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Community-based Accompaniment With Supervised Antiretrovirals in Lima, Peru (CASA)

This study has been completed.
National Institute of Mental Health (NIMH)
Partners in Health
Harvard School of Public Health
Harvard Medical School
Information provided by (Responsible Party):
Sonya Sunhi Shin, Brigham and Women's Hospital Identifier:
First received: February 16, 2010
Last updated: February 1, 2017
Last verified: February 2017
Using quantitative and qualitative data, this study will assess the impact of community accompaniment with supervised antiretrovirals (CASA) on HIV-positive individuals and community members in Lima, Peru.

Condition Intervention Phase
HIV AIDS HIV Infections Other: DOT-HAART Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Supportive Care
Official Title: Community-based Accompaniment With Supervised Antiretrovirals in Lima, Peru

Resource links provided by NLM:

Further study details as provided by Sonya Sunhi Shin, Brigham and Women's Hospital:

Primary Outcome Measures:
  • Proportion with suppressed HIV viral load after starting HAART among those receiving community-based DOT-HAART versus the control group. [ Time Frame: 18 and 24 months ]
  • Compare social capital among community members in DOT-HAART versus control communities [ Time Frame: 12 months and study completion ]
  • Cost-effectiveness of community-based DOT-HAART. [ Time Frame: 24 months ]

Secondary Outcome Measures:
  • Identify mediating mechanisms of CASA effect on individual outcomes. [ Time Frame: 24 months ]
  • Identify subgroups who respond best to CASA intervention. [ Time Frame: 24 months ]

Estimated Enrollment: 1244
Study Start Date: February 2010
Study Completion Date: August 2014
Primary Completion Date: July 31, 2012 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Intervention: DOT-HAART
Intervention group will receive community-based monthly adherence visits, standard care, and DOT-HAART.
For 8 months, DOT-HAART of all doses in the participant's home or alternate location. DOT worker ensures that HIV medications are taken as indicated and witnesses ingestion of all medications including other medications prescribed by physician. The worker will be trained to identify, triage and notify providers of any psychosocial and medical problems/complications. Transition to self-administration begins in months 9-12 when DOT will be tapered and greater participation of treatment supporter to prepare patients for self-administration.
No Intervention: No DOT-HAART
Control group receives community-based monthly adherence visits and standard care, but no DOT-HAART.

Detailed Description:
Community-based accompaniment with directly observed antiretroviral therapy (DOT-HAART) may improve adherence and clinical outcomes among impoverished individuals starting HAART in resource-poor settings. Furthermore, the utilization of community health workers may build social capital. This is cluster-randomized trial, with randomization at the level of health centers. Individuals in both intervention and control clusters will receive community-based adherence support (monthly adherence visits) and standard care. In addition, individuals residing in intervention clusters will receive 12 months of community-based DOT-HAART. We will enroll patients as well as community members (health providers, treatment supporters, and community health workers) to assess individual and community-level outcomes.

Ages Eligible for Study:   18 Years and older   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes

Inclusion Criteria for Patient Cohort:

  • Age greater than or equal to 18;
  • Diagnosis if HIV and meeting criteria for HAART;
  • Lives in poverty;
  • EITHER: 1) HAART naïve or 2) starting salvage therapy due to virologic failure;
  • Documentation of baseline CD4 cell count and HIV load;
  • Residence and receipt of HIV healthcare within the study catchment area

Exclusion Criteria for Patient Cohort:

- Imprisoned or cannot give informed consent.

Inclusion Criteria for Community Cohort:

  • Working in a health establishments in study region;
  • If health personnel, contracted employee caring for people living with HIV/AIDS.

Exclusion Criteria for Community Cohort:

- Cannot give informed consent

  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 identifier: NCT01070017

Socios En Salud
Lima, Peru
Sponsors and Collaborators
Brigham and Women's Hospital
National Institute of Mental Health (NIMH)
Partners in Health
Harvard School of Public Health
Harvard Medical School
Principal Investigator: Sonya Shin, MD, MPH Brigham and Women's Hospital
  More Information

Responsible Party: Sonya Sunhi Shin, Dr., Brigham and Women's Hospital Identifier: NCT01070017     History of Changes
Other Study ID Numbers: 1R01MH083550-01A2 ( U.S. NIH Grant/Contract )
Study First Received: February 16, 2010
Last Updated: February 1, 2017

Keywords provided by Sonya Sunhi Shin, Brigham and Women's Hospital:
Community based
social capital

Additional relevant MeSH terms:
HIV Infections
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Immunologic Deficiency Syndromes
Immune System Diseases processed this record on September 21, 2017