ikke aktuelt
Kontakter og plasseringer
Studiekontakt
- Navn: Kogieleum Naidoo, Prof
- Telefonnummer: +27 31 260 4687
- E-post: Kogie.Naidoo@caprisa.org
Studer Kontakt Backup
- Navn: Max O'Donnell, Prof
- E-post: mo2130@columbia.edu
Studiesteder
-
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KwaZulu-Natal
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Durban, KwaZulu-Natal, Sør-Afrika, 4001
- King DinuZulu Hospital
-
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Deltakelseskriterier
Kvalifikasjonskriterier
Alder som er kvalifisert for studier
Tar imot friske frivillige
Kjønn som er kvalifisert for studier
Beskrivelse
Inklusjonskriterier:
- Kultur eller molekylær test positiv for MTB
- Molekylær test positiv for HIV eller en dokumentert HIV-positiv historie
- Medikamentfølsomhetstesting ved molekylær (dvs. GeneXpert MTB/RIF) eller konvensjonell testing i samsvar med minst rifampicin-resistent TB,
- Starte behandling med et bedaquilinholdig TB-regime innen 4 uker etter innmelding og første gangs behandling med BDQ
- Ved behandling med antiretroviral terapi (ART), inkludert dolutegravir-holdig kombinasjon antiretroviral terapi (dvs. Tenofovir-Lamivudine-Dolutergravir), eller som starter innen 4 uker etter registrering,
- Kapasitet for informert samtykke på enten isiZulu eller engelsk
Ekskluderingskriterier:
- Svangerskap
- Fanger
- Skjønn av IOR eller kliniker
Studieplan
Hvordan er studiet utformet?
Designdetaljer
- Primært formål: Støttende omsorg
- Tildeling: Randomisert
- Intervensjonsmodell: Parallell tildeling
- Masking: Ingen (Open Label)
Våpen og intervensjoner
Deltakergruppe / Arm |
Intervensjon / Behandling |
---|---|
Ingen inngripen: Forbedret omsorgsstandard
|
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Annen: Psykososial støtte
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Sammenlign effekten av adherensstøtteintervensjoner på kliniske og biologiske endepunkter ved å bruke en adaptiv randomisert plattform.
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Annen: mHelse
En Wisepill-enhet er en RT2000 mobilaktivert elektronisk pilleboks som bruker 2G/3G mobilnettverk.
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Sammenlign effekten av adherensstøtteintervensjoner på kliniske og biologiske endepunkter ved å bruke en adaptiv randomisert plattform.
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Annen: mhelse og psykososial støtte
Kombinasjon av arm 2 og arm 3.
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Sammenlign effekten av adherensstøtteintervensjoner på kliniske og biologiske endepunkter ved å bruke en adaptiv randomisert plattform.
|
Hva måler studien?
Primære resultatmål
Resultatmål |
Tiltaksbeskrivelse |
Tidsramme |
---|---|---|
Biologisk utfall
Tidsramme: 06 måneder
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Konvertering av tuberkulosekultur
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06 måneder
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Klinisk utfall
Tidsramme: 12 måneder
|
Overlevelse
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12 måneder
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Biologisk utfall
Tidsramme: 12 måneder
|
HIV viral belastning
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12 måneder
|
Klinisk utfall
Tidsramme: 12 måneder
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Oppbevaring i omsorgen
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12 måneder
|
Biologisk utfall
Tidsramme: 12 måneder
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Konvertering av tuberkulosekultur
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12 måneder
|
Samarbeidspartnere og etterforskere
Sponsor
Samarbeidspartnere
Etterforskere
- Hovedetterforsker: Max O'Donnell, Prof, University of Columbia
Publikasjoner og nyttige lenker
Generelle publikasjoner
- Daftary A, Padayatchi N, O'Donnell M. Preferential adherence to antiretroviral therapy over tuberculosis treatment: a qualitative study of drug-resistant TB/HIV co-infected patients in South Africa. Glob Public Health. 2014;9(9):1107-16. doi: 10.1080/17441692.2014.934266. Epub 2014 Jul 18.
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- Diacon AH, Pym A, Grobusch MP, de los Rios JM, Gotuzzo E, Vasilyeva I, Leimane V, Andries K, Bakare N, De Marez T, Haxaire-Theeuwes M, Lounis N, Meyvisch P, De Paepe E, van Heeswijk RP, Dannemann B; TMC207-C208 Study Group. Multidrug-resistant tuberculosis and culture conversion with bedaquiline. N Engl J Med. 2014 Aug 21;371(8):723-32. doi: 10.1056/NEJMoa1313865.
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- O'Donnell MR, Padayatchi N, Daftary A, Orrell C, Dooley KE, Rivet Amico K, Friedland G. Antiretroviral switching and bedaquiline treatment of drug-resistant tuberculosis HIV co-infection. Lancet HIV. 2019 Mar;6(3):e201-e204. doi: 10.1016/S2352-3018(19)30035-9.
