HIV InfectionsNCT00080522
Strategies for Delivering Anti-HIV Therapy in South Africa
A study testing Monitoring by HIV-trained primary care nurses, Community-based directly observed therapy (DOT) and stavudine in people with HIV Infections, run by National Institute of Allergy and Infectious Diseases (NIAID) at 2 sites in South Africa.
Trial summary
Providing effective anti-HIV therapy in developing countries is challenging. This study will evaluate new strategies for delivering anti-HIV medications to people in South Africa. Read more about this study
- Who is it for?
- Ages 3 years and older
- Conditions the study is for
- HIV Infections
- What is being tested?
- Monitoring by HIV-trained primary care nurses, Community-based directly observed therapy (DOT) and stavudine
- Type of treatment
- Lifestyle or therapy programme
- How many people
- 813 participants
- Where
- 2 sitesSouth Africa
- Study dates
- Feb 2005to Jan 2007
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 3 years and older
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Who may be able to join
None listed.
Who cannot join
- Newly diagnosed AIDS-defining (CDC Classification C) opportunistic infection or condition requiring acute therapy at the time of enrollment. A stable patient on therapy for more than 7 days may be enrolled. Patients who tuberculosis treatment within 8 weeks of the baseline visit are not excluded.
- Use of medications with significant effect on bone marrow, nervous system, pancreas, or liver within 30 days prior to study entry
- Use of cytotoxic medications within 30 days prior to study entry
- Active alcohol or substance abuse
- Severe diarrhea (more than 6 stools/day for 7 consecutive days) within 30 days prior to study entry
- Acute hepatitis within 30 days prior to study entry
Show all 11Show fewer
- Bilateral peripheral neuropathy of Grade 2 or greater at the time of screening
- Women in the first trimester of pregnancy
- Women who have failed a lopinavir/ritonavir treatment regimen in Part I and who are either pregnant at entry into Part 2 or are of childbearing potential with a CD4 count of 250 cells/mm3 or more
- Inability to tolerate oral medication
- Any clinical condition that, in the opinion of the investigator, would make the person unsuitable for the study or unable to comply with the dosing requirements
Trial locations and contacts
2 sites in 1 country.
South Africa2 sites
University of Cape Town/Masiphumelele
Cape Town, South Peninsula, 8005
University of the Witwatersrand/Clinical HIV Research Unit
Johannesburg, Gauteng, 2013
About this study
Official title: Safeguard the Household: A Study of HIV Antiretroviral Therapy Treatment Strategies Appropriate for a Resource Poor Country
Providing effective anti-HIV therapy in developing countries is challenging. This study will evaluate new strategies for delivering anti-HIV medications to people in South Africa. These strategies include using specially trained nurses to administer therapy (rather than doctors), treating all HIV infected members of a household at the same time, and having community members observe patients taking their medications.
Read the detailed description
The benefit of antiretroviral therapy is well established but limited to wealthy nations. A predefined, simple sequence of treatment regimens focused on extending the durability of limited treatment options has the best potential to be implemented in resource poor countries. South Africa has 15% of the world's HIV/AIDS patients and a limited number of physicians to treat them (l per 1,600 and less than 5 infectious diseases specialists). HIV patient care in the primary care setting must therefore be delivered by personnel other than doctors. Further, treatment strategies should include entire households to ensure maximum adherence and minimize sharing of drugs.
This study will have two parts. The first part will compare a first-line antiretroviral therapy regimen administered and monitored by primary health care sisters (nurses) with the same regimen administered by doctors. The second part of the study will determine if community-based directly observed therapy (DOT) is significantly superior to continued clinic-based treatment support for patients who have failed first-line therapy, as measured by cumulative virology failure rate. The project will also evaluate the cost and economic impact of a predetermined schedule of antiretroviral therapy; treatment outcomes in terms of morbidity, opportunistic and endemic infections, and mortality; and factors contributing to treatment failure, including toxicity, resistance, compliance, and treatment interruption.
In Part 1, households will be randomly assigned to receive first-line antiretroviral therapy under the monitoring and care of either an HIV-trained medical doctor supported by adherence counselors or an HIV-trained primary health care sister (nurse with training in diagnosis and treatment prescription). Members of the household who are HIV infected will receive stavudine, lamivudine, and efavirenz (nevirapine or nelfinavir may be used for special populations).
Participants who fail first-line antiretroviral therapy in Part 1 of the study will be entered into Part 2 of the study. Participants in Part 2 will receive zidovudine, didanosine, and lopinavir/ritonavir. Participants will be randomly assigned to have their treatment monitored through either a clinic-based treatment support group or through community-based directly observed treatment (DOT). For the DOT arm, a community member will observe therapy for at least one dose a day, five days a week, at the home or work of the participant.
