Optimizing a Bio-behavioral Intervention for Sustained Viral Suppression

NCT ID: NCT05377463

Last Updated: 2024-09-03

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

RECRUITING

Clinical Phase

NA

Total Enrollment

220 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-05-10

Study Completion Date

2026-07-31

Brief Summary

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The study will test two behavioral intervention components to identify the combination of the two components that best supports people who inject drugs to achieve and sustain HIV viral load suppression.

The study design is a 2-to-the-2 factorial experiment. The 2 represents the level of each component: 0 (receive) or 1 (don't receive). The 2 represents the number of components being tested. The four components are: 1) receiving (or not receiving) peer support services for medication-assisted treatment (MAT) uptake and persistence and 2) behavioral activation therapy for depression (BAT). Therefore, in order to test which combination of components produce the best outcome, this factorial design randomizes people to 1 of 4 conditions. Each condition represents a possible combination of the 2 components above. All participants will receive patient navigation for care engagement.

Detailed Description

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Participants will be randomly assigned to one of 4 experimental conditions. Each condition will represents every possible combination of 2 components (e.g., 1 only, 2 only, 1-2, none). Participants complete a survey assessment at baseline, complete their assigned intervention components, and then return to complete follow-up assessment surveys at 3-, 6-,9-, and 12-months. The primary outcome is sustained viral suppression defined as viral load test results of \<400 copies per mL on all 6-,9-, and 12-month follow-up visits. Results of Aim 1 will yield estimates of the unique impact of each intervention component, as well as each combination of components, on sustained viral suppression. The research team and partners will make decisions about what constitutes the optimized intervention by judging the observed effect sizes and statistical significance against real-world constraints that go into the delivery of the interventions. The secondary aims are to test mediators to explain component 1-2 and its relationship to viral suppression. We will also test moderators of these relationship between each component and outcome of viral suppression.

Conditions

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HIV Viremia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

The factorial experiment is guided by the Multiphase Optimization Strategy (MOST).

The 2 intervention components are:

Component 1. Peer recovery coaching to promote uptake and persistence of medication assisted treatment in the form of methadone.

Component 2. Behavioral activation therapy to reduce depression.

Participants will be randomly assigned to receive a total of 0 or up to 2 components. There are 4 conditions because there are 4 possible combinations of the 2 components (e.g., Condition 1 = Delivery of 1 whereas Condition 3 = Delivery of 1 and 2). All participants will receive a standard of care package which will consist of referral and patient navigation to HIV treatment services, linkage to a peer support group, and harm reduction education and materials.
Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

SINGLE

Outcome Assessors
The outcome assessors will be blind to the experimental condition that the participant was assigned to.

Study Groups

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Condition 1: Component 1

1\) Peer-Support for Medication-Assisted Treatment

Group Type EXPERIMENTAL

Peer support to promote uptake and persistence of medication assisted treatment (MAT)

Intervention Type BEHAVIORAL

Participants will be assigned to receive peer support to promote uptake of MAT and persistence. This component will consist of two informational sessions, a tailored recovery plan, and on-going support from a peer for the first 6 months.

Condition 2: Component 2

2\) Behavioral Activation Therapy

Group Type EXPERIMENTAL

Behavioral Activation Treatment (BAT) to reduce depression

Intervention Type BEHAVIORAL

Participants will be assigned to receive BAT treatment for depression. This component will consist of 8 sessions where participants will identify short and long-term goals, values, and the activities unrelated to substance use that were previously enjoyed or are likely to increase a feeling of well-being. This intervention component focuses on making a plan to troubleshoot barriers to re-engage in these activities. Sessions are delivered weekly. The content includes psycho-education about what depression is, the intervention rationale, and the activities and monitoring of activities, building social contracts to engage networks, and discussion of potential barriers to following through with activities.

Condition 3: Components 1 and 2

Participants assigned to a combination of:

1. Peer-Support for Medication-Assisted Treatment
2. Behavioral Activation Therap

Group Type EXPERIMENTAL

Peer support to promote uptake and persistence of medication assisted treatment (MAT)

Intervention Type BEHAVIORAL

Participants will be assigned to receive peer support to promote uptake of MAT and persistence. This component will consist of two informational sessions, a tailored recovery plan, and on-going support from a peer for the first 6 months.

Behavioral Activation Treatment (BAT) to reduce depression

Intervention Type BEHAVIORAL

Participants will be assigned to receive BAT treatment for depression. This component will consist of 8 sessions where participants will identify short and long-term goals, values, and the activities unrelated to substance use that were previously enjoyed or are likely to increase a feeling of well-being. This intervention component focuses on making a plan to troubleshoot barriers to re-engage in these activities. Sessions are delivered weekly. The content includes psycho-education about what depression is, the intervention rationale, and the activities and monitoring of activities, building social contracts to engage networks, and discussion of potential barriers to following through with activities.

