Periodic Presumptive Treatment vs. doxyPEP for STI Control in Kenyan MSM

NCT ID: NCT06468462

Last Updated: 2025-11-19

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

PHASE4

Total Enrollment

2900 participants

Study Classification

INTERVENTIONAL

Study Start Date

2025-10-29

Study Completion Date

2029-04-30

Brief Summary

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Men who have sex with men (MSM) are at high risk for gonorrhea and chlamydia in Kenya, where nucleic acid amplification testing is not feasible and most infections therefore go undiagnosed. We propose an open-label randomized clinical trial with 2900 participants assigned to WHO-recommended periodic presumptive treatment (PPT) or doxycycline post-exposure prophylaxis (doxyPEP), compared to standard syndromic treatment, with 18 months of follow-up and rigorous culture-based and molecular analysis of antimicrobial resistance in Neisseria gonorrhoeae. This work will provide critical data needed to inform guidelines and improve STI control among MSM in sub-Saharan Africa and other resource-limited settings, including modelled estimates of the health and economic impact of scaling up these two interventions on STI control among MSM and their partners in Kenya.

Detailed Description

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Men who have sex with men (MSM) are at high risk for gonorrhoea and chlamydia in Kenya, where nucleic acid amplification testing (NAAT) is not feasible, and most infections therefore go undiagnosed. In 2011, the WHO recommended periodic presumptive treatment (PPT) of Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infections for MSM at high risk for HIV acquisition due to condomless anal intercourse with multiple sex partners or a recent STI exposure. More recently, trials in well-resourced settings have demonstrated the efficacy of doxycycline post-exposure prophylaxis (doxyPEP) for reducing NG, CT, and syphilis infections among high-risk MSM. The goal of this study is to evaluate the impact and cost-effectiveness of WHO-recommended PPT versus doxyPEP compared to standard syndromic treatment among Kenyan MSM. This study aims to (1) evaluate the effectiveness and impact on antimicrobial resistance in NG of WHO-recommended PPT given every 3 months and of doxy-PEP taken 24-72 hours after condomless sex for reducing STI burden among Kenyan MSM; (2) assess the acceptability, feasibility, and safety of implementing WHO-recommended PPT and doxy-PEP compared to standard care among providers and patients; and (3) model the health and economic impact of scaling up WHO-recommended STI PPT and doxyPEP compared to standard of care on STI control among MSM and their partners in Kenya. We will conduct an open-label randomized trial with 2900 participants to evaluate these two interventions versus standard care assigned in a 2:2:1 ratio, with 18 months of follow-up at three MSM-friendly research clinics in Kenya. Results will inform parameters to update a stochastic model of STI transmission and cost-effectiveness analysis to project the impact of scaled-up STI PPT and doxyPEP in Kenya. This work will provide the critical data needed to inform guidelines and improve STI control among this key population in sub-Saharan Africa and other resource-limited settings.

Conditions

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Gonorrhea Male Chlamydia (Male) Syphilis Male

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

The proposed study is an open-label randomized controlled trial with a hybrid type 1 implementation-effectiveness component comparing each intervention (i.e., STI PPT, doxyPEP) to a common control in a 2:2:1 ratio.

Approach for objective 1: We will conduct an open-label randomized clinical trial with 2900 participants to evaluate these two interventions versus the standard of care assigned in a 2:2:1 ratio, with 18 months of follow-up and rigorous culture-based and molecular analysis of AMR in NG at three MSM-friendly research clinics in Kenya.

Approach for objective 2: We will use multidisciplinary science to measure the acceptability, feasibility, and safety of these two interventions, using a conceptual model based on Proctor's Implementation Science Framework.

Approach for objective 3: Aim 1 and 2 results will inform parameters to update a stochastic model of STI transmission and cost-effectiveness analysis to project the impact of scaled-up STI PPT and doxyPEP in Kenya.
Primary Study Purpose

OTHER

Blinding Strategy

SINGLE

Outcome Assessors
Aptima Combo 2 testing for NG and CT will be conducted in Mombasa on a Hologic Panther platform by experienced laboratory staff blinded to randomization assignment.

Study Groups

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WHO-recommended periodic presumptive treatment

Participants assigned to the STI PPT arm will be evaluated at baseline and every 3 months thereafter for STI PPT eligibility based on having had condomless anal sex and either multiple sex partners or a sex partner with an STI in the past 6 months. If eligible, they will be offered 400 mg po cefixime plus 1 gram azithromycin po under direct observation, using the same regimen as for syndromic treatment per the latest WHO recommendations.