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- Nimmo C, Millard J, Brien K, Moodley S, van Dorp L, Lutchminarain K, Wolf A, Grant AD, Balloux F, Pym AS, Padayatchi N, O'Donnell M. Bedaquiline resistance in drug-resistant tuberculosis HIV co-infected patients. Eur Respir J. 2020 Jun 4;55(6):1902383. doi: 10.1183/13993003.02383-2019. Print 2020 Jun.
- Nimmo C, Millard J, van Dorp L, Brien K, Moodley S, Wolf A, Grant AD, Padayatchi N, Pym AS, Balloux F, O'Donnell M. Population-level emergence of bedaquiline and clofazimine resistance-associated variants among patients with drug-resistant tuberculosis in southern Africa: a phenotypic and phylogenetic analysis. Lancet Microbe. 2020 Aug;1(4):e165-e174. doi: 10.1016/S2666-5247(20)30031-8.
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- Mansoor LE, Karim QA, Werner L, Madlala B, Ngcobo N, Cornman DH, Amico KR, Fisher J, Fisher WA, Macqueen KM, Karim SS. Impact of an adherence intervention on the effectiveness of tenofovir gel in the CAPRISA 004 trial. AIDS Behav. 2014 May;18(5):841-8. doi: 10.1007/s10461-014-0752-9.
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- Brust JC, Gandhi NR, Carrara H, Osburn G, Padayatchi N. High treatment failure and default rates for patients with multidrug-resistant tuberculosis in KwaZulu-Natal, South Africa, 2000-2003. Int J Tuberc Lung Dis. 2010 Apr;14(4):413-9.
- Nelson KN, Shah NS, Mathema B, Ismail N, Brust JCM, Brown TS, Auld SC, Omar SV, Morris N, Campbell A, Allana S, Moodley P, Mlisana K, Gandhi NR. Spatial Patterns of Extensively Drug-Resistant Tuberculosis Transmission in KwaZulu-Natal, South Africa. J Infect Dis. 2018 Nov 5;218(12):1964-1973. doi: 10.1093/infdis/jiy394. Erratum In: J Infect Dis. 2019 Jan 9;219(3):509.
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- O'Donnell MR, Daftary A, Frick M, Hirsch-Moverman Y, Amico KR, Senthilingam M, Wolf A, Metcalfe JZ, Isaakidis P, Davis JL, Zelnick JR, Brust JC, Naidu N, Garretson M, Bangsberg DR, Padayatchi N, Friedland G. Re-inventing adherence: toward a patient-centered model of care for drug-resistant tuberculosis and HIV. Int J Tuberc Lung Dis. 2016 Apr;20(4):430-4. doi: 10.5588/ijtld.15.0360.
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- O'Donnell MR, Wolf A, Werner L, Horsburgh CR, Padayatchi N. Adherence in the treatment of patients with extensively drug-resistant tuberculosis and HIV in South Africa: a prospective cohort study. J Acquir Immune Defic Syndr. 2014 Sep 1;67(1):22-9. doi: 10.1097/QAI.0000000000000221.
- Daftary A, Mondal S, Zelnick J, Friedland G, Seepamore B, Boodhram R, Amico KR, Padayatchi N, O'Donnell MR. Dynamic needs and challenges of people with drug-resistant tuberculosis and HIV in South Africa: a qualitative study. Lancet Glob Health. 2021 Apr;9(4):e479-e488. doi: 10.1016/S2214-109X(20)30548-9.
- Law S, Daftary A, O'Donnell M, Padayatchi N, Calzavara L, Menzies D. Interventions to improve retention-in-care and treatment adherence among patients with drug-resistant tuberculosis: a systematic review. Eur Respir J. 2019 Jan 10;53(1):1801030. doi: 10.1183/13993003.01030-2018. Print 2019 Jan.
- Bionghi N, Daftary A, Maharaj B, Msibi Z, Amico KR, Friedland G, Orrell C, Padayatchi N, O'Donnell MR. Pilot evaluation of a second-generation electronic pill box for adherence to Bedaquiline and antiretroviral therapy in drug-resistant TB/HIV co-infected patients in KwaZulu-Natal, South Africa. BMC Infect Dis. 2018 Apr 11;18(1):171. doi: 10.1186/s12879-018-3080-2.
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- Schindler-Ruwisch JM, Roess A, Robert RC, Napolitano MA, Chiang S. Social Support for Breastfeeding in the Era of mHealth: A Content Analysis. J Hum Lact. 2018 Aug;34(3):543-555. doi: 10.1177/0890334418773302. Epub 2018 May 22.
- Zelnick JR, Seepamore B, Daftary A, Amico KR, Bhengu X, Friedland G, Padayatchi N, Naidoo K, O'Donnell MR. Training social workers to enhance patient-centered care for drug-resistant TB-HIV in South Africa. Public Health Action. 2018 Mar 21;8(1):25-27. doi: 10.5588/pha.17.0114.
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