Operational Research for Cryptococcal Antigen Screening

NCT ID: NCT01535469

Last Updated: 2020-06-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

3049 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-07-01

Study Completion Date

2015-06-30

Brief Summary

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This will be a stepped wedge randomized trial design to evaluate the implementation of cryptococcal antigen (CRAG) screening and preemptive anti-fungal therapy of HIV-infected persons entering antiretroviral therapy (ART) outpatient treatment in Uganda. Those who are ART eligible with a CD4≤100 cells/mcL will have a serum/plasma CRAG performed by lateral flow assay. Those who are CRAG-positive and asymptomatic will be treated with high dose fluconazole. After 6 months survival with retention-in-care will be compared between those who are CRAG+ and CRAG negative

Detailed Description

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Conditions

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Cryptococcal Meningitis Cryptococcus Neoformans Cryptococcosis

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

PREVENTION

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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CrAg Screening and Fluconazole

Cryptococcal Antigen (CrAg) Screening with preemptive antifungal treatment per World Health Organization (WHO) guidelines. Randomized Stepped Wedge design of phased implementation.

Group Type EXPERIMENTAL

Fluconazole

Intervention Type DRUG

Fluconazole 800mg orally daily for 2 weeks, then 400mg daily for 8 weeks

Interventions

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Fluconazole

Fluconazole 800mg orally daily for 2 weeks, then 400mg daily for 8 weeks

Intervention Type DRUG

Other Intervention Names

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Diflucan

Eligibility Criteria

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Inclusion Criteria

* HIV-1 infection
* CD4≤100 cells/mcL
* Cryptococcal antigen (CRAG) positive
* age \>14 years

Exclusion Criteria

* Suspected Cryptococcal meningitis
* Prior known history of cryptococcal meningitis
* currently receiving HIV antiretroviral therapy
* Allergy to any azole antifungal medication
* Persons with known serious hepatic co-morbidities, transaminitis, or clinical jaundice who should not receive fluconazole in the opinion of the study investigator.
* Current known pregnancy
Minimum Eligible Age

14 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Infectious Diseases Institute, Uganda

OTHER

Sponsor Role collaborator

Makerere University

OTHER

Sponsor Role collaborator

Centers for Disease Control and Prevention

FED

Sponsor Role collaborator

University of Minnesota

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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David B Meya, MMed

Role: PRINCIPAL_INVESTIGATOR

Makerere University

Radha Rajasingham, MD

Role: STUDY_DIRECTOR

Infectious Disease Institute

Locations

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Infectious Disease Institute, Makerere University

Kampala, , Uganda

Site Status

Kampala Capital Council Authority Clinics

Kampala, , Uganda

Site Status

Countries

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Uganda

References

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Rajasingham R, Meya DB, Boulware DR. Integrating cryptococcal antigen screening and pre-emptive treatment into routine HIV care. J Acquir Immune Defic Syndr. 2012 Apr 15;59(5):e85-91. doi: 10.1097/QAI.0b013e31824c837e.

Reference Type BACKGROUND
PMID: 22410867 (View on PubMed)

Meya DB, Manabe YC, Castelnuovo B, Cook BA, Elbireer AM, Kambugu A, Kamya MR, Bohjanen PR, Boulware DR. Cost-effectiveness of serum cryptococcal antigen screening to prevent deaths among HIV-infected persons with a CD4+ cell count < or = 100 cells/microL who start HIV therapy in resource-limited settings. Clin Infect Dis. 2010 Aug 15;51(4):448-55. doi: 10.1086/655143.

Reference Type BACKGROUND
PMID: 20597693 (View on PubMed)

Meya DB, Kiragga AN, Nalintya E, Morawski BM, Rajasingham R, Park BJ, Mubiru A, Kaplan JE, Manabe YC, Boulware DR. Reflexive Laboratory-Based Cryptococcal Antigen Screening and Preemptive Fluconazole Therapy for Cryptococcal Antigenemia in HIV-Infected Individuals With CD4 <100 Cells/microL: A Stepped-Wedge, Cluster-Randomized Trial. J Acquir Immune Defic Syndr. 2019 Feb 1;80(2):182-189. doi: 10.1097/QAI.0000000000001894.

Reference Type RESULT
PMID: 30399034 (View on PubMed)

Related Links

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http://www.idi-makerere.com

Infectious Disease Institute

Other Identifiers

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U01GH000517

Identifier Type: NIH

Identifier Source: secondary_id

View Link

HS1254

Identifier Type: -

Identifier Source: org_study_id

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