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Primary HIV Prevention in Pregnant and Lactating Ugandan Women (PRIMAL)
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Purpose
This study aims to test the effectiveness of a behavioral intervention aimed at preventing the primary acquisition of HIV by uninfected pregnant and lactating women in Uganda, East Africa where HIV transmission is high. Women who acquire HIV during pregnancy or lactation are at higher risk of adverse health and pregnancy outcomes and their baby is at high risk of acquiring HIV and dying.
Keeping HIV-uninfected women uninfected during pregnancy and lactation is an important component of the global World Health Organization (WHO) strategy to eliminate mother-to-child transmission of HIV but there has been no study to date to assess interventions that can effectively keep these women uninfected.
In this study, the investigators will test the hypotheses that:
- extended repeat HIV testing and enhanced counseling (ERHTEC) during late pregnancy (>36 weeks) and breastfeeding can increase and sustain risk reduction behaviors and prevent incident STI and HIV infections among HIV-uninfected pregnant women, and
- that couple HIV testing and counseling (HTC) can further enhance this effect through improved couple communication and emotional and economic support from male partners.
| Condition | Intervention |
|---|---|
| Primary Prevention of HIV Acquisition | Behavioral: Extended repeat HIV testing and enhanced counseling |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Intervention Model: Parallel Assignment Masking: None (Open Label) Primary Purpose: Prevention |
| Official Title: | PRIMARY HIV PREVENTION IN PREGNANT AND LACTATING UGANDAN WOMEN: A RANDOMIZED TRIAL |
- Frequency of unprotected sex [ Time Frame: 27 months ]Self-reported number of unprotected sex episodes among women participants validated by detection of semen (Y chromosome) in vaginal swabs
- STI incidence [ Time Frame: 27 months ]Incidence of Syphilis, N. gonorrhea, C. trachomatis and T. vaginalis infections among women and men participants
- HIV incidence [ Time Frame: 27 months ]Incidence of HIV infection among women and men participants
- Incidence of recurrent wanted and unwanted pregnancy [ Time Frame: 24 months ]Incidence of wanted and unwanted recurrent pregnancy within 24 months of delivery
| Enrollment: | 1230 |
| Study Start Date: | February 2013 |
| Study Completion Date: | May 2016 |
| Primary Completion Date: | May 2016 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: Women-Extended Repeat Testing and Enhanced Counseling
Pregnant/breastfeeding women enrolled individually and randomized to the intervention arm will receive extended repeat HIV testing and enhanced counseling at the time of labor and delivery and throughout the lactation period at 3, 6, 12, 18 and 24 months postpartum or until cessation of breastfeeding, whichever occurs first.
|
Behavioral: Extended repeat HIV testing and enhanced counseling
Pregnant/breastfeeding women in the intervention arm and their male partners if present will receive extended repeat HIV testing and enhanced counseling around the time of labor and delivery and throughout the breastfeeding period.
Other Name: ERHTEC
|
|
Experimental: Couples-Extended Repeat Testing and Enhanced Counseling
Pregnant/breastfeeding women enrolled in couples with their male partners and randomized to the intervention arm will receive extended repeat HIV testing and enhanced counseling at the time of labor and delivery and throughout the lactation period at 3, 6, 12, 18 and 24 months postpartum or until cessation of breastfeeding, whichever occurs first.
|
Behavioral: Extended repeat HIV testing and enhanced counseling
Pregnant/breastfeeding women in the intervention arm and their male partners if present will receive extended repeat HIV testing and enhanced counseling around the time of labor and delivery and throughout the breastfeeding period.
Other Name: ERHTEC
|
Detailed Description:
The specific aims of the study are:
- Aim 1: to assess the effect of an extended repeat HIV testing and enhanced counseling (ERHTEC) intervention on sexual risk behavior and sexually transmitted infections (STI) and HIV acquisition in HIV-uninfected pregnant and lactating women enrolled individually
- Aim 2: to assess the effect of ERHTEC on sexual risk behavior and the incidence of STI and HIV in uninfected pregnant and lactating women enrolled with their partner, and
- Aim 3: to assess the costs and estimate the cost-effectiveness of the intervention.
We will conduct a stratified randomized trial of 410 HIV-negative pregnant Ugandan women enrolled individually and 410 HIV-negative pregnant women enrolled with their male partners in Mulago Hospital, Kampala and St Joseph Hospital, Kitgum, Northern Uganda. In each site, 205 women enrolled individually and 205 couples will be randomized to be either retested and counseled for HIV in late pregnancy only (>36 weeks) as per the WHO/Ministry of Health (MOH) recommendation, or to receive ERHTEC throughout pregnancy and breastfeeding.
Individual women and couples randomized to the intervention arm will receive the ERHTEC intervention at 3, 6, 12, and 18 months postpartum. Follow-up will end at 24 months postpartum or 6 weeks after the end of breastfeeding, whichever occurs first.
Eligibility| Ages Eligible for Study: | 15 Years to 49 Years (Child, Adult) |
| Sexes Eligible for Study: | All |
| Accepts Healthy Volunteers: | Yes |
Inclusion Criteria:
- Women: 15-49 years old, confirmed HIV negative, confirmed pregnant, living within 30kms /19 miles of hospital, willingness to sign informed consent
- Men: > or = 15 years old, being an established partner of a woman participant, living within 30kms /19 miles of hospital, willingness to sign informed consent
Exclusion Criteria:
- condition requiring hospitalization
Contacts and LocationsPlease refer to this study by its ClinicalTrials.gov identifier: NCT01882998
| Uganda | |
| Mulago Hospital | |
| Kampala, Uganda | |
| Principal Investigator: | Jaco Homsy, MD, MPH | University of California, San Francisco |
More Information
Additional Information:
Publications:
| Responsible Party: | University of California, San Francisco |
| ClinicalTrials.gov Identifier: | NCT01882998 History of Changes |
| Other Study ID Numbers: |
R01HD070767 ( U.S. NIH Grant/Contract ) 1R01HD070767-01A1 ( U.S. NIH Grant/Contract ) |
| Study First Received: | June 17, 2013 |
| Last Updated: | May 20, 2016 |
Keywords provided by University of California, San Francisco:
|
HIV and pregnancy HIV and breastfeeding Mother-to-child transmission of HIV Africa Uganda |
ClinicalTrials.gov processed this record on August 17, 2017