Durability of Adherence in Self-Management of HIV (DASH)

This study has been completed.
Sponsor:
Collaborator:
Information provided by (Responsible Party):
AIDS Clinical Trials Group
ClinicalTrials.gov Identifier:
NCT00991302
First received: October 7, 2009
Last updated: July 30, 2015
Last verified: July 2015
  Purpose

Adherence to highly active antiretroviral therapy (HAART) is critical to successful treatment of HIV. This study tested an intervention that helps people infected with HIV take all their medications when and how they were supposed to.


Condition Intervention Phase
HIV Infections
Behavioral: CAP-IT
Phase 3

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Durability of Adherence in Self-Management of HIV

Resource links provided by NLM:


Further study details as provided by AIDS Clinical Trials Group:

Primary Outcome Measures:
  • Mean Self-reported Adherence Score (%) Over a One-month Recall [ Time Frame: From week 4 to week 48 ] [ Designated as safety issue: No ]

    The adherence self-report questionnaire captured adherence at an Antiretroviral Therapy (ART) regimen over a one-month recall (0-100): 0 means none of anti-HIV medications were taken, 100 means every single dose of anti-HIV medications were taken. The primary endpoint evaluated for each participant was the average self-reported adherence over a one-month recall across each of their study visit week 4, 12, 24, 36, and 48: missing values were ignored.

    Note: This was a change to the primary endpoint as described in the study protocol. This was due to an update to ACTG Case Report Form (CRF) that captured self-report adherence. Since the data captured on this form captured adherence over a longer timeframe and allowed for more variability in response, it was anticipated this endpoint would provide greater power to assess treatment differences.



Secondary Outcome Measures:
  • Mean Self-reported Adherence Score Over a One-month Recall [ Time Frame: From week 4 to week 72 ] [ Designated as safety issue: No ]
    The mean of participant's average self-reported adherence score over a one-month recall across visit week 4, 12, 24, 36, 48, 60, and 72; missing values were ignored.

  • Time to Change of Initial Antiretroviral (ARV) Treatment Regimen [ Time Frame: From study entry to week 48 ] [ Designated as safety issue: No ]

    The Kaplan-Meier estimate of the cumulative probability of drug-class change for any reason by week 48.

    Time to drug-class change was defined as first time to change in the drug class of participant's ART regimen for any reason from study entry. Participants completing the study without a change in the drug class of their ART regimen were censored at their last visit.


  • Virologic Suppression [ Time Frame: At week 24, 48, 72 ] [ Designated as safety issue: No ]
    Virologic suppression was defined as HIV-1 RNA <=200 copies/mL at week 24, 48, and 72. The results obtained within +/- 12 weeks of 24, 48, and 72 weeks were included. If there were multiple HIV-1 RNA measurement within the specified window, the HIV-1 RNA result closest to the center of the window was selected.

  • Self-management Skills, as Measured by Self-reported General Self-efficacy Scale (GSES) Scores [ Time Frame: Measured at entry and at Weeks 4, 12, 24, 36, 48, 60, and 72 ] [ Designated as safety issue: No ]

    The GSES is a 10-item scale designed to assess optimistic self-beliefs used to cope with a variety of demands in life. The scale was designed to assess self efficacy, i.e., the belief that one's actions are responsible for successful outcomes. The scaled score for each question ranges from 1 to 4. Higher scores indicate participant's stronger belief in self-efficacy.

    The GSES score was sum of all responses. The range was from 0 to 40 points: any unfinished question got a score of zero.


  • Cumulative Probability of First Grade 3 or 4 Adverse Events (AEs) [ Time Frame: From study entry to week 72 ] [ Designated as safety issue: Yes ]

    The Kaplan-Meier estimate of the cumulative probability of experiencing a grade 3 or 4 adverse event by week 72.

    New Grade 3 or 4 signs, symptoms were identified by MedDRA preferred term. Events were included regardless of participant status on ART. If a participant had multiple reports of the same event, only the event reported at the highest grade were included.

    Time was measured from the study entry until the date of the first new grade 3 or 4 adverse event. Participants lost to follow-up prior to reaching an adverse event endpoint or not documented to have reached an adverse event endpoint at the end of the study had their endpoint censored at the date of their last visit.



Enrollment: 172
Study Start Date: January 2010
Study Completion Date: January 2015
Primary Completion Date: January 2015 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: CAP-IT

Participants received the modified CAP-IT adherence intervention in addition to standard care.

Modified client adherence profiling and intervention tailoring (CAP-IT): Interventions designed to improve medication adherence, modified to specifically target people first starting highly active antiretroviral therapy (HAART)

Behavioral: CAP-IT
Interventions designed to improve medication adherence, modified to specifically target people first starting highly active antiretroviral therapy (HAART)
Other Name: Client adherence profiling and intervention tailoring
No Intervention: Standard care
Participants received standard care.

Detailed Description:

People infected with HIV must take the regimen of highly active antiretroviral therapy (HAART) medications as prescribed to them, without missing doses, or they risk developing a resistant strain of the virus. Resistant strains of the virus do not respond to certain HAART regimens and are more dangerous for patients. Poor HAART adherence can lead to further HIV progression, more hospitalizations and opportunistic infections, and required use of second-line therapies. Interventions to increase adherence have had mixed success, with little data to support long-term effects and no one strategy emerging that provides consistent positive effects. The client adherence profiling and intervention tailoring (CAP-IT) program was first developed to increase adherence among people already on HAART with in-home nursing. This study modified CAP-IT to treat people newly on HAART and then tested whether this modified CAP-IT improved long-term HAART adherence.

