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Impact of Immediate Versus South African Recommendations Guided ART Initiation on HIV Incidence (TasP)

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ClinicalTrials.gov Identifier: NCT01509508
Recruitment Status : Completed
First Posted : January 13, 2012
Last Update Posted : July 21, 2016
Sponsor:
Collaborators:
Africa Centre For Health and Population Studies
University of KwaZulu
Information provided by (Responsible Party):
ANRS, Emerging Infectious Diseases

Study Description
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Brief Summary:

This trial is evaluating a public health intervention strategy trial which aims to reduce the incidence of HIV at a population-level.

The proposed strategy is a two steps process:

  • Extensive HIV counselling and testing, and comprehensive prevention programme among a target population
  • Immediate ART initiation after HIV diagnosis, irrespective of CD4 count criteria.

The underlaying trial hypothesis is that HIV testing followed by immediate ART initiation of all HIV-infected individuals will prevent onward transmission and reduce HIV incidence in the population. This is a cluster randomised controlled trial with a total of 22 communities used as the units for randomisation. Enrolment of a population of 22 000 individuals among which 4 400 are expected to be HIV-Infected.


Condition or disease Intervention/treatment Phase
HIV Infection Drug: Immediate ARV treatment initiation with TDF/FTC/EFV Other: South African recommendation guided ARV (TDF/FTC/EFV) initiation Not Applicable

Detailed Description:

The trial objective is to estimate the effect of ART initiated immediately after HIV diagnosis on the reduction in incidence of new HIV infections in the general population. It will be conducted in two phases:

  • First phase: aiming to evaluate the feasibility and acceptability of extensive HIV testing and early ARV treatment initiation on a subset of the target population (Hlabisa sub-district in KwaZulu Natal, South Africa); completion on February 2014.
  • Second phase: full implementation of the trial in the target population from May 2014.

The proposed intervention has two components :

  • Component 1 "Test": HIV counselling and testing, and comprehensive prevention programme among the entire target population

  • Component 2 "Treat": ART treatment initiation for HIV infected individuals following two strategies

    • control group: ART initiation when eligible for treatment as per WHO guidelines
    • intervention group: immediate ART initiation regardless of immunological and clinical staging
Study Design
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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 28153 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Prevention
Official Title: A Cluster Randomised Trial Comparing the Impact of Immediate Versus South African Recommendations Guided ART Initiation on HIV Incidence. The ARNS 12249 TasP (Treatment as Prevention) Trial in Hlabisa Sub-district, KwaZulu-Natal, South Africa.
Study Start Date : March 2012
Actual Primary Completion Date : June 2016
Actual Study Completion Date : June 2016

Resource links provided by the National Library of Medicine

MedlinePlus related topics: HIV/AIDS

Arms and Interventions
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Arm Intervention/treatment
Experimental: Immediate ARV treatment initiation
Initiation of ARV treatment regardless of participants's immunological and clinical staging
 Drug: Immediate ARV treatment initiation with TDF/FTC/EFV

All HIV-infected adults will be offered ART regardless of their immunological and clinical staging.

The first line regimen proposed will be Atripla (R), a fixed dose combination containing tenofovir disoproxil (245 mg)/emtricitabine (200 mg)/efavirenz (600 mg)(FTC/TDF/EFV). The dosing will be 1 tablet OD.
South African recommendation guided ARV initiation
HIV-infected individuals will be assessed clinically and immunologically and when eligible for treatment as per South African guidelines will be offered ART
 Other: South African recommendation guided ARV (TDF/FTC/EFV) initiation

HIV-infected adult participants will be eligible for ART as per the South African guidelines (August 2011) if:

  • CD4 count ≤ 350 cells/mm3 irrespective of clinical symptoms
  • WHO clinical stage 3 or 4 irrespective of CD4 count
  • MDR or XDR TB The first line regimen proposed will be Atripla (R), a fixes dose combination containing tenofovir disoproxil (245 mg)/emtricitabine (200 mg)/efavirenz (600 mg)(TDF/FTC/EFV). The dosing will be 1 tablet OD.


Outcome Measures
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Primary Outcome Measures :
  1. Uptake of initial and repeat HIV counselling and testing (Feasibility phase) [ Time Frame: 14 months ]
    Percentage of the target population tested for HIV

  2. Uptake of ARV treatment among HIV-infected individuals (Feasibility phase) [ Time Frame: 14 months ]
    Percentage of HIV-infected patients followed-up in the trial clinics receiving ARV treatment when eligible

  3. HIV infection incidence [ Time Frame: 4 years after enrolment initiation ]
    Serology will be done on Dry Blood Spot collected during repeated surveys


Secondary Outcome Measures :
  1. Sexual partnerships [ Time Frame: Repeated measure every 6 months during follow-up ]
    Percentage of participants reporting a certain number of sexual partnerships in the last 12 months

  2. Safe sex and condom use [ Time Frame: Repeated measure every 6 months during follow-up ]
    Percentage of participants using a male condom with their partner during the last sexual intercourse

  3. Quality of life [ Time Frame: Repeated measure every 6 months during follow-up ]
    • the EQ-5D scale among the whole sample
    • the Patient Reported Outcomes Quality Of Life specific to HIV (PROQOL-HIV) instrument and the HIV/AIDS stigma instrument for PLWHA (HASI-P) tool among HIV-infected participants

  4. Health care use and health care expenditures [ Time Frame: Repeated measure every 6 months during follow-up ]
    Percentage of participants reporting health care visits (primary care centre, pharmacy, hospitalisation) in the past four weeks and cost incurred

  5. Stigma at community level [ Time Frame: Repeated measure every 6 months during follow-up ]
    Percentage of participants agreeing that people in the community do not blame people for having HIV Percentage of participants agreeing that people in the community avoid people with HIV

  6. Adherence to ART [ Time Frame: Repeated measure every 6 months during follow-up ]
    Measured three-monthly using a visual analogue scale, pill identification test and pill count

  7. Retention [ Time Frame: Repeated measure every 6 months during follow-up ]
    Proportion of HIV-infected participants still under active follow-up in the trial at key timepoints


Eligibility Criteria
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Ages Eligible for Study:   16 Years and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Aged 16 and more
  • Member of a household in the designated cluster within the Hlabisa sub-district of KwaZulu Natal in South Africa
  • Able and willing to give written informed consent for trial participation and/or HIV counselling and testing
Contacts and Locations
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Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01509508


Locations
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South Africa
Hlabisa Hospital
Hlabisa, KwaZulu-Natal, South Africa, 3937
Sponsors and Collaborators
ANRS, Emerging Infectious Diseases
Africa Centre For Health and Population Studies
University of KwaZulu
Investigators
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Study Chair: François Dabis, PhD INSERM unit 897, ISPED, Université Bordeaux II, France
Study Chair: Marie-Louise Newell, PhD University of Southamton, United Kingdom
Study Chair: Deenan Pillay, PhD Africa Centre for Health and Population Studies, University of KwaZullu Natal, South Africa
More Information
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Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

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Responsible Party: ANRS, Emerging Infectious Diseases
ClinicalTrials.gov Identifier: NCT01509508    
Other Study ID Numbers: ANRS 12249 TasP
First Posted: January 13, 2012    Key Record Dates
Last Update Posted: July 21, 2016
Last Verified: July 2016
Keywords provided by ANRS, Emerging Infectious Diseases:
HIV
Prevention
Treatment
South Africa
Additional relevant MeSH terms:
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HIV Infections
Blood-Borne Infections
Communicable Diseases
Infections
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
 Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Immunologic Deficiency Syndromes
Immune System Diseases