The Study for the "Cervical Cancer Screening and Treatment Algorithms Study Using HPV Testing in Africa"

NCT ID: NCT04794660

Last Updated: 2024-03-13

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

ACTIVE_NOT_RECRUITING

Clinical Phase

PHASE3

Total Enrollment

1500 participants

Study Classification

INTERVENTIONAL

Study Start Date

2019-10-01

Study Completion Date

2025-10-01

Brief Summary

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The main objectives of CESTA are (1) to compare the efficacy of two cervical cancer screening algorithms: HPV test followed by visual inspection with acetic acid (VIA) and treatment (HPV + VIA + treat) and HPV test followed by immediate treatment (HPV + treat). The study will be conducted to address its objectives in women living with HIV (from now on called HIV positive women); and 2) To evaluate the performance of other techniques for primary screening and as triage for HPV positives WLHIV.

1,500 women living with HIV WLHIV will be recruited from HIV care clinics, also called antiretrovirals (ARV) clinics in South Africa. After giving informed consent, women will be screened with HPV testing and those that have a HPV positive test will be randomized at a 4:1 ratio into HPV + VIA + treat (Arm 1) and HPV + treat (Arm 2). Women in Arm 1 will receive VIA and only positive for VIA will be treated. In Arm 2, all HPV positive women will be treated. Women that are eligible for ablative treatment will be randomized into treatment with TA or cryotherapy in both arms. Others will be referred to colposcopy. After VIA in Arm 1 or before treatment in Arm 2, the nurses will collect 2-4 biopsies on all HPV positive women. The biopsies will be used as gold standard for disease detection. Treated women will be called by telephone after 1 week and 1 month to assess side-effects and satisfaction with the procedures. Cervical samples from women will be tested with HPV DNA test and HPV mRNA test to evaluate different screening tests for WLHIV. All women with a positive HPV test (treated or not) will be called back after 1 year for a follow-up visit. At this visit, women will be screened with HPV testing and VIA and 2-4 colposcopy-directed biopsies will be taken from all HPV positive women. Women with remaining/recurrent CIN2+ disease will receive appropriate management.

Detailed Description

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Conditions

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HPV Infection

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SCREENING

Blinding Strategy

DOUBLE

Participants Caregivers
Care providers and participants are masked to the intervention ahead of the intervention. However, the strategy delivery is not blinded.

Study Groups

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Arm 1

In this arm, HPV-positive women will undergo a Visual Inspection with Acetic Acid (VIA) triage test followed by biopsies. Treatment by thermal ablation (or cryotherapy in South Africa) will be applied to VIA positive women eligible for ablative treatment. Non eligible women will be referred to colposcopy.

Group Type ACTIVE_COMPARATOR

HPV DNA Test

Intervention Type DIAGNOSTIC_TEST

Screening for HPV using a HPV DNA test

VIA triage test

Intervention Type DIAGNOSTIC_TEST

VIA is a technique in which cervical neoplastic lesions are visually diagnosed after application of 3-5% acetic acid without using any magnification device.

After application of 3 - 5% acetic acid, using the naked eye, the cervix is examined for the presence of an aceto-white lesion located in the transformation zone. The results are classified as either positive or negative, inadequate or suspicion of cancer

Treatment by ablative treatment

Intervention Type PROCEDURE

Cryotherapy or Thermal Ablation are performed on the cervix.

Colposcopy

Intervention Type PROCEDURE

Colposcopy visit are offered to women with non visible squamous columnar junction or ineligible for ablative treatment.

Arm 2

In this arm, HPV positive women will get biopsies and receive an ablative treatment by thermal ablation (or cryotherapy in South Africa) if they are eligible to ablative treatment. Non eligible women will be referred to colposcopy

Group Type ACTIVE_COMPARATOR

HPV DNA Test

Intervention Type DIAGNOSTIC_TEST

Screening for HPV using a HPV DNA test

Treatment by ablative treatment

Intervention Type PROCEDURE

Cryotherapy or Thermal Ablation are performed on the cervix.

Colposcopy

Intervention Type PROCEDURE

Colposcopy visit are offered to women with non visible squamous columnar junction or ineligible for ablative treatment.

Interventions

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HPV DNA Test

Screening for HPV using a HPV DNA test

Intervention Type DIAGNOSTIC_TEST

VIA triage test

VIA is a technique in which cervical neoplastic lesions are visually diagnosed after application of 3-5% acetic acid without using any magnification device.

After application of 3 - 5% acetic acid, using the naked eye, the cervix is examined for the presence of an aceto-white lesion located in the transformation zone. The results are classified as either positive or negative, inadequate or suspicion of cancer

Intervention Type DIAGNOSTIC_TEST

Treatment by ablative treatment

Cryotherapy or Thermal Ablation are performed on the cervix.

Intervention Type PROCEDURE

Colposcopy

Colposcopy visit are offered to women with non visible squamous columnar junction or ineligible for ablative treatment.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Willing to disclose HIV status
* HIV negative women aged 30-54 years; HIV positive women aged 25-54 years
* Mentally competent to give informed consent
* Physically able to have a pelvic exam

Exclusion Criteria

* Women reporting no previous sexual activity
* History of cervical cancer
* Treatment for cervical precancer in the last six months
* Hysterectomy
* Pregnancy
* Serious pre-existing medical conditions (e.g. history of bleeding disorders, serious physical or mental disease)
Minimum Eligible Age

25 Years

Maximum Eligible Age

54 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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World Health Organization

OTHER

Sponsor Role collaborator

University of KwaZulu

OTHER

Sponsor Role collaborator

Cheikh Anta Diop University, Senegal

OTHER

Sponsor Role collaborator

Walter Sisulu University

OTHER

Sponsor Role collaborator

International Agency for Research on Cancer

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Nathalie Broutet, Dr

Role: PRINCIPAL_INVESTIGATOR

World Health Organization

Maribel Almonte, Dr

Role: PRINCIPAL_INVESTIGATOR

IARC

Locations

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Roi Baudoin hospital

Dakar, , Senegal

Site Status

Wentworth Hospital

Durban, , South Africa

Site Status

Frere Hospital

East London, , South Africa

Site Status

Countries

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Senegal South Africa

Provided Documents

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Document Type: Study Protocol

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

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CESTA / PP202104-08

Identifier Type: -

Identifier Source: org_study_id

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