Situkulwane Lesiphephile-Safe Generations

This study is currently recruiting participants.
Verified November 2013 by Columbia University
Sponsor:
Collaborators:
United States Agency for International Development (USAID)
Ministry of Health, Swaziland
University of Cape Town
Elizabeth Glaser Pediatric AIDS Foundation
National Emergency Response Council on HIV and AIDS (NERCHA)
Information provided by (Responsible Party):
Elaine J. Abrams, MD, Columbia University
ClinicalTrials.gov Identifier:
NCT01891799
First received: June 28, 2013
Last updated: November 7, 2013
Last verified: November 2013
  Purpose

The purpose of this study is to understand how best to provide care and treatment services to human immunodeficiency virus (HIV) positive pregnant women and their babies in Swaziland. The study is designed to evaluate a new approach for Preventing Mother-to-Child Transmission (PMTCT)where all HIV positive pregnant women initiate lifelong triple ARV therapy regardless of their disease stage. The goal is to prevent delays in women accessing treatment for their own health and ensure that women and their children remain in care. This study will compare this new approach to PMTCT, known as Option B+, to Option A, which is the current standard of care for PMTCT in Swaziland. The study will be conducted at 10 health facilities in the Manzini and Lubombo regions in Swaziland. The study has three components: the main component is a PMTCT Options Evaluation where data from medical records will be abstracted on all HIV positive pregnant women attending antenatal services at the 10 selected study facilities; data will be abstracted on their HIV exposed infants as well. Other components of the study include a PMTCT Options Acceptability Evaluation using semi-structured questionnaires with PMTCT clients and health care workers (HCWs) as well as a cost effectiveness evaluation comparing costs under conditions of Option A and Option B+.


Condition Intervention
HIV/AIDS
Other: Option B+

Study Type: Observational
Study Design: Time Perspective: Prospective
Official Title: Situkulwane Lesiphephile-Safe Generations: Improving Approaches to Antiretroviral Therapy for HIV-Positive Pregnant Women

Resource links provided by NLM:


Further study details as provided by Columbia University:

Primary Outcome Measures:
  • Number of (1) infant HIV positive PCR at six months postpartum OR (2) mother lost to follow-up from at six months postpartum [ Time Frame: Up to 24 months ] [ Designated as safety issue: No ]
    Combined maternal-child endpoint: The primary outcome will be measured on all HIV+ pregnant women not on ART at their first ANC visit at a participating study site, approximately 2600 women(becoming mother-infant pairs postpartum). This includes women entering PMTCT with known HIV+ status, not on ART, and women testing HIV+ on entry into ANC.


Secondary Outcome Measures:
  • Proportion of pregnant women with CD4+<350 cells/mm3 initiating ART during pregnancy [ Time Frame: Up to 24 months ] [ Designated as safety issue: No ]
    ART Initiation During Pregnancy: Proportion of pregnant women with CD4+<350 cells/mm3 initiating ART during pregnancy

  • Proportion of women and children retained in HIV care at 12 and 18 months postpartum [ Time Frame: Up to 24 months ] [ Designated as safety issue: No ]
    Maternal/Infant Retention in Care: Proportion of women and children retained in HIV care at 12 and 18 months postpartum

  • Duration of ART/ARV received prior to delivery [ Time Frame: Up to 24 months ] [ Designated as safety issue: No ]
    ART/ARV Duration: Duration of ART/ARV received prior to delivery


Biospecimen Retention:   None Retained

50 microliters of capillary blood will be drawn via heelstick or finger prick phlebotomy from infants using filter paper. Blood will be collected from infants at 6mos of age to conduct DNA PCR HIV testing, specifically for this study.


Estimated Enrollment: 2600
Study Start Date: August 2013
Estimated Study Completion Date: September 2015
Estimated Primary Completion Date: March 2015 (Final data collection date for primary outcome measure)
Groups/Cohorts Assigned Interventions
PMTCT Options Evaluation
All HIV positive pregnant women not on ART engaging in PMTCT services at the study sites will be included. This will include HIV+ women not on ART enrolling in PMTCT services and pregnant women newly testing HIV+ in the ANC.
Other: Option B+
  • Using one low toxicity triple ARV regimen [(tenofovir (TDF) + lamivudine/emtricitabine (3TC/FTC) + efavirenz (EFV)] for all women, rather than adapting regimens by CD4+
  • Engaging all pregnant and postpartum women and their infants in the structured appointment and follow-up system currently only available to women receiving ART
  • Providing a simplified standardized public health approach both antenatally and postnatally, with adherence and retention support tailored to the particular health and social needs of peripartum women

  Show Detailed Description

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Female
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population

For the PMTCT Options Evaluation component, the target population is all HIV+ pregnant women not on ART at their first ANC visit at the 10 study facilities. A total of approximately 2600 mother-infant pairs (2600 HIV positive women + 2600 of their HIV exposed babies) will be observed.

Criteria

Inclusion:

  • HIV+ pregnant women
  • Currently not on ART
  • Presents at one the 10 study facilities for PMTCT services
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT01891799

Contacts
Contact: Harriet Nuwagaba-Biribonwoha, MD/PhD +26824045797 hn2158@columbia.edu

Locations
Swaziland
ICAP-Swaziland Recruiting
Mbabane, Swaziland
Contact: Harriet Nuwagaba-Biribonwoha, MD/PhD    +26824045797    hn2158@columbia.edu   
Sponsors and Collaborators
Columbia University
United States Agency for International Development (USAID)
Ministry of Health, Swaziland
University of Cape Town
Elizabeth Glaser Pediatric AIDS Foundation
National Emergency Response Council on HIV and AIDS (NERCHA)
Investigators
Principal Investigator: Elaine J Abrams, MD Columbia University
  More Information

No publications provided

Responsible Party: Elaine J. Abrams, MD, Professor of Epidemiology, Columbia University
ClinicalTrials.gov Identifier: NCT01891799     History of Changes
Other Study ID Numbers: AAAL0661, AID-OAA-A-12-000020
Study First Received: June 28, 2013
Last Updated: November 7, 2013
Health Authority: United States: Institutional Review Board

Keywords provided by Columbia University:
HIV/AIDS
PMTCT
Option B+
Swaziland

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

ClinicalTrials.gov processed this record on April 21, 2014