Point of Care Virologic Testing to Improve Outcomes of HIV-Infected Children

NCT ID: NCT02682810

Last Updated: 2022-02-28

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

NA

Total Enrollment

4000 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-02-29

Study Completion Date

2019-09-24

Brief Summary

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This is a two-arm, unmasked, randomized, controlled trial to test the effectiveness of the Alere Q point-of-care (POC) HIV diagnostic assay for use in resource-poor settings.

Detailed Description

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At public sector clinics in Lusaka, Zambia, approximately 4,000 HIV-exposed infants between 4 and 12 weeks of life will be randomized in this trial of point-of-care virologic testing to improve outcomes of HIV-infected children in Zambia. There is a standard of care (SOC) or control arm and an intervention arm known as the Alere arm. In both study arms, early infant diagnosis (EID) will be provided at 6 weeks of life. Infants randomized to the SOC arm will receive EID through the existing prevention of mother-to-child-transmission (PMTCT) program, with samples sent to an off-site laboratory for DNA PCR testing. Infants randomized to the intervention arm will receive POC diagnostic Alere Q qualitative test (along with a dried blood spot (DBS) drawn for confirmatory DNA PCR).

HIV-infected infants will be followed for 12 months. The acceptability of point-of-care testing for EID will also be determined through the use of cross-sectional surveys of clinicians, laboratory personnel, and parents/guardians.

The feasibility will be assessed by a time-in-motion (TIM) and value stream mapping (VSM) analyses will also be conducted to compare the Alere Q to two additional testing technologies.

Conditions

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Early Infant HIV Diagnosis

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SCREENING

Blinding Strategy

NONE

Study Groups

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DNA PCR HIV diagnostic test

SOC or control arm through existing PMTCT program, with DBS samples sent to an off-site laboratory for DNA PCR testing.

Group Type ACTIVE_COMPARATOR

DNA PCR HIV diagnostic test

Intervention Type DEVICE

standard of care

Alere Q POC nucleic acid-based platform

POC test to provide same-day diagnosis

Group Type EXPERIMENTAL

Alere Q

Intervention Type DEVICE

POC diagnostic Alere Q qualitative test (along with a DBS drawn for confirmatory DNA PCR)

Interventions

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DNA PCR HIV diagnostic test

standard of care

Intervention Type DEVICE

Alere Q

POC diagnostic Alere Q qualitative test (along with a DBS drawn for confirmatory DNA PCR)

Intervention Type DEVICE

Eligibility Criteria

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Inclusion Criteria

* 4 to 12 weeks of life
* documented HIV exposure through seropositive maternal or infant HIV antibody test
* with a parent or guardian will and able to provide written informed consent and to have the participant followed for 12 months after study enrolment

Exclusion Criteria

* Infants will be excluded from participation if they have major congenital anomalies or other medical conditions that would require management at a referral facility or otherwise interfere with study procedures
Minimum Eligible Age

4 Weeks

Maximum Eligible Age

12 Weeks

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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National Institute of Allergy and Infectious Diseases (NIAID)

NIH

Sponsor Role collaborator

University of North Carolina, Chapel Hill

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Jeff Stringer, MD

Role: PRINCIPAL_INVESTIGATOR

University of North Carolina, Chapel Hill

Locations

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Chawama Health Centre

Lusaka, , Zambia

Site Status

Chelstone Health Centre

Lusaka, , Zambia

Site Status

Chilenje Health Centre

Lusaka, , Zambia

Site Status

Chipata Health Centre

Lusaka, , Zambia

Site Status

Kanyama Health Centre

Lusaka, , Zambia

Site Status

Mtendere Health Centre

Lusaka, , Zambia

Site Status

Countries

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Zambia

References

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Violari A, Cotton MF, Gibb DM, Babiker AG, Steyn J, Madhi SA, Jean-Philippe P, McIntyre JA; CHER Study Team. Early antiretroviral therapy and mortality among HIV-infected infants. N Engl J Med. 2008 Nov 20;359(21):2233-44. doi: 10.1056/NEJMoa0800971.

Reference Type BACKGROUND
PMID: 19020325 (View on PubMed)

UNAIDS. 2014 Progress Report on The Global Plan: http://www.unaids.org/sites/default/files/documents/JC2681_2014-Global-Plan-progress_en.pdf. Accessed: 01 February 2015.

Reference Type BACKGROUND

Stringer EM, Ekouevi DK, Coetzee D, Tih PM, Creek TL, Stinson K, Giganti MJ, Welty TK, Chintu N, Chi BH, Wilfert CM, Shaffer N, Dabis F, Stringer JS; PEARL Study Team. Coverage of nevirapine-based services to prevent mother-to-child HIV transmission in 4 African countries. JAMA. 2010 Jul 21;304(3):293-302. doi: 10.1001/jama.2010.990.

Reference Type BACKGROUND
PMID: 20639563 (View on PubMed)

Stringer JS, Sinkala M, Maclean CC, Levy J, Kankasa C, Degroot A, Stringer EM, Acosta EP, Goldenberg RL, Vermund SH. Effectiveness of a city-wide program to prevent mother-to-child HIV transmission in Lusaka, Zambia. AIDS. 2005 Aug 12;19(12):1309-15. doi: 10.1097/01.aids.0000180102.88511.7d.

