A Pilot Study of Pre-Exposure Prophylaxis (PrEP) to Evaluate Safety, Acceptability, and Adherence in At-Risk Populations in Kenya, Africa

This study has been completed.
Sponsor:
Information provided by:
International AIDS Vaccine Initiative
ClinicalTrials.gov Identifier:
NCT00971230
First received: September 2, 2009
Last updated: August 5, 2010
Last verified: August 2010
  Purpose

This study will evaluate the safety and acceptability of an intermittent and daily PrEP regimen using Tenofovir Disoproxil Fumarate plus Emtricitabine (FTC/TDF) in men and women at risk for HIV, and it will directly compare adherence and intracellular drug levels in daily and intermittent PrEP recipients. It will also evaluate the relationship between drug adherence, sexual behavior and intracellular drug levels with an intermittent PrEP regimen. In addition it will evaluate the relationship between adherence to an intermittent PrEP regimen and timing of sexual activity in relation to PrEP dosing. The study will use objective medication event monitoring medication event monitors (MEMS) adherence measurement and evaluate the feasibility of newer adherence measurements such as hair sampling and plasma drug levels. The study will also evaluate the feasibility of using SMS (text messages) to collect sexual activity data in an African setting. It will allow study teams and communities to prepare for potential subsequent larger trials of intermittent PrEP. This study is not sized to evaluate efficacy. If the intermittent PrEP regimen is shown to be safe, feasible in terms of adherence, and achieves intracellular drug levels similar to daily PrEP, these data could be used to design a larger phase 2 study with one or more intermittent PrEP regimens. The goal of such a trial would be to provide bridging data if daily PrEP regimens are found to be effective or to prepare for efficacy or non-inferiority trials of intermittent versus daily PrEP.

Investigation of immune responses associated with FTC/TDF will also be evaluated in the pilot study. The proportion of volunteers on FTC/TDF with HIV-specific immune responses, due to exposures that did not lead to established HIV infection, will be assessed at 2-3 time points and compared to responses in volunteers assigned to placebo. Immune responses may be correlated with risk behavior and host factors, such as human leukocyte antigen (HLA) type. As noted above, very few HIV infections are expected to occur during the study, so correlation of HIV-specific immune responses and protection from infection or attenuation of disease progression will not be possible until a larger study is conducted.


Condition Intervention Phase
HIV Infections
Drug: FTC/TDF
Drug: Placebo
Phase 1
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Safety Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor)
Primary Purpose: Prevention
Official Title: A Pilot Study of Pre-Exposure Prophylaxis (PrEP) to Evaluate Safety, Acceptability, and Adherence in At-risk Populations in Kenya, Africa

Resource links provided by NLM:


Further study details as provided by International AIDS Vaccine Initiative:

Primary Outcome Measures:
  • Safety and tolerability: The proportion of volunteers with moderate and greater severity clinical adverse events; mild, moderate and greater severity of renal toxicities, and other moderate and severe laboratory abnormalities. [ Time Frame: 6 months ] [ Designated as safety issue: Yes ]
  • Acceptability: The proportion of volunteers who report willingness to use the study regimen [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  • Intracellular drug concentrations: The mean intracellular drug concentration for each group assigned to FTC/TDF [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  • Adherence: Proportion of volunteers who took, by MEMS data, at least 80% of expected doses of the IP; Proportion of volunteers assigned to FTC/TDF who have detectable drug plasma levels within 48 hrs of use. [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  • Behavioral: Reported number of steady and casual sex partners; Frequency of unprotected vaginal and/or anal intercourse; Substance use prior to or during sex [ Time Frame: 6 months ] [ Designated as safety issue: No ]

Secondary Outcome Measures:
  • Proportion of volunteers who report somewhat high or high levels of burden in using electronic medication monitoring to measure adherence, and using cell phone communication to measure sexual activity [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  • The proportion of study days with missing SMS sexual activity data [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  • The proportion of volunteers who report sharing medications [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  • The proportion of volunteers assigned to placebo who have detectable intracellular drug levels [ Time Frame: 6 months ] [ Designated as safety issue: No ]
  • The proportion of volunteers with HIV-specific immune responses as measured by analysis of cellular or humoral immune response, or changes in gene regulation as measured by microarray or proteomic techniques [ Time Frame: 6 months ] [ Designated as safety issue: No ]

