Rural New England Health Study (Phase 2)

NCT ID: NCT05466331

Last Updated: 2023-12-01

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

2022-05-18

Study Completion Date

2024-07-31

Brief Summary

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This study will integrate mobile hepatitis C virus (HCV) testing and treatment with expanded syringe access in order to improve uptake of HCV testing and treatment, and reduce syringe sharing behavior in rural northern New England. The intervention aims to reach rural opioid injectors with HCV and to fill service gaps identified around access to syringe services and HCV testing and treatment, while limiting the burden on local partners. If effective, this mobile model of HCV telehealth integrated with syringe services will provide a promising approach for local public health authorities seeking to curb opioid injection, syringe sharing and HCV rates in rural America, and reduce the risk environment for HIV outbreaks in those communities.

Detailed Description

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This study will employ a randomized, parallel-group design to determine the best strategy for mobile testing-and-treatment of rural opioid users for HCV. This Type 1 hybrid effectiveness-implementation study will examine the effectiveness of a model of mobile telemedicine service delivery integrated into rural harm reduction programming. The model aims to reach rural opioid injectors who are living with HCV and to fill service gaps identified in previous work around access to syringe services and HCV testing and treatment. Working closely with local harm reduction agencies, this study will employ a mobile van to expand antibody and viral load testing for HCV, distribute syringes in rural communities with poor access to brick-and-mortar syringe service providers, and provide HCV telemedicine treatment. The study will also replicate prior validation of the accuracy of dried blood spot (DBS) testing for HCV viral load as a potential strategy to address limited access to effective phlebotomy. All consenting volunteers with HCV antibody present will receive HCV viral load and liver elastography results, and, if current HCV carriers, initial vaccination for HBV and/or HAV. Participants with current HCV will be randomized to one of two intervention arms for HCV work-up and care.

Conditions

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Hepatitis C Opioid Use Disorder IV Drug Usage

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Mobile Tele-HCV Care

Direct Acting Antiviral (DAA) treatment for HCV on a mobile van via telemedicine

Group Type EXPERIMENTAL

Mobile Tele-HCV Care

Intervention Type OTHER

Study participants receive HCV care via telemedicine. Telemedicine appointments are performed on a mobile van.

Enhanced Usual Care

Referral with care navigation to a local or regional HCV treatment provider

Group Type ACTIVE_COMPARATOR

Enhanced Usual Care

Intervention Type OTHER

Study participants are referred to a clinician in their area for HCV care.

Interventions

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Mobile Tele-HCV Care

Study participants receive HCV care via telemedicine. Telemedicine appointments are performed on a mobile van.

Intervention Type OTHER

Enhanced Usual Care

Study participants are referred to a clinician in their area for HCV care.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

1. Current or past history of drug injection;
2. Health insurance that will cover HCV medications (study staff will work with those who are eligible but have not signed up for insurance prior to study enrollment)
3. Lives in one of the study counties in NH and VT, and plans to remain in the study region for the next 12 months;
4. Age 18 years or older;
5. Speaks English;
6. Capacity to voluntarily provide informed consent;
7. Will accept randomized assignment, and participate in follow-up over 12 months;
8. Will provide releases to access community medical records;
9. Will provide names and contact information of at least 3 persons for re-contact purposes;
10. Not previously treated for HCV;
11. Not pregnant or trying to conceive;
12. HCV antibody positive on point-of-care rapid test.

Exclusion Criteria

1. Unable to obtain venous blood sample for mandatory laboratory testing
2. HCV viral load undetectable
3. Hepatitis B surface antigen (HBsAg) positive;
4. Significant renal failure (eGFR 30 mL/min/1.73m2 or less, or end-stage renal disease requiring dialysis);
5. Decompensated cirrhosis, as manifested by liver fibrosis on elastography (FibroScan) and/or Fibrosure blood test plus at least one of the following symptoms:

i. Observed jaundice (yellowing of the eyes and skin) ii. Self-reported increasing abdominal size (ascites) and leg edema iii. Observed periods of confusion consistent with encephalopathy iv. Self-reported history of gastrointestinal bleeding.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Tufts University

OTHER

Sponsor Role collaborator

University of New Hampshire

OTHER

Sponsor Role collaborator

University of Vermont

OTHER

Sponsor Role collaborator

Dartmouth-Hitchcock Medical Center

OTHER

Sponsor Role collaborator

Better Life Partners Inc

UNKNOWN

Sponsor Role collaborator

National Institute on Drug Abuse (NIDA)

NIH

Sponsor Role collaborator

Baystate Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Peter D Friedmann, MD, MPH

Role: PRINCIPAL_INVESTIGATOR

Baystate Medical Center

Thomas J Stopka, PhD, MHS

Role: PRINCIPAL_INVESTIGATOR

Tufts University

Locations

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Mobile Study Van

Keene, New Hampshire, United States

Site Status RECRUITING

Mobile Study Van

Bennington, Vermont, United States

Site Status RECRUITING

Mobile Study Van

Brattleboro, Vermont, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Randall A Hoskinson

Role: CONTACT

Phone: 413-794-7034

Email: [email protected]

Lizbeth Del Toro-Mejias

Role: CONTACT

Phone: 787-462-1262

Email: [email protected]

Facility Contacts

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Randall A Hoskinson

Role: primary

Lizbeth Del Toro-Mejias

Role: backup

Randall Hoskinson

Role: primary

Lizbeth DelToro-Mejias

Role: backup

Randall Hoskinson

Role: primary

Lizbeth Del Toro-Mejias

Role: backup

Other Identifiers

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UH3DA044830

Identifier Type: NIH

Identifier Source: secondary_id

View Link

BH19-166

Identifier Type: -

Identifier Source: org_study_id