Optimizing the Delivery of HIV nPEP

NCT ID: NCT03259698

Last Updated: 2021-11-22

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

UNKNOWN

Clinical Phase

PHASE2

Total Enrollment

434 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-11-04

Study Completion Date

2023-08-31

Brief Summary

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Despite decades of traditional prevention efforts based on behavior change and condom use, Ontario has seen over 700 new HIV infections annually over the past 10 years. Post-exposure prophylaxis (PEP) is one such approach, in which uninfected persons use 28 days of antiretroviral medications (ARVs) shortly after an HIV exposure to minimize the risk of acquiring HIV. PEP is highly efficacious, is considered a standard of care intervention based on medical and ethical grounds, and is supported by treatment guidelines. Yet several implementation challenges have limited its clinical and public health impact in Ontario, where no formal PEP policy exists. Our proposal seeks to optimize two aspects of delivering PEP for sexual exposures (nPEP). Results will inform the development of a standardized approach to nPEP both province-wide and elsewhere.

Thus study has pragmatic, multicenter randomized controlled trial using a 2x2 factorial design to determine whether the proportion of nPEP patients that successfully complete follow-up:

1. is higher among those receiving mobile phone-based text messaging support than among those receiving standard care; and
2. is non-inferior among those receiving care from a sexual health clinic nurse compared to those receiving hospital-based physician care.

The prospective, randomized, non-blinded, 2x2 factorial trial that will enroll 318 study participants in Toronto. In Intervention A, we will randomize half of study participants to a text messaging support service ('WelTel'), in which a trained, community-based counselor provides standardized weekly 'check-in' messages during their 12-week course of PEP follow-up. The other half will receive standard care, which does not include any form of active outreach or reminders outside of scheduled appointments. In Intervention B, we will randomize half of participants to receive nurse-led care for PEP follow-up at a local sexual health clinic; the other half will receive standard care by a hospital-based ID physician. The specific activities for each follow-up visit will be clearly defined in a medical directive. In keeping with Ontario legislation on medical directives, nurses will review cases with their authorizing physician or nurse practitioner on a routine basis.

Detailed Description

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Conditions

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HIV Infections

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SEQUENTIAL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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ARM 1 = TEXT MESSAGING SUPPORT

PEP will be delivered by ID physician and participants will receive weekly text message "check-ins" and optional automated text appointment reminders via the WelTel system.

Group Type EXPERIMENTAL

nPEP

Intervention Type DRUG

Participants will receive Bictegravir/emtricitabine/tenofovir alafenamide 50/200/25mg (Biktarvy®) one tablet once daily as study drug to complete a 28 day course of PEP.

Text Messaging Support

Intervention Type BEHAVIORAL

Text messaging support service ('WelTel'): community-based counselors will provides standardized weekly 'check-in' messages during the participants 12-week course of nPEP follow-up. Participants in the text-message arm will also have the option of receiving generic non-specific automated text reminders of their upcoming appointments in the form of "Don't forget about tomorrow".

ARM 2 = NO TEXT MESSAGING SUPPORT

PEP will be delivered according to the standard of care by an infectious diseases physician. Participants will not receive text message reminders or "check-in".

Group Type EXPERIMENTAL

nPEP

Intervention Type DRUG

Participants will receive Bictegravir/emtricitabine/tenofovir alafenamide 50/200/25mg (Biktarvy®) one tablet once daily as study drug to complete a 28 day course of PEP.

ARM 3 = NURSE-LED nPEP

PEP will be delivered by a sexual health clinic nurse operating under a medical directive.

Group Type EXPERIMENTAL

nPEP

Intervention Type DRUG

Participants will receive Bictegravir/emtricitabine/tenofovir alafenamide 50/200/25mg (Biktarvy®) one tablet once daily as study drug to complete a 28 day course of PEP.

Nurse-Led nPEP

Intervention Type OTHER

nPEP follow-up is provided by nurse-led care at a local sexual health clinic instead of a hospital-based ID physician.

ARM 4 = ID PHYSICIAN-LED nPEP,

PEP will be delivered according to the standard of care by an infectious diseases physician.

Group Type ACTIVE_COMPARATOR

nPEP

Intervention Type DRUG

Participants will receive Bictegravir/emtricitabine/tenofovir alafenamide 50/200/25mg (Biktarvy®) one tablet once daily as study drug to complete a 28 day course of PEP.

