Pre-Exposure Prophylaxis (PrEP) Adherence Monitoring Using Dried Blood Spots

NCT ID: NCT02022657

Last Updated: 2019-04-30

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE1/PHASE2

Total Enrollment

52 participants

Study Classification

INTERVENTIONAL

Study Start Date

2014-04-30

Study Completion Date

2017-01-31

Brief Summary

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The primary objective of this study is to define the mean, variance, and dose proportionality for tenofovir-diphosphate(TFV-DP) in dried blood spots resulting from 33%, 67%, and 100% of daily dosing with 200mg emtricitabine and 300mg of tenofovir disoproxil fumarate (as Truvada®). With this information, a model will be established to predict adherence rates to TFV-DP using DBS. Forty-eight healthy HIV-uninfected adult participants who are at low risk for HIV infection will be randomized to one of 6 sequences consisting of two directly observed dosing regimens, 33%/67%, 33%/100%, 67%/33%, 67%/100%, 100%/33%, and 100%/67% with each dose regimen lasting approximately 12 weeks, separated by an approximately 12 week washout period. DBS will be collected at regular intervals, including during the washout. The hypothesis of the study is that levels of TFV-DP in DBS will predict adherence rates in the preceding 1-3 months.

Detailed Description

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Conditions

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PrEP Adherence Monitoring

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Primary Study Purpose

OTHER

Blinding Strategy

NONE

Study Groups

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33%/67%

Participants will be randomized to one of 6 sequences consisting of two directly observed dosing regimens expressed as % of daily dosing of Truvada

Group Type ACTIVE_COMPARATOR

Truvada

Intervention Type DRUG

Truvada is a combination pill consisting of tenofovir and emtricitabine used in PrEP

33%/100%

Participants will be randomized to one of 6 sequences consisting of two directly observed dosing regimens expressed as % of daily dosing of Truvada

Group Type ACTIVE_COMPARATOR

Truvada

Intervention Type DRUG

Truvada is a combination pill consisting of tenofovir and emtricitabine used in PrEP

67%/33%

Participants will be randomized to one of 6 sequences consisting of two directly observed dosing regimens expressed as % of daily dosing of Truvada

Group Type ACTIVE_COMPARATOR

Truvada

Intervention Type DRUG

Truvada is a combination pill consisting of tenofovir and emtricitabine used in PrEP

67%/100%

Participants will be randomized to one of 6 sequences consisting of two directly observed dosing regimens expressed as % of daily dosing of Truvada

Group Type ACTIVE_COMPARATOR

Truvada

Intervention Type DRUG

Truvada is a combination pill consisting of tenofovir and emtricitabine used in PrEP

100%/33%

Participants will be randomized to one of 6 sequences consisting of two directly observed dosing regimens expressed as % of daily dosing of Truvada

Group Type ACTIVE_COMPARATOR

Truvada

Intervention Type DRUG

Truvada is a combination pill consisting of tenofovir and emtricitabine used in PrEP

100%/67%

Participants will be randomized to one of 6 sequences consisting of two directly observed dosing regimens expressed as % of daily dosing of Truvada

Group Type ACTIVE_COMPARATOR

Truvada

Intervention Type DRUG

Truvada is a combination pill consisting of tenofovir and emtricitabine used in PrEP

Interventions

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Truvada

Truvada is a combination pill consisting of tenofovir and emtricitabine used in PrEP

Intervention Type DRUG

Other Intervention Names

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Tenofovir Emtricitabine

Eligibility Criteria

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Inclusion Criteria

1. Ambulatory 18-50 year old adults. Enrollment will target approximately half women and approximately one third African-Americans and one third Latino.
2. Ability to comply with study procedures, including directly observed dosing visits and availability and use of audio-video streaming technology.