Reference Type BACKGROUND
PMID: 16052086 (View on PubMed)

Antiretroviral Therapy for HIV Infection in Infants and Children: Towards Universal Access: Recommendations for a Public Health Approach: 2010 Revision. Geneva: World Health Organization; 2010. Available from http://www.ncbi.nlm.nih.gov/books/NBK138576/

Reference Type BACKGROUND
PMID: 23741772 (View on PubMed)

Braun M, Kabue MM, McCollum ED, Ahmed S, Kim M, Aertker L, Chirwa M, Eliya M, Mofolo I, Hoffman I, Kazembe PN, van der Horst C, Kline MW, Hosseinipour MC. Inadequate coordination of maternal and infant HIV services detrimentally affects early infant diagnosis outcomes in Lilongwe, Malawi. J Acquir Immune Defic Syndr. 2011 Apr 15;56(5):e122-8. doi: 10.1097/QAI.0b013e31820a7f2f.

Reference Type BACKGROUND
PMID: 21224736 (View on PubMed)

Newell ML, Coovadia H, Cortina-Borja M, Rollins N, Gaillard P, Dabis F; Ghent International AIDS Society (IAS) Working Group on HIV Infection in Women and Children. Mortality of infected and uninfected infants born to HIV-infected mothers in Africa: a pooled analysis. Lancet. 2004 Oct 2-8;364(9441):1236-43. doi: 10.1016/S0140-6736(04)17140-7.

Reference Type BACKGROUND
PMID: 15464184 (View on PubMed)

Laursen L. Point-of-care tests poised to alter course of HIV treatment. Nat Med. 2012 Aug;18(8):1156. doi: 10.1038/nm0812-1156. No abstract available.

Reference Type BACKGROUND
PMID: 22869167 (View on PubMed)

UNITAID. HIV/AIDS diagnostic technology landscape.Tech. Rep., WHO, Geneva, Switzerland, 2012.

Reference Type BACKGROUND

Jani IV, Meggi B, Mabunda N, Vubil A, Sitoe NE, Tobaiwa O, Quevedo JI, Lehe JD, Loquiha O, Vojnov L, Peter TF. Accurate early infant HIV diagnosis in primary health clinics using a point-of-care nucleic acid test. J Acquir Immune Defic Syndr. 2014 Sep 1;67(1):e1-4. doi: 10.1097/QAI.0000000000000250.

Reference Type BACKGROUND
PMID: 24933096 (View on PubMed)

Yusuf S, Collins R, Peto R. Why do we need some large, simple randomized trials? Stat Med. 1984 Oct-Dec;3(4):409-22. doi: 10.1002/sim.4780030421. No abstract available.

Reference Type BACKGROUND
PMID: 6528136 (View on PubMed)

Palumbo P, Lindsey JC, Hughes MD, Cotton MF, Bobat R, Meyers T, Bwakura-Dangarembizi M, Chi BH, Musoke P, Kamthunzi P, Schimana W, Purdue L, Eshleman SH, Abrams EJ, Millar L, Petzold E, Mofenson LM, Jean-Philippe P, Violari A. Antiretroviral treatment for children with peripartum nevirapine exposure. N Engl J Med. 2010 Oct 14;363(16):1510-20. doi: 10.1056/NEJMoa1000931.

Reference Type BACKGROUND
PMID: 20942667 (View on PubMed)

Bolton-Moore C, Mubiana-Mbewe M, Cantrell RA, Chintu N, Stringer EM, Chi BH, Sinkala M, Kankasa C, Wilson CM, Wilfert CM, Mwango A, Levy J, Abrams EJ, Bulterys M, Stringer JS. Clinical outcomes and CD4 cell response in children receiving antiretroviral therapy at primary health care facilities in Zambia. JAMA. 2007 Oct 24;298(16):1888-99. doi: 10.1001/jama.298.16.1888.

Reference Type BACKGROUND
PMID: 17954540 (View on PubMed)

Chibwesha CJ, Mollan KR, Ford CE, Shibemba A, Saha PT, Lusaka M, Mbewe F, Allmon AG, Lungu R, Spiegel HML, Mweni E, Mwape H, Kankasa C, Chi BH, Stringer JSA. A Randomized Trial of Point-of-Care Early Infant Human Immunodeficiency Virus (HIV) Diagnosis in Zambia. Clin Infect Dis. 2022 Aug 25;75(2):260-268. doi: 10.1093/cid/ciab923.

Reference Type DERIVED
PMID: 34718462 (View on PubMed)

Chibwesha CJ, Ford CE, Mollan KR, Stringer JS. Point-of-Care Virologic Testing to Improve Outcomes of HIV-Infected Children in Zambia: A Clinical Trial Protocol. J Acquir Immune Defic Syndr. 2016 Aug 1;72 Suppl 2(Suppl 2):S197-201. doi: 10.1097/QAI.0000000000001050.

Reference Type DERIVED
PMID: 27355509 (View on PubMed)

Related Links

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http://www.unc.edu

University of North Carolina website

Other Identifiers

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5U01AI100053-03

Identifier Type: NIH

Identifier Source: secondary_id

View Link

12-1346

Identifier Type: -

Identifier Source: org_study_id

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