This study included two stages. The first stage consisted of two focus groups, one made up of HIV care providers and professionals and the other made up of people infected with HIV who had started HAART within the last year. Each focus group met once, for approximately 2 hours, to determine what modifications would best adapt the CAP-IT program to HIV-infected people first starting HAART.

The second stage consisted of a randomized trial comparing the modified CAP-IT program to standard of care. Participation in this stage lasted for 72 weeks. Participants were randomly assigned to receive either standard care or the modified CAP-IT program in addition to standard care. The CAP-IT program involved two steps. The first was an assessment of factors relating to adherence, and the second was development of an individualized plan to address the deficits found.

Study visits were completed at entry, at Weeks 4 and 12, and then every 12 weeks for approximately 72 weeks. Assessments for the study included a questionnaire about health attitudes, a physical exam, counting of pills, and answering questions about taking medications.

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • Stage 1

    • HIV infected Individuals on Highly Active Antiretroviral Therapy (HAART):

      • HIV-1 infection
      • Initiated HAART within 1 year prior to study entry and remained on HAART for at least 30 consecutive days
      • Men and women who hade reached the legal age of majority in the country where they are being enrolled
      • Ability and willingness to provide informed consent
      • Willingness to discuss personal topics during an audio-taped group interview
      • Willingness to protect the confidentiality of other focus group participants
    • Health Care Providers and Professionals:

      • Healthcare providers or professionals (e.g., medical doctors [MDs], nurse practitioner [NPs], physician assistants [PAs], adherence counselors) recruited from outside of the local clinical research site (CRS) whose patient population included a majority of HIV-1 seropositive patients and who had recent experience managing ART-naive individuals starting HAART
      • Men and women who had reached the legal age of majority in the country where they are being enrolled
      • Willingness to discuss personal topics during an audio-taped group interview
      • Willingness to protect the confidentiality of other focus group participants and of the proceedings
  • Stage 2:

    • HIV-1 infection
    • Antiretroviral (ARV) treatment naive, but planning to initiate HAART within 7 days of study entry either in the context of an approved parent AIDS Clinical Trial Group (ACTG) clinical trial or in the context of primary HIV care at a University of California, San Diego (UCSD), USA or Asociacion Civil Impacta Salud Y Educaci (IMPACTA), Peru, CRS-affiliated site
    • HIV-1 RNA greater than 1,000 copies/mL obtained within 90 days prior to study entry by any laboratory that has a clinical laboratory improvement amendments (CLIA) certification or its equivalent
    • CD4+/CD8+ count obtained within 90 days prior to study entry by any laboratory that has a CLIA certification or its equivalent
    • Men and women who had reached the legal age of majority in the country where they are being enrolled
    • Ability to follow instructions and complete surveys and questionnaires with minimal assistance

Exclusion Criteria:

  • Stage 1

    • HIV-1 Infected Individuals on HAART:

      • Failure to remain on HAART for at least 30 consecutive days
      • Diminished cognitive capacity that, in the opinion of the screening CRS clinician, would interfere with study participation
      • Participation in any prior focus group for study A5250
    • Health Care Providers and Professionals:

      • Health care providers and professionals who would be involved in administering standard of care (SOC) treatment and adherence counseling to Stage 2 participants randomized to the SOC arm or CRS investigators or health care providers and professionals directly involved in measuring adherence outcomes in Stage 2
      • Participation in any prior focus group for study A5250
  • Stage 2:

    • Potential participants who were, in the judgment of the research team, unable to complete the protocol
    • Potential participants who were starting a NNRTI-based regimen within 12 months after receiving single-dose NVP during pregnancy to prevent MTCT of HIV
    • Potential participants who were partners or close contacts of participants enrolled in Stage 2
    • Potential participants who were currently enrolled in an ACTG protocol utilizing or testing an adherence intervention
  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 ClinicalTrials.gov identifier: NCT00991302

Locations
United States, California
Ucsd, Avrc Crs
San Diego, California, United States, 92037
Peru
Barranco CRS (11301)
Lima, Peru, 18 PE
Sponsors and Collaborators
AIDS Clinical Trials Group
Investigators
Study Chair: Constance Benson, MD University of California, San Diego
Study Chair: Tari Gilbert, MSN University of California, San Diego
  More Information

Publications:
Responsible Party: AIDS Clinical Trials Group
ClinicalTrials.gov Identifier: NCT00991302     History of Changes
Other Study ID Numbers: ACTG A5250, 1U01AI068636, 10654
Study First Received: October 7, 2009
Results First Received: July 29, 2015
Last Updated: July 30, 2015
Health Authority: United States: Federal Government

Keywords provided by AIDS Clinical Trials Group:
Adherence
Behavioral Intervention
Antiretroviral Therapy
ART
Highly Active Antiretroviral Therapy
HAART
Treatment experienced

ClinicalTrials.gov processed this record on August 30, 2015