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Dolutegravir in Real Life in Lesotho (DO-REAL)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT04238767
Recruitment Status : Completed
First Posted : January 23, 2020
Last Update Posted : May 23, 2023
Sponsor:
Collaborators:
SolidarMed
Ministry of Health, Lesotho
District Health Management Team of Butha-Buthe, Lesotho
District Health Management Team of Mokhotlong, Lesotho
University of Basel
Information provided by (Responsible Party):
Swiss Tropical & Public Health Institute

Study Description
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Brief Summary:

DO-REAL is an observational cohort study assessing the large-scale roll-out of the antiretroviral drug dolutegravir (DTG) in Lesotho.

DTG has been shown to have low side-effects and superior treatment outcomes for people living with HIV-1 when compared to other antiretroviral drugs currently in use in low-income countries. The use of DTG in first-line antiretroviral therapy (ART) regimens was recommended by the World Health Organisation in 2018 and adopted by the Ministry of Health in Lesotho in 2019. While DTG-based ART regimens have led to promising health outcomes in high-income and clinical trial settings, certain concerns remain regarding the risk of ART-experienced patients transitioning to a DTG-based ART regimen being placed on a functional monotherapy (increasing the otherwise low risk of viral resistance to DTG) as well as side-effects including psychological symptoms and weight gain.

Thus, the DO-REAL study intends to address these concerns and provide data on health outcomes of HIV patients on DTG in a "real-life" high-prevalence setting.


Condition or disease Intervention/treatment
HIV-1-infection Drug: Dolutegravir

Detailed Description:

SUMMARY: DO-REAL is an observational cohort study assessing the large-scale roll-out of the antiretroviral drug dolutegravir (DTG) in Lesotho.

BACKGROUND: DTG is a second-generation integrase strand transfer inhibitor with low side-effects and superior treatment outcomes for people living with HIV-1 when compared to other antiretroviral drugs currently in use in low-income countries. Though some cases have been described, HIV-1 resistance to DTG is rare in clinical settings when DTG is used as part of a combination therapy. The use of DTG in first-line antiretroviral therapy (ART) regimens was recommended by the World Health Organisation in 2018 and was adopted by the Ministry of Health in Lesotho in 2019. DTG now forms part of the recommended first-line therapy for many ART-naïve patients in Lesotho. In addition, many patients on a non-DTG-based first-line ART regimen will be transitioned to a DTG-based regimen.

OBJECTIVES: Despite the positive health outcomes observed in patients receiving DTG-based ART in high-income countries and in clinical trial settings, there is little data on virologic outcomes of patients on DTG during large-scale implementation in low- and lower middle-income countries. Concerns remain regarding the risk that some patients transitioning to a DTG-based regimen will be placed on a functional monotherapy. Furthermore, there are concerns as to psychological side-effects and observed weight gain. This observational study aims to assess the virologic outcomes (viral suppression rates as well as potential drug resistance) as well as side-effects of people living with HIV-1 and transitioning to a DTG-based ART regimen in Lesotho.

DO-REAL has two major objectives:

  • To assess virologic outcomes after the programmatic shift to DTG-based regimens.
  • To assess psychological and somatic wellbeing in patients before and after the programmatic shift to DTG-based regimens.

METHODS: DO-REAL is a cohort study enrolling people living with HIV who are initiating or are eligible (according to national guidelines and the local implementation thereof) to initiate a DTG-based antiretroviral therapy (ART) regimen. The study will take place at three hospitals in two districts (Butha-Buthe, Mokhotlong) in Lesotho, and aims to enrol over 2000 participants. Viral loads will be measured on the day of initiating a DTG-based regimen (or on the day this was offered), as well as four, 12 and 24 months thereafter. In a post-hoc analysis, samples will be tested for drug resistance in samples where the viral load permits (approx. ≥100 c/mL). A subset of participants will complete screenings for depression, general health, and HIV-related symptoms.

Study Design
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Study Type : Observational [Patient Registry]
Actual Enrollment : 1433 participants
Observational Model: Cohort
Time Perspective: Prospective
Target Follow-Up Duration: 2 Years
Official Title: Observational Assessment of the Nation-wide Roll-out of Dolutegravir in Lesotho
Actual Study Start Date : February 10, 2020
Actual Primary Completion Date : May 19, 2021
Actual Study Completion Date : May 20, 2021

Resource links provided by the National Library of Medicine

MedlinePlus related topics: HIV/AIDS

Groups and Cohorts
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Group/Cohort Intervention/treatment
HIV-1-positive individuals
HIV-1-positive individuals eligible to receive a DTG-based ART regimen at enrolment.
 Drug: Dolutegravir
Eligibility to receive DTG-based ART at enrolment (i.e., initiation or offer to initiate DTG-based ART)


Outcome Measures
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Primary Outcome Measures :
  1. Virologic outcomes after programmatic transition to DTG-containing regimens [ Time Frame: 4 months after initiation of a DTG-containing regimen ]
    Viral load

  2. Quality of life screening score (change from baseline) [ Time Frame: Change between time of initiation of a DTG-containing ART regimen and 4 months thereafter ]
    12-Item Short Form Health Survey (SF-12; 12-item index in which questions are scored and weighted into 2 subscales, physical health and mental health; scores can range from 0-100 with higher scores indicating higher physical or mental health)

