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Enhancing Use of Hydroxyurea In Sickle Cell Disease Using Patient Navigators (SHiP HU)

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ClinicalTrials.gov Identifier: NCT02197845
Recruitment Status : Recruiting
First Posted : July 23, 2014
Last Update Posted : July 13, 2018
Sponsor:
Collaborators:
Eastern Virginia Medical School
Children's Hospital of The King's Daughters
Virginia Department of Health
James Madison University
National Heart, Lung, and Blood Institute (NHLBI)
Information provided by (Responsible Party):
Virginia Commonwealth University

Brief Summary:

Multi-phase, patient navigator-based program in the Richmond and Tidewater regions of Virginia to demonstrate:

  1. the feasibility of using patient navigators to improve the percentage of children and adult (age 15 and older) patients with sickle cell disease (SCD) in SCD specialty care
  2. the efficacy of using patient navigators to improve hydroxyurea (HU) (re-)initiation and adherence among adult patients with SCD eligible for HU

(Patient navigators may also be known as public health workers.)


Condition or disease Intervention/treatment Phase
Sickle Cell Disease Behavioral: Patient Navigator Behavioral: Recruitment into Specialty Care Not Applicable

Detailed Description:

The state of Virginia, including the Virginia Department of Health and three academic medical centers and one federally qualified health center, plans a two-phase demonstration, first of improvement in the percentage of adults with SCD who are in SCD specialty care (Phase I), then of improvement in adherence to HU of eligible SCD adults (Phase II). Both phases will use existing academic SCD providers, and an innovative, multimodal strategy, featuring specially trained SCD patient navigators (PNs), that addresses barriers to care and to HU use. In Phase I we will demonstrate the feasibility of utilizing PNs to overcome patient access barriers to SCD care. In Phase II we will test the efficacy of PNs for overcoming barriers to acceptance of and adherence with HU therapy. Patients will be randomized to a PN arm or to a usual care arm. Providers will implement NIH guidelines for HU eligibility and prescribing in both arms. All HU eligible patients will be offered HU at each clinical visit. Among patients prescribed HU, if a maximum tolerated dose (MTD, defined in end points) has not been reached, providers will dose escalate every 8-12 weeks to MTD, rather than to clinical effect, before declaring treatment success or failure.

This project will be critically important and impactful by demonstrating the feasibility of a statewide community-based strategy to assist vulnerable SCD adults in obtaining SCD specialty care and likely prolonging life, a model that other states could adopt.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 439 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Investigator)
Primary Purpose: Health Services Research
Official Title: Enhancing Use of Hydroxyurea In Sickle Cell Disease Using Patient Navigators
Study Start Date : October 2012
Estimated Primary Completion Date : December 2018
Estimated Study Completion Date : December 2018

Resource links provided by the National Library of Medicine

Drug Information available for: Hydroxyurea

Arm Intervention/treatment
Experimental: Phase I: Recruitment into Specialty Care
Participants in the Phase I Experimental Arm are enrolled into SCD specialty care. PN's will contact patient up to 3 times to assure patients have had an initial visit by 3 months time.
Behavioral: Recruitment into Specialty Care
A specially trained (SCD knowledgeable) Patient Navigator will act as a liaison to participants in increasing adherence to Hydroxyurea. Interventions utilized by a PN include teaching disease management skills, addressing barriers to care, disease education, HU management, motivational interviewing, care coordination and social support.
Other Name: Sickle Cell Disease Specialty Care

Experimental: Phase II: Patient Navigator Arm
Participants in the Phase II Experimental Arm follow routine clinical care and are assigned a Patient Navigator. A specially trained (SCD specefic)PN will work with participants for one year. Participants will be contacted by their Navigator weekly for the first 6 months, then biweekly for the second 6 months.
Behavioral: Patient Navigator
A specially trained (SCD knowledgable) Patient Navigator will act as a liaison who assists participants in increasing adherence to HU through disease education, addressing barriers to care and improving adherence to HU. PN utilize various techniques geared toward the individual patients needs. Interventions utilized by a PN include improving disease management skills, educational materials about disease, HU adherence, motivational interviewing, care coordination and social support.
Other Names:
  • Public Health Worker
  • Community Health Worker

No Intervention: Phase II: Passenger Arm
No Intervention. Participants in the Phase II Passenger Arm follow routine clinical care.



Primary Outcome Measures :
  1. Phase I: Percent of enrolled Phase I subjects who complete a provider visit by 3 months post enrollment [ Time Frame: 3 months ]
  2. Phase II: Increase in fetal hemoglobin (HbF) as measured by hemoglobin electrophoresis [ Time Frame: Baseline, 6 months, 1 year ]

Secondary Outcome Measures :
  1. Phase II: Measures of adherence to HU [ Time Frame: Baseline, 6 months, 1 year ]
    For patients prescribed HU, clinical research coordinators will assess HU prescription refills from pill counts, pharmacy records, and self-report at baseline, 6 months, and 1 year. Patient navigators will regularly assess their patients' HU adherence by conducting pill counts at home visits.

