Antiretroviral Treatment Strategies in Relation to Adherence, Resistance and Virological Treatment Failure (DotArv)
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Purpose
This project aims to assess different antiretroviral treatment strategies, optimally controlled and conventional, in relation to drug resistance and virological treatment failure. A Randomised Controlled trial (RCT) where Vietnamese HIV+ patients with CD4+ T-cells <200/ul are randomized into either enhanced treatment support (ETS) through peer supporters or The National AIDS Control Program recommended self supervised treatment (SST). The treatment strategies will be assessed and compared in relation to treatment adherence and drug resistance development with virological treatment failure as primary endpoint. The results from this project will lead to an increased knowledge in relation the impact of treatment support on adherence, virological suppression and resistance development and have an impact on HIV treatment policies in low income settings globally.
| Condition | Intervention |
|---|---|
|
Human Immunodeficiency Virus (HIV) |
Behavioral: Enhanced Treatment Support (ETS) |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Supportive Care |
| Official Title: | A Randomised Controlled Trial to Assess Antiretroviral Treatment Strategies in Relation to Adherence, Resistance and Virological Treatment Failure |
- Virological treatment failure [ Time Frame: 24 months ] [ Designated as safety issue: No ]HIV viral load of 1 fg reverse transcriptase activity/ml, corresponding to 200 copies/ml, at 1 year and 2 years after starting treatment.
- Immunological treatment failure [ Time Frame: 24 months ] [ Designated as safety issue: No ]
Immunological treatment failure
- CD4 count returns to or falls below pre-therapy baseline level or
- 50% decline from the on-treatment peak value since the initiation of ART (if known); or
- CD4 count < 100 cells/mm3 after a year without any increase.
- Clinical treatment failure [ Time Frame: 24 months ] [ Designated as safety issue: No ]Occurrence or recurrence of stage 4 diseases or conditions after at least 6 months of therapy
| Enrollment: | 640 |
| Study Start Date: | August 2007 |
| Estimated Study Completion Date: | November 2011 |
| Estimated Primary Completion Date: | November 2011 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
No Intervention: Self Supervised Treatment (SST)
Treatment according to the National Treatment Guidelines in Vietnam including treatment counseling before initiation of ART and clinical follow up every 3 months. The patient is self responsible to take the drugs and no additional adherence support is provided.
|
|
|
Experimental: Enhanced Treatment Support (ETS)
Treatment according to the National Treatment Guidelines in Vietnam including treatment counseling before initiation of ART and clinical follow up every 3 months. In addition adherence support is provided according to the description under intervention.
|
Behavioral: Enhanced Treatment Support (ETS)
An "internal supporter" - family member or other person trusted by the patient is trained to fill in a checklist whether the drugs has been taken and if this was observed. An"external supporter" - a peer selected PLWHA visit the patient twice weekly the first two months. The external supporter follows a checklist and ask about general well being, psychological problems or adverse drugs reactions as well as go through the adherence since last visit, using the internal supporter checklist. If the adherence is good, the number of visits are decreased to once weekly after two months, if not, the number of visits are intensified. If there are any symptoms of opportunistic infections, immunological reconstruction syndrome or adverse drug reactions the patient are refered for medical checkup.
Other Names:
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Show Detailed Description
Eligibility| Ages Eligible for Study: | 18 Years to 59 Years |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
- WHO stage IV of HIV disease, regardless of the CD4 count
- WHO stage III of HIV disease with a CD4 count < 350/mm3
- WHO stages I or II with a CD4 count < 200/mm3
Exclusion Criteria:
- Pregnancy
- Ongoing severe opportunistic infections
- Institutionalized patients.
Contacts and Locations
More Information
No publications provided by Karolinska Institutet
Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
| Responsible Party: | Mattias Larsson, MD PhD, Karolinska Institutet |
| ClinicalTrials.gov Identifier: | NCT01433601 History of Changes |
| Other Study ID Numbers: | DotArv_Vietnam |
| Study First Received: | September 9, 2011 |
| Last Updated: | September 13, 2011 |
| Health Authority: | Vietnam: Ministry of Health |
Keywords provided by Karolinska Institutet:
|
Adherence Peer support Treatment failure |
Additional relevant MeSH terms:
|
Acquired Immunodeficiency Syndrome HIV Infections Immunologic Deficiency Syndromes Lentivirus Infections Retroviridae Infections RNA Virus Infections |
Virus Diseases Sexually Transmitted Diseases, Viral Sexually Transmitted Diseases Slow Virus Diseases Immune System Diseases |
ClinicalTrials.gov processed this record on May 22, 2013