Same-Day HIV Testing and Treatment Initiation to Improve Retention in Care

NCT ID: NCT01900080

Last Updated: 2016-10-11

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: NA
• Total Enrollment: 814 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2013-08-31
• Study Completion Date: 2017-01-31

Brief Summary

The purpose of this study is to determine if same-day HIV testing and antiretroviral therapy (ART) initiation improves retention in care (as measured by the proportion of participants who are alive and in-care with an undetectable viral load 12 months after HIV testing), compared with standard of care (three visits prior to ART initiation). Secondary outcomes include survival, ART initiation, retention in care with viral load < 200 and < 1000 copies/ml, 6-month viral load, and adherence as measured by self-report and pharmacy refill records. Enrollment for the main study was completed in October 2015.

In June 2015, enrollment was started for a new sub-study. This sub-study, funded by MAC AIDS, includes patients with WHO stage 1 or 2 disease and CD4 count >500 cells/mm3. The purpose of the sub-study is to compare 6-month retention for patients who receive same-day ART vs. standard pre-ART care. Secondary outcomes include adherence to INH and Bactrim, and cost-effectiveness between the two groups. Enrollment for the sub-study is ongoing.

Detailed Description

This study is a randomized trial to establish the effectiveness of same-day ART initiation for patients who present for HIV testing with early HIV clinical disease (World Health Organization [WHO] stage 1 or 2) who qualify for ART by immunologic criteria (CD4 cell count ≤500 cells/mm3) with rapid CD4 cell testing at the GHESKIO Center in Port-au-Prince, Haiti. All patients in the intervention group received rapid HIV antibody testing, CD4 cell testing, clinically relevant testing for opportunistic infections, WHO staging, comprehensive counseling and social support, and ART initiation on the day of presentation. The standard group received the same services as the same-day ART group (including CD4 cell testing) except that instead of same-day ART, they received the standard GHESKIO protocol of three sequential visits for ART readiness counseling and testing for opportunistic infections prior to ART initiation. For the same-day ART group, these activities took place on the day of ART initiation and during the subsequent two weeks. Three specific aims are proposed. The first aim is to compare the proportion of patients in the standard and same-day ART groups that are alive and in-care with an undetectable HIV viral load at 12 months after HIV testing. The second aim is to compare six-month ART adherence between the two groups using pharmacy refill records. The third aim is to compare the cost and cost-effectiveness of standard and same-day ART, where cost is measured by the mean treatment cost and effectiveness is measured by being alive and in care with an undetectable viral load at 12 months after HIV testing.

In a sub-study funded by MAC AIDS Foundation (enrollment started June 2015), patients with WHO stage 1 or 2 disease and CD4 count >500 cells/mm3 were included. They are being randomized to receive ART vs. standard pre-ART care. Participants are being enrolled in the study on the same day they receive CD4 count results, which is within 7 days of the date of HIV testing. All patients will receive additional tests as clinically indicated. All participants will receive prophylactic treatment with trimethoprim-sulfamethoxazole and isoniazid, and a daily multivitamin, as is standard of care at GHESKIO. Participants who are randomized to the standard pre-ART group will receive standard GHESKIO pre-ART care, which includes a monthly visit with a physician for 3 months, and then every other month physician visits. They will have a CD4 count annually, and start ART when they meet WHO criteria. Participants who are randomized to the same-day ART group will receive counseling and start ART on the day of study enrollment. They will have follow-up visits with the physician on Days 3, 10, 17, and 24, and with the social worker on Days 3, 10, and 17. They will have also have physician visits at weeks 8 and 12. Participants who are clinically stable, asymptomatic, and adherent at week 12 will then qualify for expedited care at future visits, which includes dispensing of ART directly by nurses in the clinic every four weeks, to reduce waiting time for patients. Participants who are symptomatic or non-adherent will be referred to a physician for evaluation.

Conditions

HIV

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: TREATMENT
• Blinding Strategy: NONE

Study Groups

Same-Day ART Group

Same-Day HIV testing and ART initiation:

All participants in the same-day ART group will receive rapid HIV antibody testing, CD4 cell testing, clinically relevant testing for OIs, WHO staging, counseling and social support, and ART initiation on the day of presentation for HIV testing.

Group Type: EXPERIMENTAL

Same-Day HIV testing and ART initiation

Intervention Type: OTHER

Same-day HIV testing and ART initiation

Standard ART Group

Standard ART Initiation:

The standard group will receive the same services as the same-day ART group (including same-day HIV and CD4 cell testing) except that instead of same-day ART, they will receive the standard GHESKIO protocol of 3 sequential visits for ART readiness counseling and testing for OIs prior to ART initiation.