HIV infected children age 3 months to 16 years who live in a participating household will also be included in the study. These children will receive first-line treatment with clinic visits monitored by either the assigned sister (nurse) or doctor along with their households. In Part 2, children will be provided with a second-line treatment regimen with continued daily monitoring of doses in the household.
The study will last 5 years.
- Conditions
- HIV Infections
- Being tested
- Monitoring by HIV-trained primary care nurses, Community-based directly observed therapy (DOT), stavudine, lamivudine, efavirenz
- Keywords
- Treatment Naive, Resource Poor Setting, Drug Delivery, Household, South Africa
- Medical subject headings
- HIV Infections
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Monitoring by HIV-trained primary care nursesBehavioural
Community-based directly observed therapy (DOT)Behavioural
stavudineDrug
lamivudineDrug
efavirenzDrug
zidovudineDrug
didanosineDrug
lopinavir/ritonavirDrug
What is being measured
The primary outcome is the main question the study is designed to answer.
Cumulative treatment failure rate, determined by comparing a primary health care level first line antiretroviral therapy regimen to a doctor monitored treatment regimen
48-week cumulative virology failure rate, determined by comparing community-based directly observed therapy (DOT) by identified and trained community members to continued clinic-based treatment support for subjects who have failed first line therapy
Secondary outcomes (14)
Overall clinical safety of antiretroviral therapy, as measured by the occurrence of clinical and laboratory Grade 3 and 4 adverse events, between primary health care monitoring arms in adults and children
CD4+ count, viral load, drug toxicity, adherence, participation in MTCT programs, intercurrent medical conditions, age as factors potentially contributing to cumulative treatment failure in participants age 16 and older
cumulative treatment failure rate between groups, defined by clinical staging (CDC and WHO classification) prior to initiation of antiretroviral therapy and monitoring arms in adults and children
cumulative treatment failure rate of second line therapy from time of Phase 1 randomization in adults and children, between the doctor and the primary health care sister-based monitoring arm
comparison of immune reconstitution in adults and children, using change in CD4+ percent from baseline between the two treatment monitoring models over the duration of the study
comparison of HIV resistance mutations in adults and children who have demonstrated virologic failure between the doctor and the primary health care sister-based monitoring arms
comparison of adherence to antiretroviral treatment in Phase 1 in both adults and children as measured by pill count (or weight or volume of drug solution) between the two primary health care monitoring models
comparison of adherence to antiretroviral treatment in adults as measured by pill count between those randomized to community-based DOT and those randomized to continued clinic-based adherence support
comparison of HIV disease progression/death in adults and children between the two primary health care monitoring arms
total and incremental costs of adding the 4 approaches for the provision of antiretrovirals to primary health care services in each study site
potential costs to the government of provincial and national based scale-up for the provision of antiretroviral therapy in the short, long and medium term and resulting net costs/savings of each approach as a national strategy
relative cost effectiveness of the introduction of the four alternative models of HAART provision versus no provision, using life-years gained and quality adjusted life-years gained
household preferences for various aspects of antiretroviral therapy provision program design, including assessing their relationship with adherence
personnel required for a nurse-based monitoring program, including the training process and implementation
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted7 Apr 2004 (estimated)
- Study startFeb 2005
- Study completionJan 2007
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for HIV InfectionsStudies of the same condition, open and under way.
- More trials run by National Institute of Allergy and Infectious Diseases (NIAID)The sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Factorial
- Masking
- None (open label)
- Enrolment
- 813 participants
Sponsor and investigators
- Sponsor type
- US National Institutes of Health
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00080522
- Sponsor's protocol ID
- 5U19AI053217-02
- Other IDs
- CIPRA-SA Project 1, 5U19AI053217-02
- Status last verified
- Aug 2007
- First submitted
- 6 Apr 2004
- Last updated
- 18 Sep 2007
- Results posted
- No
Study at a glance
From the registry record, last updated by the sponsor on 18 Sep 2007. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Safeguard the Household: A Study of HIV Antiretroviral Therapy Treatment Strategies Appropriate for a Resource Poor Country
- ClinicalTrials.gov ID
- NCT00080522
- Acronym / sponsor ID
- 5U19AI053217-02
- Conditions
- HIV Infections
- Keywords
- Treatment Naive, Resource Poor Setting, Drug Delivery, Household, South Africa
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 813 participants
- Lead sponsor
- National Institute of Allergy and Infectious Diseases (NIAID)US National Institutes of Health
- Study start
- Feb 2005
- Study completion
- Jan 2007 (actual)
- First posted
- 7 Apr 2004 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Providing effective anti-HIV therapy in developing countries is challenging. This study will evaluate new strategies for delivering anti-HIV medications to people in South Africa. These strategies include using specially trained nurses to administer therapy (rather than doctors), treating all HIV infected members of a household at the same time, and having community members observe patients taking their medications.
