Impact of Immediate Versus South African Recommendations Guided ART Initiation on HIV Incidence (TasP)
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.
|HIV Infection||Drug: Immediate ARV treatment initiation with TDF/FTC/EFV Other: South African recommendation guided ARV (TDF/FTC/EFV) initiation|
|Study Design:||Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: 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.|
- Uptake of initial and repeat HIV counselling and testing (Feasibility phase) [ Time Frame: 14 months ]Percentage of the target population tested for HIV
- 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
- HIV infection incidence [ Time Frame: 4 years after enrolment initiation ]Serology will be done on Dry Blood Spot collected during repeated surveys
- 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
- 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
- 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
- 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
- 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
- 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
- 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
|Study Start Date:||March 2012|
|Study Completion Date:||June 2016|
|Primary Completion Date:||June 2016 (Final data collection date for primary outcome measure)|
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:
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
Please refer to this study by its ClinicalTrials.gov identifier: NCT01509508
|Hlabisa, KwaZulu-Natal, South Africa, 3937|
|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|