Non-Communicable Diseases and Antiretroviral Therapy Outcomes in the RapIT Study Population

NCT ID: NCT02012972

Last Updated: 2021-01-08

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 354 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2014-01-31
• Study Completion Date: 2017-04-30

Brief Summary

For national antiretroviral therapy (ART) programs, the most important health system goals in reducing morbidity and mortality among HIV-infection patients are to initiate treatment as early as eligibility criteria allow and to achieve the highest possible long-term retention of patients on ART. In South Africa, cohort data have consistently found high attrition among ART patients, with the combined cumulative outcomes of death and loss to follow up averaging 25-40% over the first five years after ART initiation. Like many other middle income countries, South Africa also faces very high rates of non-communicable diseases (NCDs) and NCD risks. Despite this, there are virtually no studies looking at interactions between ART and NCDs, and none that have considered the effect of NCDs and NCD risk factors on achieving the second health system goal mentioned above: long term retention on ART.

Detailed Description

The main RapIT study focuses on rapid initiation of ART, with short-term (6-month) attrition from treatment and viral suppression as the primary outcomes. In this supplemental study, we will evaluate the role of NCDs and NCD risk factors on long-term retention on ART, with outcomes including mortality, loss to follow up, viral suppression and immunologic improvement, and physical functioning, ability to perform normal daily activities, and economic productivity among patients already on ART. The study will enroll up to 400 adult patients already on ART for ≥ 12 months at the RapIT study site. At enrollment, consented subjects will be screened for elevated levels of several NCD risk factors including body mass index; glucose using HbA1c levels; blood pressure and cholesterol; as well as signs of abnormalities in hepatic, renal, and lung function. A medical history will be taken, and a questionnaire will gather information about chronic pain, alcohol use, smoking, physical functioning, ability to perform normal daily activities, and economic productivity. Referral for further NCD diagnosis and care will be offered as needed. Existing electronic medical records will be accessed to obtain retrospective data since ART initiation and to follow subjects prospectively for up to 24 months after the enrollment screening is completed. Six months after enrollment, subjects with NCDs or at high risk of NCDs will be re-screened at a routine ART medication pickup visit to assess uptake of referral and whether risks, conditions, or outcomes have changed. The study will help identify reasons for poor outcomes on ART and point to interventions that will help achieve the overall goals of the national ART program.

Conditions

Antiretroviral Therapy, Highly Active; Diabetes Mellitus, Type 2; Cardiovascular Diseases

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Study Groups

NCD Risks

Study subjects with NCD risks or disease at enrollment. Each of these subjects will have a Referral for NCD care

Referral for NCD care

Intervention Type: BEHAVIORAL

Subjects in the NCD Risks group not already receiving care for the condition will be referred to a primary health clinic for care.

No NCD Risks

Study subjects without NCD risks or disease at enrollment.

No interventions assigned to this group

Interventions

Referral for NCD care

Subjects in the NCD Risks group not already receiving care for the condition will be referred to a primary health clinic for care.

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

• Adult ART patients >35 years old.
• Initiated ART at least 12 months prior to study enrollment.
• Presenting at study clinic for a routine ART monitoring visit.

Exclusion Criteria

• Pregnant or within first six months post-partum.
• Already enrolled in the RapIT study or another research study.
• Stated intention to transfer care to another location during the next 12 months.
• Not physically or emotionally able to participate in the study, in the opinion of the investigators.
• Not willing or able to provide written informed consent to participate in the study.
• Previously enrolled in the same study.

• Minimum Eligible Age: 35 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of Witwatersrand, South Africa

OTHER

Sponsor Role: collaborator

National Institute of Allergy and Infectious Diseases (NIAID)

NIH

Sponsor Role: collaborator

City of Johannesburg

UNKNOWN

Sponsor Role: collaborator

Boston University

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Sydney Rosen, MPA

Role: PRINCIPAL_INVESTIGATOR

Boston University

Locations

Thuthukani Health Centre

Johannesburg, Gauteng, South Africa

Countries

South Africa

Other Identifiers

U01AI100015

Identifier Type: NIH

Identifier Source: secondary_id

View Link

M130958

Identifier Type: OTHER

Identifier Source: secondary_id

H-32549

Identifier Type: -

Identifier Source: org_study_id