Exclusion Criteria

1. Inability to give informed consent
2. A minimum scalp hair length of 2 cm in the occipital region.
3. Pregnancy or plan to become pregnant or unwillingness to use birth control
4. Current breastfeeding.
5. High risk of HIV-1 infection (for example: sexually active with an HIV infected partner; men who have sex with men who may engage in condom-less intercourse with HIV-infected partners or partner of unknown status during the study; males or females who exchange sex for money, shelter, or gifts; active injection drug use or during the last 12 months; newly diagnosed sexually transmitted infections in last 6 months)
6. Positive screening HIV+ ELISA or suspected acute HIV infection in the opinion of the clinician. (example signs and symptoms of acute HIV infection include combinations of fever, headache, fatigue, arthralgia, vomiting, myalgia, diarrhea, pharyngitis, rash, night sweats, and adenopathy cervical or inguinal)
7. Positive Hepatitis B (HBV) surface antigen test at screening
8. Active psychiatric illness, social condition, or alcohol/drug abuse that, in the opinion of the investigators, would interfere with study requirements.
9. History of non-traumatic, pathologic bone fractures
10. Glomerular Filtration Rate (GFR, creatinine clearance) \< 60 ml/min (MDRD equation).
11. Urine dipstick protein ≥ 2+
12. Total bilirubin and/or hepatic transaminases (ALT and AST) ≥ 2.5x upper limit of normal
13. Absolute neutrophil count ≤ 1,500/mm3, platelets count ≤ 100,000/mm3, or hemoglobin ≤ 10 g/dL.
14. Medical condition that alters red blood cell kinetics including hemoglobinopathies or active hemolysis.
15. Any laboratory value or uncontrolled medical conditions that would interfere with the study conditions such as, heart disease and/or cancer.
16. Contraindicated concomitant medications (including investigational agents, aminoglycosides, ganciclovir/valganciclovir, chronic high-dose acyclovir/valacyclovir, cyclosporine, amphotericin B, foscarnet, and cidofovir, and products with same or similar active ingredients as the study medications (Truvada®) including ATRIPLA®, COMPLERA®, EMTRIVA®, VIREAD®; or drugs containing lamivudine or adefovir, which are close analogs of Emtricitabine (FTC) and tenofovir, respectively).
Minimum Eligible Age

18 Years

Maximum Eligible Age

50 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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San Francisco Department of Public Health

OTHER_GOV

Sponsor Role collaborator

National Institute of Allergy and Infectious Diseases (NIAID)

NIH

Sponsor Role collaborator

University of Colorado, Denver

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Peter L Anderson, PharmD

Role: PRINCIPAL_INVESTIGATOR

University of Colorado, Denver

Locations

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University of California San Francisco/San Francisco Department of Public Health

San Francisco, California, United States

Site Status

University of Colorado Denver

Aurora, Colorado, United States

Site Status

Countries

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United States

References

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Anderson PL, Liu AY, Castillo-Mancilla JR, Gardner EM, Seifert SM, McHugh C, Wagner T, Campbell K, Morrow M, Ibrahim M, Buchbinder S, Bushman LR, Kiser JJ, MaWhinney S. Intracellular Tenofovir-Diphosphate and Emtricitabine-Triphosphate in Dried Blood Spots following Directly Observed Therapy. Antimicrob Agents Chemother. 2017 Dec 21;62(1):e01710-17. doi: 10.1128/AAC.01710-17. Print 2018 Jan.

Reference Type BACKGROUND
PMID: 29038282 (View on PubMed)

Ibrahim ME, Castillo-Mancilla JR, Yager J, Brooks KM, Bushman L, Saba L, Kiser JJ, MaWhinney S, Anderson PL. Individualized Adherence Benchmarks for HIV Pre-Exposure Prophylaxis. AIDS Res Hum Retroviruses. 2021 Jun;37(6):421-428. doi: 10.1089/AID.2020.0108. Epub 2020 Dec 10.

Reference Type DERIVED
PMID: 33191774 (View on PubMed)

Grant RM, Pellegrini M, Defechereux PA, Anderson PL, Yu M, Glidden DV, O'Neal J, Yager J, Bhasin S, Sevelius J, Deutsch MB. Sex Hormone Therapy and Tenofovir Diphosphate Concentration in Dried Blood Spots: Primary Results of the Interactions Between Antiretrovirals And Transgender Hormones Study. Clin Infect Dis. 2021 Oct 5;73(7):e2117-e2123. doi: 10.1093/cid/ciaa1160.

Reference Type DERIVED
PMID: 32766890 (View on PubMed)

Koss CA, Liu AY, Castillo-Mancilla J, Bacchetti P, McHugh C, Kuncze K, Morrow M, Louie A, Seifert S, Okochi H, MaWhinney S, Gandhi M, Anderson PL. Similar tenofovir hair concentrations in men and women after directly observed dosing of tenofovir disoproxil fumarate/emtricitabine: implications for preexposure prophylaxis adherence monitoring. AIDS. 2018 Sep 24;32(15):2189-2194. doi: 10.1097/QAD.0000000000001935.

Reference Type DERIVED
PMID: 30212404 (View on PubMed)

Castillo-Mancilla J, Seifert S, Campbell K, Coleman S, McAllister K, Zheng JH, Gardner EM, Liu A, Glidden DV, Grant R, Hosek S, Wilson CM, Bushman LR, MaWhinney S, Anderson PL. Emtricitabine-Triphosphate in Dried Blood Spots as a Marker of Recent Dosing. Antimicrob Agents Chemother. 2016 Oct 21;60(11):6692-6697. doi: 10.1128/AAC.01017-16. Print 2016 Nov.

Reference Type DERIVED
PMID: 27572401 (View on PubMed)

Other Identifiers

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U01AI106499

Identifier Type: NIH

Identifier Source: secondary_id

View Link

13-0427

Identifier Type: -

Identifier Source: org_study_id

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