  2. Phase II: Percent of patients achieving either maximum tolerated dose (MTD) or maximum dose [ Time Frame: Baseline, 6 months, 1 year ]
    Maximum tolerated dose (MTD) is the daily single oral dose that can be maintained for at least 16 weeks without toxicity (< 3 x l09 neutrophils/L, <100 x l09 platelets/L, < 125 x l09 reticulocytes/L, 20% drop in [Hb] or an absolute value of <4.5 g/dL, 50% rise in creatinine or absolute increase of >0.4 mg/dL, 100% rise in ALT,GI disturbance, or rash or hair loss not attributable to other causes). Maximum dose is 35 mg/kg.

  3. Phase II: Number of emergency department and hospital visits [ Time Frame: Baseline, 6 months, 1 year ]
  4. Phase II: Mean corpuscular volume [ Time Frame: Baseline, 6 months, 1 year ]
  5. Phase II: Total hemoglobin [ Time Frame: Baseline, 6 months, 1 year ]
  6. Phase II: White blood cell count [ Time Frame: Baseline, 6 months, 1 year ]
  7. Phase II: Reticulocyte count [ Time Frame: Baseline, 6 months, 1 year ]
  8. Phase II: Quality of life measures [ Time Frame: Baseline, 6 months, 1 year ]
    Adult Sickle Cell Quality of Life Measurement System (ASCQ-Me), Patient Reported Outcomes Measurement Information System (PROMIS)

  9. Phase II: Patient activation measures [ Time Frame: Baseline, 6 months, 1 year ]
    Patient Activation Measure

  10. Phase II: Patient knowledge measures [ Time Frame: 1 year ]
    Assessment of Sickle Cell Knowledge - University of Florida (UF-ASCK) (unpublished)

  11. Phase II: Health care knowledge and skills, self-efficacy, sickle cell stress measures [ Time Frame: Baseline, 6 months, 1 year ]
    Sickle Cell Transition intervention Program (TIP) Survey (non-validated)

  12. Phase II: Social support measures [ Time Frame: Baseline, 6 months, 1 year ]
    Sickle Cell Transition intervention Program (TIP) Survey (non-validated) and Multidimensional Scale of Perceived Social Support

  13. Phase II: Coping strategies [ Time Frame: Baseline, 6 months, 1 year ]
    Coping Strategies Questionnaire for SCD

  14. Phase II: Associated pain conditions and comorbidities [ Time Frame: Baseline, 6 months, 1 year ]
    Chart Review, Self Report and Surveys: Adult Sickle Cell Quality of Life Measurement System (ASCQ-Me), Patient Reported Outcomes Measurement Information System (PROMIS)

  15. Phase II: Blood transfusion measures (if applicable) [ Time Frame: 6 months, 1 year ]
    Chart review

  16. Phase II: Patient Navigator Satisfaction (if applicable) [ Time Frame: 1 year ]
    Patient Navigator Satisfaction Surveys, 12 month follow up, Patient Study Experience Review for Patient Navigators



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Ages Eligible for Study:   15 Years and older   (Child, Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

PHASE I:

Inclusion Criteria:

  • Patient Self Report of Sickle Cell Disease (Genotypes: Hb SS, SC, SBoThal, SB+Thal)
  • 15 years or older
  • Virginia resident

Exclusion Criteria:

-Visited one of a pre-selected list of sickle cell specialists in Virginia within the last 6 months

PHASE II:

Inclusion Criteria:

  • Sickle Cell Disease (SCD) patient (Genotypes: SS or SBoThal)
  • Eligible for Hydroxyurea (according to NIH guidelines)
  • 15 years or older
  • Virginia resident

Exclusion Criteria:

  • Pregnancy
  • Enrollment in scheduled chronic transfusion program
  • SCD Genotype: Hb SC and SB+Thal)

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): NCT02197845


Contacts
Contact: Shirley Johnson 804-628-2627 shirley.johnson@vcuhealth.org
Contact: Wally R Smith, MD 804-828-6938 wally.smith@vcuhealth.org

Locations
United States, Virginia
Virginia Commonwealth University Recruiting
Richmond, Virginia, United States, 23298
Principal Investigator: Wally R. Smith, MD         
Sponsors and Collaborators
Virginia Commonwealth University
Eastern Virginia Medical School
Children's Hospital of The King's Daughters
Virginia Department of Health
James Madison University
National Heart, Lung, and Blood Institute (NHLBI)
Investigators
Principal Investigator: Wally R Smith, MD Virginia Commonwealth University

Responsible Party: Virginia Commonwealth University
ClinicalTrials.gov Identifier: NCT02197845     History of Changes
Other Study ID Numbers: HM14641
1R18HL112737-01 ( U.S. NIH Grant/Contract )
First Posted: July 23, 2014    Key Record Dates
Last Update Posted: July 13, 2018
Last Verified: July 2018
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Keywords provided by Virginia Commonwealth University:
sickle cell disease
hydroxyurea
patient navigator
community health worker
public health worker
fetal hemoglobin
health services research

Additional relevant MeSH terms:
Anemia, Sickle Cell
Anemia, Hemolytic, Congenital
Anemia, Hemolytic
Anemia
Hematologic Diseases
Genetic Diseases, Inborn
Hemoglobinopathies
Hydroxyurea
Antineoplastic Agents
Antisickling Agents
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
Nucleic Acid Synthesis Inhibitors