Condition 4: No Components

Participants not assigned to any of the 2 components. They are placed on a wait list and will receive components after the primary data collection period.

Group Type EXPERIMENTAL

No Intervention Components

Intervention Type BEHAVIORAL

Participants not assigned to components 1 and 2

Interventions

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Peer support to promote uptake and persistence of medication assisted treatment (MAT)

Participants will be assigned to receive peer support to promote uptake of MAT and persistence. This component will consist of two informational sessions, a tailored recovery plan, and on-going support from a peer for the first 6 months.

Intervention Type BEHAVIORAL

Behavioral Activation Treatment (BAT) to reduce depression

Participants will be assigned to receive BAT treatment for depression. This component will consist of 8 sessions where participants will identify short and long-term goals, values, and the activities unrelated to substance use that were previously enjoyed or are likely to increase a feeling of well-being. This intervention component focuses on making a plan to troubleshoot barriers to re-engage in these activities. Sessions are delivered weekly. The content includes psycho-education about what depression is, the intervention rationale, and the activities and monitoring of activities, building social contracts to engage networks, and discussion of potential barriers to following through with activities.

Intervention Type BEHAVIORAL

No Intervention Components

Participants not assigned to components 1 and 2

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* be at least 18 years of age
* be able to provide informed consent
* be eligible to receive free HIV care services in Mexico
* be HIV positive
* have injected drugs in the last 30 days
* not be on methadone replacement therapy
* be willing to discuss MAT uptake with a peer
* sign a medical release form to have medical data abstracted
* agree to submit and describe locator information
* agree to return to follow-up visits
* able to communicate in Spanish
* screen positive for depression on the PHQ-2
* have no plans of moving outside the study area in the next 12-months
* meet one of the following:

1. not currently in possession of ART or not taking ART but prescribed ART or
2. sub-optimal ART adherence as at least one 4-day treatment interruption in the past 90 days or
3. sub-optimal retention in HIV care - never engaged or disengaged from HIV care as 2 or more missed clinic appointments in the last 9 months or
4. no viral load test done in the past six months or
5. self-reports a detectable viral load within the past 6 months

Exclusion Criteria

* has not injected drugs in the last 30 days or do not have a verifiable opioid use disorder
* is not HIV positive
* is receiving methadone
* is unwilling to discuss methadone uptake with a peer
* does not screen positive for depression
* is not able to provide informed consent
* does not speak Spanish
* has plans to move out of the city
* does not qualify to receive free HIV care services in Mexico
* has an appearance of psychological disturbance or severe cognitive impairment that could limit understanding of study procedures as determined by study staff
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of California, San Francisco

OTHER

Sponsor Role collaborator

Centro de Integracion Juvenil

UNKNOWN

Sponsor Role collaborator

El Centro Ambulatorio para la Prevención y Atención en SIDA e Infecciones de Transmisión Sexual

UNKNOWN

Sponsor Role collaborator

University of Texas, El Paso

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Julia Lechuga

Role: PRINCIPAL_INVESTIGATOR

The University of Texas at El Paso

John A Sauceda

Role: PRINCIPAL_INVESTIGATOR

The University of California San Francisco

Locations

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Programa Compañeros

Ciudad Juárez, Chihuahua, Mexico

Site Status RECRUITING

Countries

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Mexico

Central Contacts

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Julia Lechuga, PhD

Role: CONTACT

915-747-7221

John A Sauceda, PhD

Role: CONTACT

415-502-1000 ext. 17172

Facility Contacts

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Maria E Ramos, LSW

Role: primary

+526566113792

Jocelyn Hernandez, LSW

Role: backup

+526566113792

References

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Sauceda JA, Lechuga J, Ramos ME, Puentes J, Ludwig-Barron N, Salazar J, Christopoulos KA, Johnson MO, Gomez D, Covarrubias R, Hernandez J, Montelongo D, Ortiz A, Rojas J, Ramos L, Avila I, Gwadz MV, Neilands TB. A factorial experiment grounded in the multiphase optimization strategy to promote viral suppression among people who inject drugs on the Texas-Mexico border: a study protocol. BMC Public Health. 2023 Feb 10;23(1):307. doi: 10.1186/s12889-023-15172-2.

Reference Type DERIVED
PMID: 36765309 (View on PubMed)

Provided Documents

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Document Type: Informed Consent Form

View Document

Other Identifiers

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1780619-1

Identifier Type: -

Identifier Source: org_study_id

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