An Adaptive Strategy for Preventing and Treating Lapses of Retention in Adult HIV Care (AdaPT-R) in Nyanza, Kenya (AdaPT-R)
11 de março de 2021 atualizado por: 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.
Visão geral do estudo
Status
Concluído
Condições
Intervenção / Tratamento
- Comportamental: REC; Outreach if Failure
- Comportamental: REC; SMS + Voucher if Failure
- Comportamental: REC; Navigator if Failure
- Comportamental: SMS; Outreach if Failure
- Comportamental: SMS; Outreach if Failure; Stop SMS if Success
- Comportamental: SMS; SMS+Voucher if Failure
- Comportamental: SMS; SMS+Voucher if Failure; Stop SMS if Success
- Comportamental: SMS; Navigator if Failure
- Comportamental: SMS; Navigator if Failure; Stop SMS if Success
- Comportamental: Voucher; Outreach if Failure
- Comportamental: Voucher; Outreach if Failure; Stop Voucher if Success
- Comportamental: Voucher; SMS+Voucher if Failure
- Comportamental: Voucher; SMS+Voucher if Failure; Stop Voucher if Success
- Comportamental: Voucher; Navigator if Failure
- Comportamental: Voucher; Navigator if Failure; Stop Voucher if Success
Tipo de estudo
Intervencional
Inscrição (Real)
1816
Estágio
- Não aplicável
Contactos e Locais
Esta seção fornece os detalhes de contato para aqueles que conduzem o estudo e informações sobre onde este estudo está sendo realizado.
Locais de estudo
-
-
Nyanza
-
Kisumu, Nyanza, Quênia
- Kenya Medical Research Institute
-
-
Critérios de participação
Os pesquisadores procuram pessoas que se encaixem em uma determinada descrição, chamada de critérios de elegibilidade. Alguns exemplos desses critérios são a condição geral de saúde de uma pessoa ou tratamentos anteriores.
Critérios de elegibilidade
Idades elegíveis para estudo
18 anos e mais velhos (Adulto, Adulto mais velho)
Aceita Voluntários Saudáveis
Não
Gêneros Elegíveis para o Estudo
Tudo
Descrição
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.
Plano de estudo
Esta seção fornece detalhes do plano de estudo, incluindo como o estudo é projetado e o que o estudo está medindo.
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Pesquisa de serviços de saúde
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Nenhum (rótulo aberto)
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
|---|---|
|
Comparador Ativo: 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.
|
|
Comparador Ativo: 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.
|
|
Comparador Ativo: 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
|
|
Comparador Ativo: SMS; Outreach if Failure
|
SMS text messages for patients; followed by SOC outreach for patients 14 days late for a scheduled visit
|
|
Comparador Ativo: 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
|
|
Comparador Ativo: 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.
|
|
Comparador Ativo: 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
|
|
Comparador Ativo: 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
|
|
Comparador Ativo: 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
|
|
Comparador Ativo: 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
|
|
Comparador Ativo: 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
|
|
Comparador Ativo: 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
|
|
Comparador Ativo: 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
|
|
Comparador Ativo: 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
|
|
Comparador Ativo: 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
|
O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Retention
Prazo: Up to two years after enrollment
|
Fraction of time in care
|
Up to two years after enrollment
|
Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Alive with suppressed HIV RNA level (<400 copies/ml)
Prazo: 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
Prazo: 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)
Prazo: 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
Prazo: Two years after enrollment
|
Fraction of time in care
|
Two years after enrollment
|
|
Fraction on-time pharmacy pick-ups for antiretroviral drugs
Prazo: Two years after enrollment
|
Proportion of prescriptions filled and picked up by participants to prescriptions written
|
Two years after enrollment
|
|
Cost effectiveness
Prazo: 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
Prazo: At years one and two after study enrollment
|
Self-reported by questionnaire
|
At years one and two after study enrollment
|
Colaboradores e Investigadores
É aqui que você encontrará pessoas e organizações envolvidas com este estudo.
Patrocinador
Colaboradores
Investigadores
- Investigador principal: Elvin Geng, MD, University of California, San Francisco
- Investigador principal: Maya Petersen, MD, PhD, University of California, Berkeley
Datas de registro do estudo
Essas datas acompanham o progresso do registro do estudo e os envios de resumo dos resultados para ClinicalTrials.gov. Os registros do estudo e os resultados relatados são revisados pela National Library of Medicine (NLM) para garantir que atendam aos padrões específicos de controle de qualidade antes de serem publicados no site público.
Datas Principais do Estudo
Início do estudo
1 de março de 2015
Conclusão Primária (Real)
1 de novembro de 2020
Conclusão do estudo (Real)
1 de novembro de 2020
Datas de inscrição no estudo
Enviado pela primeira vez
11 de dezembro de 2014
Enviado pela primeira vez que atendeu aos critérios de CQ
9 de janeiro de 2015
Primeira postagem (Estimativa)
14 de janeiro de 2015
Atualizações de registro de estudo
Última Atualização Postada (Real)
16 de março de 2021
Última atualização enviada que atendeu aos critérios de controle de qualidade
11 de março de 2021
Última verificação
1 de março de 2021
Mais Informações
Termos relacionados a este estudo
Palavras-chave
Outros números de identificação do estudo
- 1R01MH104123-01 (Concessão/Contrato do NIH dos EUA)
Informações sobre medicamentos e dispositivos, documentos de estudo
Estuda um medicamento regulamentado pela FDA dos EUA
Não
Estuda um produto de dispositivo regulamentado pela FDA dos EUA
Não
produto fabricado e exportado dos EUA
Não
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