  3. Depression screening score (change from baseline) [ Time Frame: Change between time of initiation of a DTG-containing ART regimen and 4 months thereafter ]
    Patient Health Questionnaire-9 (PHQ-9; 9-item index with each item scored 0-3, providing a 0-27 severity score with a higher score indicating higher severity)

  4. HIV symptom screening score (change from baseline) [ Time Frame: Change between time of initiation of a DTG-containing ART regimen and 4 months thereafter ]
    Modified HIV Symptom Index (21-item index with each item scored 0-4, providing a 0-84 severity score with a higher score indicating higher severity)


Secondary Outcome Measures :
  1. Virologic status at programmatic transition to DTG-containing regimens [ Time Frame: On day of initiation of a DTG-containing regimen ]
    Viral load (post-hoc analysis)

  2. Viral drug resistance at programmatic transition to DTG-containing regimens [ Time Frame: On day of initiation of a DTG-containing ART regimen ]
    HIV-1 drug resistance (assessed by Sanger sequencing) in the case of an unsuppressed viral load (post-hoc analysis)

  3. Weight (change from baseline) [ Time Frame: On day of initiation of a DTG-containing ART regimen and 4, 12 and 24 months thereafter ]
    Change from time of enrolment; median and interquartile range; in kg

  4. Reasons for discontinuation of a DTG-containing regimen [ Time Frame: Up to 24 months after enrolment ]
    Reasons for discontinuing a DTG-containing regimen as noted in medical records, where applicable

  5. Long-term virologic outcomes after programmatic transition to DTG-containing regimens [ Time Frame: 12 and 24 months after initiation of a DTG-containing regimen ]
    Viral load

  6. Viral drug resistance after programmatic transition to DTG-containing regimens [ Time Frame: 4, 12 and 24 months after initiation of a DTG-containing regimen ]
    HIV-1 drug resistance (assessed by Sanger sequencing) in the case of an unsuppressed viral load


Biospecimen Retention:   Samples Without DNA
Blood plasma

Eligibility Criteria
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Information from the National Library of Medicine

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, Learn About Clinical Studies.


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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
Participants will be enrolled at two government hospitals and one missionary hospital in two districts (Butha-Buthe and Mokhotlong) in Lesotho.
Criteria

Inclusion Criteria:

  • HIV-1-positive
  • Initiating or eligible to initiate (offered to initiate) a DTG-based ART regimen
  • Informed written consent (and assent, if applicable) provided

Exclusion Criteria:

  • None
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): NCT04238767


Locations
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Lesotho
Butha-Buthe Government Hospital
Butha-Buthe, Lesotho
Seboche Mission Hospital
Butha-Buthe, Lesotho
Sponsors and Collaborators
Swiss Tropical & Public Health Institute
SolidarMed
Ministry of Health, Lesotho
District Health Management Team of Butha-Buthe, Lesotho
District Health Management Team of Mokhotlong, Lesotho
University of Basel
Investigators
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Study Chair: Niklaus D Labhardt, MD, MIH Swiss Tropical & Public Health Institute
Study Director: Thomas Klimkait, PhD University of Basel
Study Director: Josephine Muhairwe, MD, MPH SolidarMed Lesotho
Principal Investigator: Jennifer A Brown, MSc, MAS D&C Swiss Tropical & Public Health Institute
More Information
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Study Data/Documents: Individual Participant Data Set  This link exits the ClinicalTrials.gov site
Identifier: 10.5281/zenodo.6654462

Dataset relating to:

Brown JA, Nsakala BL, Mokhele K, et al. Dolutegravir in real life: Self-reported mental and physical health outcomes after transitioning from efavirenz- to dolutegravir-based antiretroviral therapy in a prospective cohort study in Lesotho. HIV Med. Published online June 22, 2022. doi:10.1111/hiv.13352


Individual Participant Data Set  This link exits the ClinicalTrials.gov site

Dataset relating to:

Brown JA, Nsakala BL, Mokhele K, et al. Viral suppression after transition from nonnucleoside reverse transcriptase inhibitor- to dolutegravir-based antiretroviral therapy: A prospective cohort study in Lesotho (DO-REAL study). HIV Med. 2022;23(3):287-293. doi:10.1111/hiv.13189



Publications of Results:

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Responsible Party: Swiss Tropical & Public Health Institute
ClinicalTrials.gov Identifier: NCT04238767    
Other Study ID Numbers: P001-19-1.2
First Posted: January 23, 2020    Key Record Dates
Last Update Posted: May 23, 2023
Last Verified: October 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: Yes
Plan Description:

Pseudonymized dataset for the published manuscripts "Viral suppression after transition from nonnucleoside reverse transcriptase inhibitor- to dolutegravir-based antiretroviral therapy: A prospective cohort study in Lesotho (DO-REAL study)" and "Dolutegravir in Real Life: self-reported mental and physical health outcomes after transitioning from efavirenz- to dolutegravir-based antiretroviral therapy in a prospective cohort study in Lesotho" are publicly available on Zenodo:

https://zenodo.org/record/5948369 https://zenodo.org/record/6654462

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Swiss Tropical & Public Health Institute:
HIV-1
AIDS
dolutegravir
 antiretroviral therapy
Lesotho
sub-Saharan Africa
Additional relevant MeSH terms:
Layout table for MeSH terms
Dolutegravir
HIV Integrase Inhibitors
Integrase Inhibitors
Enzyme Inhibitors
Molecular Mechanisms of Pharmacological Action
 Anti-HIV Agents
Anti-Retroviral Agents
Antiviral Agents
Anti-Infective Agents