Simplified Antiviral Treatment Strategy for Hepatitis C in Myanmar

NCT ID: NCT03579576

Last Updated: 2019-07-29

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 803 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2017-12-20
• Study Completion Date: 2019-06-30

Brief Summary

The project will evaluate cost and treatment outcomes of a simplified hepatitis C virus (HCV) testing, treatment and care model integrated with HIV testing and treatment among key affected populations including people who inject drugs (PWID) in Myanmar.

Detailed Description

Affected populations will be screened for HCV and HIV and treated with direct a fixed-dose combination of sofosbuvir 400 mg/velpatasvir 100 mg (SOF/VEL) orally once daily for 12 weeks with or without weight-based ribavirin. Before and after completion of the treatment course viral load assessments will be undertaken using low-cost laboratory monitoring for comparison to standard HCV viral load measurement. Up to 800 patients enrolled on treatment will be followed up at 4, 8, 12 and 24 weeks when Sustained Viral Load ( SVL) will be determined. Safety monitoring will be undertaken at applicable visits for those on Ribavirin and all adverse events will be reported based on Good Clinical Practice. In addition to assessing to assessing cost outcomes, the project will assess HCV treatment efficacy in terms of sustained virologic response at 12 weeks after end of HCV treatment (defined as undetected HCV RNA or less than lower limit of detection), compare the cost of low cost HCV viral assay platforms to standard of care, assess rates of ART initiation and virologic suppression of HIV-infected persons within the simplified HCV testing and treatment model and impact of HIV co-infection in participants on the HCV treatment outcome of sustained virologic response (SVR12). The project will be conducted 3 treatment sites in Yangon, Mandalay, and Kachin state in Myanmar.

Conditions

Hepatitis C; Hepatitis B; HIV Infections

Study Design

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

Study Groups

HCV infected patients

All participants found HCV infected with or without HIV will be initiated treatment and followed up until 24 weeks ( 12 weeks after treatment)

sofosbuvir 400 mg/velpatasvir 100 mg (SOF/VEL) orally once daily for 12 weeks with or without weight-based ribavirin.

Intervention Type: DRUG

Direct Acting anti-HCV drugs given to all HCV infected participants at baseline.Those with Co-infections like HIV and or HBV will be given treatment as per national guidelines.

Interventions

sofosbuvir 400 mg/velpatasvir 100 mg (SOF/VEL) orally once daily for 12 weeks with or without weight-based ribavirin.

Direct Acting anti-HCV drugs given to all HCV infected participants at baseline.Those with Co-infections like HIV and or HBV will be given treatment as per national guidelines.

Intervention Type: DRUG

Eligibility Criteria

Inclusion Criteria

1. Ability and willingness of participant to provide informed consent.

2. Men and women age 18 years.

3. Active HCV infection as defined by detectable serum or plasma HCV RNA at any time prior to study entry. Documentation may be obtained from medical records if available. NOTE: If no medical records on HCV infection are available, active HCV infection must be confirmed by a detectable HCV RNA PCR prior to project entry.

4. Allowed HCV treatment history:

1. HCV treatment naïve defined as not having been previously treated for Hepatitis C infection with any medications approved for the treatment of HCV in any country.

2. HCV treatment experienced with interferon with or without ribavirin only (no prior DAA treatment).

5. Chronic Hepatitis B status must be documented by hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (HBsAb), and hepatitis B core antibody (HBcAb) testing. Participants with positive HBsAg must be already on an active HBV regimen at study entry.

6. HIV-1 infection status must be documented as either absent or present, as defined below:

1. Absence of HIV-1 infection, as documented by rapid HIV test or HIV-1 enzyme immunoassay (ELISA) test kit, within 60 days prior to entry.

OR

2. Presence of HIV-1 infection, documented by rapid HIV test or HIV-1 ELISA test kit at any time prior to entry.

OR

3. HIV-1 infection confirmed by medical documentation as participant is registered in care at AIDS Center and receiving or preparing to initiate ARV treatment.

7. HIV co-infected participants taking ART or planning to initiate ART, should be:

1. Tolerating ART for at least 2 weeks without signs of needing to modify or discontinue the ART regimen before initiating HCV treatment.

AND

2. The ART regimen must be a regimen that can be co-administered with SOF/VEL.

8. Participants who are assigned to receive ribavirin as part of the treatment protocol must have hemoglobin ≥11.0 g/dL

9. For females of reproductive potential who will receive ribavirin, a negative urine pregnancy test (urine -HCG with a sensitivity of <25 mIU/mL) within 48 hours prior to project entry (HCV treatment initiation) must be documented.

10. Male and female participants who are able to impregnate or become pregnant (ie, of reproductive potential) and are participating in sexual activity that could lead to pregnancy must agree to practice contraception/birth control as indicated below or agree to not participate in a conception process while on treatment with ribavirin through at least 12 weeks post-treatment.

11. Life expectancy >12 months, in the opinion of the site investigator

Exclusion Criteria

1. Child-Pugh Score corresponding to Class B or C (decompensated cirrhosis). This requires assessment for encephalopathy and ascites, as well as measurement of serum bilirubin, albumin, and international normalized ratio (prothrombin time).

2. Breastfeeding or pregnancy if patient will be receiving ribavirin.

3. Known allergy/sensitivity or any hypersensitivity to components of drug(s) or their formulation.

4. Acute tuberculosis (TB) infection. They will be followed and offered enrolment when they complete TB treatment.

5. Renal impairment defined as estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73m2 or end-stage renal disease receiving dialysis as treatment with SOF/VEL is contraindicated (https://www.mdcalc.com/mdrd-gfr-equation).

6. Unwilling to provide informed consent for participation in the project.

7. Prior treatment with any HCV Direct Acting Agents (DAA).

8. Unable or unwilling to adhere to the HCV treatment course and monitoring in the opinion of the investigator.

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

Sponsors

Community Partners International

OTHER

Sponsor Role: collaborator

Myanmar Liver Foundation

OTHER

Sponsor Role: collaborator

Boston University

OTHER

Sponsor Role: collaborator

University of California, Los Angeles

OTHER

Sponsor Role: collaborator

Ministry of Health and Sports, Myanmar

OTHER_GOV

Sponsor Role: collaborator

Right to Care

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Ian Sanne, MBBCH,FRCP

Role: STUDY_CHAIR

Right to Care

Khin Pyone Khi, MBBS,FRCP,PhD

Role: PRINCIPAL_INVESTIGATOR

Myanmar Liver Foundation

Charles Chasela, PhD

Role: STUDY_DIRECTOR

Right to Care

Locations

Waimaw

Kāchen, Kachin State, Burma

Myanmar Liver Foundation Clinic

Mandalay, , Burma

Myanmar Liver Foundation Charity Clinic

Yangon, , Burma

Countries

Burma

Other Identifiers

EQUIPHCV01-MY

Identifier Type: -

Identifier Source: org_study_id