Decentralization of Hepatitis B Care in Sub-Saharan Africa: a Pilot Program in Ethiopia

NCT ID: NCT06586983

Last Updated: 2024-09-19

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

Total Enrollment

4500 participants

Study Classification

OBSERVATIONAL

Study Start Date

2024-09-04

Study Completion Date

2028-09-05

Brief Summary

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The goal of this observational study is to study models of care for decentralized hepatitis B treatment in Ethiopia.

Three different models of decentralized HBV care (standard model, simplified model, test-and-treat model) will be implemented at primary hospitals or health clinics in Ethiopia. Treatment will be given for free to patients who meet the treatment criteria. We will compare clinical outcome, laboratory outcomes and programmatic outcome measures between the 3 models.

Detailed Description

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Chronic hepatitis B (CHB) is a major health problem globally, and in Ethiopia 5-10 % of the general population are infected with hepatitis B. In the absence of treatment, 15-40 % of these will die from its complications. Antiviral therapy effectively prevents disease progression and death in CHB. However, In low-income countries antiviral treatment is rarely available due to complex treatment guidelines, poor laboratory capacity, restrictions on antiviral treatment and lack of public funding.

In 2015, we set up a pilot treatment program for CHB at a tertiary hospital in Addis Ababa, Ethiopia. In 2021/22, this program was extended to four regional secondary hospitals to study simplified CHB care in a low-income country. With the present study we aim to decentralize CHB therapy to rural settings, which will be essential to achieve universal access to antiviral therapy in Africa. We will study different treatment models, each of which has its theoretical pros and cons: i) standard model ("treat only if…"), ii) inclusive model ("treat all except…"), and iii) test-and-treat ("treat all"). The primary endpoint will be death or liver decompensation, and secondary endpoints will be programmatic and laboratory success indicators. Moreover, we will study the cost-effectiveness of these decentralized models and compare with the tertiary/secondary hospital-based model.

Implementation research, such as our study, is of vital importance to respond to the research gaps identified by the World Health Organization in hepatitis B care. Our study is expected to directly inform international hepatitis B guidelines and will be a major contribution to the efforts to eliminate viral hepatitis as a public health threat by 2030.

Conditions

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Hepatitis B

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Standard model ("treat only if")

HBsAg positive patients will be eligible for treatment of they fulfill one of the following criteria:

i) Clinically diagnosed cirrhosis; or ii) APRI ≥0.5; or iii) Persistently elevated ALT \>40 U/L; or iv) Co-infection with HCV or HDV; or v) Family history of HCC/cirrhosis; or vi) Relevant co-morbidity

Tenofovir Disoproxil Fumarate

Intervention Type DRUG

300 mg po OD

Inclusive model ("treat all except")

HBsAg positive patients will receive treatment, except if APRI ≤0.3 and no clinical signs/symptoms of cirrhosis and no risk factors for liver disease.

Tenofovir Disoproxil Fumarate

Intervention Type DRUG

300 mg po OD

Test-and-treat model ("treat all")

All HBsAg positive patients will receive treatment.

Tenofovir Disoproxil Fumarate

Intervention Type DRUG

300 mg po OD

Interventions

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Tenofovir Disoproxil Fumarate

300 mg po OD

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

* Adult (at least 18 years of age) who is HBsAg positive.

Exclusion Criteria

* Below 18 years of age.
* Negative HBsAg rapid test at screening visit.
* Other disease with short life expectancy (disseminated cancer etc.)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Norges Forskningsråd, Stenberggata 26, pb. 2700, N-0131 Oslo, Norway

UNKNOWN

Sponsor Role collaborator

Addis Ababa University

OTHER

Sponsor Role collaborator

Sykehuset i Vestfold HF

OTHER

Sponsor Role collaborator

St. Paul's Hospital Millennium Medical College, Ethiopia

OTHER

Sponsor Role collaborator

Oslo University Hospital

OTHER

Sponsor Role lead

Responsible Party

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Asgeir Johannessen

Researcher / project manager

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Asgeir Johannessen, MD PhD

Role: STUDY_DIRECTOR

The Hospital of Vestfold

Nega Berhe, MD PhD

Role: PRINCIPAL_INVESTIGATOR

Addis Ababa University

Locations

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Addis Ababa University

Addis Ababa, Addis Ababa, Ethiopia

Site Status RECRUITING

Countries

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Ethiopia

Central Contacts

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Asgeir Johannessen, MD PhD

Role: CONTACT

+4797983264

Facility Contacts

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Nega Berhe, MD PhD

Role: primary

+251911408340

Other Identifiers

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656480

Identifier Type: -

Identifier Source: org_study_id

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