Estimated Enrollment: 72
Study Start Date: October 2009
Study Completion Date: July 2010
Primary Completion Date: June 2010 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: FTC/TDF- Daily
FTC/TDF dosed daily
Drug: FTC/TDF
emtricitabine/tenofovir disoproxil fumarate
Experimental: FTC/TDF-Intermittent
FTC/TDF dosed intermittently
Drug: FTC/TDF
emtricitabine/tenofovir disoproxil fumarate
Placebo Comparator: Placebo-Daily
Placebo dosed daily
Drug: Placebo
Placebo
Placebo Comparator: Placebo-Intermittent
Placebo dosed intermittently
Drug: Placebo
Placebo

  Eligibility

Ages Eligible for Study:   18 Years to 49 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria

  • Willing to comply with the requirements of the protocol and available for follow-up for the planned duration of the study
  • Has understood the information provided and has provided written informed consent before any study-related procedures are performed
  • Willing to undergo HIV testing, STI screening, HIV counselling and receive HIV and STI test results
  • At risk for HIV infection as defined by at least one of the following:

    • Current sexually-transmitted infection (STI) or STI in the previous 3 months
    • In the past 3 months had multiple episodes of unprotected vaginal sex
    • In the past 3 months had multiple episodes of unprotected anal sex
    • In the past 3 months engaged in sex work for money or drugs
  • If a female of childbearing potential (i.e., not post-menopausal or surgically sterile), using an effective method of non-barrier contraception (hormonal contraceptive; intrauterine device (IUD); surgical sterility) from 7 days prior to randomization until the end of the study. All female volunteers must be willing to undergo urine pregnancy tests

Exclusion Criteria

  • Confirmed HIV-1 or HIV-2 infection
  • Any clinically significant acute or chronic medical condition that is considered progressive or in the opinion of the investigator would make the volunteer unsuitable for the study, including severe infections requiring treatment such as tuberculosis, and alcohol or drug abuse
  • Any of the following abnormal laboratory parameters:

    • Haemoglobin <9.0 g/dL
    • Creatinine clearance <80mL/min, as calculated by Cockcroft-Gault equation
    • AST: >2.5 x ULN
    • ALT: >2.5 x ULN
    • Total bilirubin >1.5 x ULN
    • Serum amylase >1.5 x ULN
    • Serum phosphorus <2.4 mg/dL
    • Urinalysis: Two abnormal dipsticks showing any of the following:

      • blood = 2+ or more (not due to menses)
      • protein = 1+ or more
      • leucocytes = 2+ or more
      • glucose= 1+ or more
  • Confirmed diagnosis of chronic hepatitis B infection (HBsAg positive)
  • If female, pregnant or planning a pregnancy within 4 months after enrolment or lactating
  • Participation in another clinical study of an investigational product currently, within the 3 months prior to enrolment or expected participation during this study
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00971230

Locations
Kenya
Kenya Medical Research Institute, Center for Geographic Medicine Research - Coast
Kilifi, Kenya
Kenya AIDS Vaccine Initiative, University of Nairobi
Nairobi, Kenya
Sponsors and Collaborators
International AIDS Vaccine Initiative
Investigators
Principal Investigator: Gaudensia Mutua, MB.ChB, MPH Kenya AIDS Vaccine Initiative, University of Nairobi
Principal Investigator: E.J. Sanders, MD, MPH, PhD Kenya Medical Research Institute, Center for Geographic Medicine Research - Coast
Study Chair: Omu Anzala, MB.ChB, Phd Kenya AIDS Vaccine Initiative, University of Nairobi
  More Information

Additional Information:
No publications provided by International AIDS Vaccine Initiative

Additional publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
Responsible Party: Patricia Fast MD PhD, Chief Medical Officer, International AIDS Vaccine Initiative
ClinicalTrials.gov Identifier: NCT00971230     History of Changes
Other Study ID Numbers: IAVI E001
Study First Received: September 2, 2009
Last Updated: August 5, 2010
Health Authority: Kenya: Pharmacy and Poisons Board

Keywords provided by International AIDS Vaccine Initiative:
HIV
Human Immunodeficiency Virus

Additional relevant MeSH terms:
HIV Infections
Acquired Immunodeficiency Syndrome
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Immunologic Deficiency Syndromes
Immune System Diseases
Slow Virus Diseases

ClinicalTrials.gov processed this record on September 16, 2014