Group Type ACTIVE_COMPARATOR

WHO-recommended periodic presumptive treatment

Intervention Type DRUG

400 mg po cefixime plus 1 gram azithromycin po under direct observation

Doxycycline post-exposure prophylaxis

Participants assigned to the doxyPEP arm will be provided with a 30-day supply of doxycycline hyclate at each quarterly visit, with refills as needed. They will have 1:1 counselling on the self-administration of 200 mg po doxycycline within 24-72 hours after condomless anal or vaginal sex as frequently as daily if indicated but not more than once daily, in accordance with the doxyPEP trial in the United States.

Group Type ACTIVE_COMPARATOR

Doxycycline post-exposure prophylaxis

Intervention Type DRUG

200 mg po doxycycline within 24-72 hours after condomless anal or vaginal sex as frequently as daily

Standard care

Participants assigned to the standard care arm will receive screening for STI symptoms at every scheduled visit and syndromic treatment with cefixime 400 mg po stat plus azithromycin 1 gram po stat under direct observation, in accordance with current Kenyan recommendations for genital and anorectal infections. This regimen will be updated if Kenyan recommendations change.

Group Type NO_INTERVENTION

No interventions assigned to this group

Interventions

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WHO-recommended periodic presumptive treatment

400 mg po cefixime plus 1 gram azithromycin po under direct observation

Intervention Type DRUG

Doxycycline post-exposure prophylaxis

200 mg po doxycycline within 24-72 hours after condomless anal or vaginal sex as frequently as daily

Intervention Type DRUG

Other Intervention Names

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WHO PPT doxyPEP

Eligibility Criteria

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Inclusion Criteria

* 18-29 years old
* Assigned male sex at birth
* Identifies as male (cis-gender)
* Reports condomless anal intercourse with a man in the past 6 months
* Reports multiple male sex partners OR a male sex partner with a syndromic (urethritis, proctitis, or genital ulcer disease) or laboratory-diagnosed sexually transmitted infection in the past 6 months
* Willing and able to provide written informed consent and participate in all study procedures
* Planning to remain in the study area for 18 months

Exclusion Criteria

* Unable to understand the study purpose and procedures
* Allergy to cephalosporin (cefixime), macrolide (erythromycin or azithromycin), or tetracycline (doxycycline) class antibiotics
* Recent use of prolonged antibiotics (≥14-day course in the month before enrolment)
* Use of medications that impact cefixime, azithromycin, or doxycycline metabolism (check versus list in screening SOP)
Minimum Eligible Age

18 Years

Maximum Eligible Age

29 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

Yes

Sponsors

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Aurum Institute

OTHER

Sponsor Role collaborator

Nyanza Reproductive Health Society

OTHER

Sponsor Role collaborator

National Institute of Allergy and Infectious Diseases (NIAID)

NIH

Sponsor Role collaborator

Partners for Health & Development in Africa

UNKNOWN

Sponsor Role collaborator

University of Washington

OTHER

Sponsor Role lead

Responsible Party

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Susan Graham

Professor: Global Health

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Susan M Graham, MD, PhD, MPH

Role: PRINCIPAL_INVESTIGATOR

University of Washington

Locations

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Anza Mapema Clinic

Kisumu, , Kenya

Site Status RECRUITING

University of Washington/Pwani Research Centre at the Ganjoni Municipal Clinic, Mombasa

Mombasa, , Kenya

Site Status RECRUITING

TRANSFORM Clinic

Nairobi, , Kenya

Site Status RECRUITING

Countries

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Kenya

Central Contacts

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Susan M Graham, MD, PhD, MPH

Role: CONTACT

+1-206-351-0414

Eduard J Sanders, MD, PhD, MPH

Role: CONTACT

+254-723-593762

Facility Contacts

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Fredrick O Otieno, PhD MPH

Role: primary

254572024065

Carol Agwanda

Role: backup

254725323274

Eduard J Sanders, MD PhD

Role: primary

254 723 593762

R. Scott McClelland, MD MPH

Role: backup

2064730392

Joshua Kimani, MBChB, MPH

Role: primary

+254 20 210 1155

Rhoda W Kabuti, MBChB

Role: backup

+254 20 210 1155

Provided Documents

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Document Type: Study Protocol and Statistical Analysis Plan

View Document

Document Type: Informed Consent Form

View Document

Other Identifiers

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1R01AI179838-01

Identifier Type: NIH

Identifier Source: secondary_id

View Link

STUDY00018588

Identifier Type: -

Identifier Source: org_study_id

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