Interventions

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nPEP

Participants will receive Bictegravir/emtricitabine/tenofovir alafenamide 50/200/25mg (Biktarvy®) one tablet once daily as study drug to complete a 28 day course of PEP.

Intervention Type DRUG

Text Messaging Support

Text messaging support service ('WelTel'): community-based counselors will provides standardized weekly 'check-in' messages during the participants 12-week course of nPEP follow-up. Participants in the text-message arm will also have the option of receiving generic non-specific automated text reminders of their upcoming appointments in the form of "Don't forget about tomorrow".

Intervention Type BEHAVIORAL

Nurse-Led nPEP

nPEP follow-up is provided by nurse-led care at a local sexual health clinic instead of a hospital-based ID physician.

Intervention Type OTHER

Other Intervention Names

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Biktarvy Bictegravir/emtricitabine/tenofovir alafenamide BIC/FTC/TAF

Eligibility Criteria

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Inclusion Criteria

1. Be 18 years or older
2. Be known or presumed to be HIV-uninfected at baseline
3. Be initiated on PEP by a healthcare provider in the past six days for a sexual exposure to a known or suspected HIV-infected source
4. STAGE 1 only: Own a mobile phone with text messaging capabilities on which they are willing to potentially receive messages from the text messaging service
5. Be capable of communicating verbally and via text in English
6. Be planning to continue their follow-up locally or be willing to have follow-up study visits conducted remotely; either by telephone or via an encrypted video conferencing system (such as Zoom for healthcare).
7. Be referred to a sexual assault center and provided with necessary counselling and support services if presented for nPEP following sexual assault.

Exclusion Criteria

1. Creatinine clearance \<30 mL/min (using Cockcroft-Gault formula)
2. Enrolled in any other clinical trial of an HIV prevention intervention
3. Prior participation in this clinical trial for a previous episode of nPEP
4. Known co-infection with chronic hepatitis B at enrollment
5. Current or planned pregnancy or breastfeeding
6. Use of a medication whose co-administration with Biktarvy is contraindicated (dofetilide, carbamazepine, oxcarbazepine, phenobarbital, phenytoin, rifampin, rifampicin, rifabutin, rifapentine, modafinil, dexamethasone, metformin, St. John's Wort)
7. Concomitant use of HIV pre-exposure prophylaxis (PrEP)
8. Stage 2 only: Concomitant use of any non-prescription medication, supplement, vitamin or natural remedy which the patient is unwilling to discontinue during Biktarvy® administration
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Canadian Institutes of Health Research (CIHR)

OTHER_GOV

Sponsor Role collaborator

CIHR Canadian HIV Trials Network

NETWORK

Sponsor Role collaborator

Unity Health Toronto

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Darrell HS Tan, MD, FRCPC, PhD

Role: PRINCIPAL_INVESTIGATOR

Unity Health Toronto

Isaac I Bogoch, MD, FRCPC, MSc

Role: PRINCIPAL_INVESTIGATOR

Toronto General Hospital

Locations

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HIV Prevention Clinic (Toronto General Hospital)

Toronto, Ontario, Canada

Site Status RECRUITING

Positive Care Clinic (St. Michael's Hospital)

Toronto, Ontario, Canada

Site Status RECRUITING

Crossways Sexual Health Clinic (TPH)

Toronto, , Canada

Site Status RECRUITING

Countries

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Canada

Central Contacts

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Darrell HS Tan, MD, FRCPC, PhD

Role: CONTACT

Phone: 416-864-5568

Email: [email protected]

Attia Qamar, BME

Role: CONTACT

Email: [email protected]

Facility Contacts

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Karla Fisher, BSc, MSc

Role: primary

Attia Qamar, BME

Role: primary

Natalie Fawcett, BSN, MSN, NP

Role: primary

References

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Palmer MJ, Henschke N, Villanueva G, Maayan N, Bergman H, Glenton C, Lewin S, Fonhus MS, Tamrat T, Mehl GL, Free C. Targeted client communication via mobile devices for improving sexual and reproductive health. Cochrane Database Syst Rev. 2020 Jul 14;8(8):CD013680. doi: 10.1002/14651858.CD013680.

Reference Type DERIVED
PMID: 32779730 (View on PubMed)

Other Identifiers

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CTN 287

Identifier Type: -

Identifier Source: org_study_id