Group Type: ACTIVE_COMPARATOR

Standard ART Initiation

Intervention Type: OTHER

Standard ART Initiation

Sub-Study - Same-Day ART, CD4>500

Sub-Study - Same-Day CD4 Count and ART Initiation for Patients with CD4 Count \>500 cells/mm3: Participants will receive counseling and start ART on the day of study enrollment. They will have follow-up visits with the physician on Days 3, 10, 17, and 24, and with the social worker on Days 3, 10, and 17. They will have also have physician visits at weeks 8 and 12. Participants who are clinically stable, asymptomatic, and adherent at week 12 will then qualify for expedited care at future visits, which includes dispensing of ART directly by nurses in the clinic every four weeks, to reduce waiting time for patients. Participants who are symptomatic or non-adherent will be referred to a physician for evaluation.

Group Type: EXPERIMENTAL

Sub-Study: Same-Day ART, CD4 Count >500

Intervention Type: OTHER

Same-day CD4 count and ART initiation for patients with CD4 count \>500 cells/mm3 (CD4 count within 7 days of HIV test)

Sub-Study - Pre-ART Care, CD4>500

Participants will receive standard GHESKIO pre-ART care, which includes a monthly visit with a physician for 3 months, and then every other month physician visits.

Group Type: ACTIVE_COMPARATOR

Sub-Study: Standard Pre-ART Care, CD4 Count >500

Intervention Type: OTHER

Standard pre-ART care for patients with CD4 count \>500 cells/mm3

Interventions

Same-Day HIV testing and ART initiation

Same-day HIV testing and ART initiation

Intervention Type: OTHER

Standard ART Initiation

Standard ART Initiation

Intervention Type: OTHER

Sub-Study: Same-Day ART, CD4 Count >500

Same-day CD4 count and ART initiation for patients with CD4 count \>500 cells/mm3 (CD4 count within 7 days of HIV test)

Intervention Type: OTHER

Sub-Study: Standard Pre-ART Care, CD4 Count >500

Standard pre-ART care for patients with CD4 count \>500 cells/mm3

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Age ≥18 years;
• Ability and willingness of participant to give written informed consent;
• CD4 cell count </=500 cells/mm3
• WHO stage 1 or 2 disease as defined by the following conditions: Asymptomatic; Persistent generalized lymphadenopathy; Moderate unexplained weight loss (under 10% of presumed or measured body weight); Recurrent upper respiratory tract infections (sinusitis, tonsillitis, otitis media, pharyngitis); Herpes zoster; Angular cheilitis; Recurrent oral ulcerations; Papular pruritic eruptions; Seborrheic dermatitis; Fungal nail infections

Exclusion Criteria

• Any use of ART in the past;
• Pregnancy or breastfeeding at the screening visit;
• Psychologically unprepared to start ART, based on ART readiness survey;
• Plans to transfer care to another clinic during the study period;
• WHO stage 3 or 4 disease.

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 100 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic

OTHER

Sponsor Role: collaborator

Weill Medical College of Cornell University

OTHER

Sponsor Role: collaborator

Harvard Medical School (HMS and HSDM)

OTHER

Sponsor Role: collaborator

Florida International University

OTHER

Sponsor Role: collaborator

Brigham and Women's Hospital

OTHER

Sponsor Role: lead

Responsible Party

Serena Patricia Koenig

Associate Physician

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Serena P Koenig, MD

Role: PRINCIPAL_INVESTIGATOR

Brigham and Women's Hospital

Jean W Pape, MD

Role: STUDY_DIRECTOR

GHESKIO; Weill Medical College of Cornell University

Marie Marcelle Deschamps, MD

Role: STUDY_DIRECTOR

Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic

Locations

Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections (GHESKIO)

Port-au-Prince, , Haiti

Countries

Haiti

References

Koenig SP, Dorvil N, Devieux JG, Hedt-Gauthier BL, Riviere C, Faustin M, Lavoile K, Perodin C, Apollon A, Duverger L, McNairy ML, Hennessey KA, Souroutzidis A, Cremieux PY, Severe P, Pape JW. Same-day HIV testing with initiation of antiretroviral therapy versus standard care for persons living with HIV: A randomized unblinded trial. PLoS Med. 2017 Jul 25;14(7):e1002357. doi: 10.1371/journal.pmed.1002357. eCollection 2017 Jul.

Reference Type: DERIVED

PMID: 28742880 (View on PubMed)

Other Identifiers

AI104344-01A1

Identifier Type: -

Identifier Source: org_study_id