Detailed description
The benefit of antiretroviral therapy is well established but limited to wealthy nations. A predefined, simple sequence of treatment regimens focused on extending the durability of limited treatment options has the best potential to be implemented in resource poor countries. South Africa has 15% of the world's HIV/AIDS patients and a limited number of physicians to treat them (l per 1,600 and less than 5 infectious diseases specialists). HIV patient care in the primary care setting must therefore be delivered by personnel other than doctors. Further, treatment strategies should include entire households to ensure maximum adherence and minimize sharing of drugs.
This study will have two parts. The first part will compare a first-line antiretroviral therapy regimen administered and monitored by primary health care sisters (nurses) with the same regimen administered by doctors. The second part of the study will determine if community-based directly observed therapy (DOT) is significantly superior to continued clinic-based treatment support for patients who have failed first-line therapy, as measured by cumulative virology failure rate. The project will also evaluate the cost and economic impact of a predetermined schedule of antiretroviral therapy; treatment outcomes in terms of morbidity, opportunistic and endemic infections, and mortality; and factors contributing to treatment failure, including toxicity, resistance, compliance, and treatment interruption.
In Part 1, households will be randomly assigned to receive first-line antiretroviral therapy under the monitoring and care of either an HIV-trained medical doctor supported by adherence counselors or an HIV-trained primary health care sister (nurse with training in diagnosis and treatment prescription). Members of the household who are HIV infected will receive stavudine, lamivudine, and efavirenz (nevirapine or nelfinavir may be used for special populations).
Participants who fail first-line antiretroviral therapy in Part 1 of the study will be entered into Part 2 of the study. Participants in Part 2 will receive zidovudine, didanosine, and lopinavir/ritonavir. Participants will be randomly assigned to have their treatment monitored through either a clinic-based treatment support group or through community-based directly observed treatment (DOT). For the DOT arm, a community member will observe therapy for at least one dose a day, five days a week, at the home or work of the participant.
HIV infected children age 3 months to 16 years who live in a participating household will also be included in the study. These children will receive first-line treatment with clinic visits monitored by either the assigned sister (nurse) or doctor along with their households. In Part 2, children will be provided with a second-line treatment regimen with continued daily monitoring of doses in the household.
The study will last 5 years.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Factorial
- Masking
- None (open label)
Who may qualify
- Ages
- 3 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (0 listed)
Key exclusion criteria (11 listed)
- Newly diagnosed AIDS-defining (CDC Classification C) opportunistic infection or condition requiring acute therapy at the time of enrollment. A stable patient on therapy for more than 7 days may be enrolled. Patients who tuberculosis treatment within 8 weeks of the baseline visit are not excluded.
- Use of medications with significant effect on bone marrow, nervous system, pancreas, or liver within 30 days prior to study entry
- Use of cytotoxic medications within 30 days prior to study entry
- Active alcohol or substance abuse
- Severe diarrhea (more than 6 stools/day for 7 consecutive days) within 30 days prior to study entry
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Monitoring by HIV-trained primary care nurses | Behavioural | – |
| Community-based directly observed therapy (DOT) | Behavioural | – |
| stavudine | Drug | – |
| lamivudine | Drug | – |
| efavirenz | Drug | – |
| zidovudine | Drug | – |
| didanosine | Drug | – |
| lopinavir/ritonavir | Drug | – |
Primary outcome
Cumulative treatment failure rate, determined by comparing a primary health care level first line antiretroviral therapy regimen to a doctor monitored treatment regimen
48-week cumulative virology failure rate, determined by comparing community-based directly observed therapy (DOT) by identified and trained community members to continued clinic-based treatment support for subjects who have failed first line therapy
14 secondary outcomes
Overall clinical safety of antiretroviral therapy, as measured by the occurrence of clinical and laboratory Grade 3 and 4 adverse events, between primary health care monitoring arms in adults and children
CD4+ count, viral load, drug toxicity, adherence, participation in MTCT programs, intercurrent medical conditions, age as factors potentially contributing to cumulative treatment failure in participants age 16 and older
cumulative treatment failure rate between groups, defined by clinical staging (CDC and WHO classification) prior to initiation of antiretroviral therapy and monitoring arms in adults and children
cumulative treatment failure rate of second line therapy from time of Phase 1 randomization in adults and children, between the doctor and the primary health care sister-based monitoring arm
comparison of immune reconstitution in adults and children, using change in CD4+ percent from baseline between the two treatment monitoring models over the duration of the study
comparison of HIV resistance mutations in adults and children who have demonstrated virologic failure between the doctor and the primary health care sister-based monitoring arms
comparison of adherence to antiretroviral treatment in Phase 1 in both adults and children as measured by pill count (or weight or volume of drug solution) between the two primary health care monitoring models
comparison of adherence to antiretroviral treatment in adults as measured by pill count between those randomized to community-based DOT and those randomized to continued clinic-based adherence support
comparison of HIV disease progression/death in adults and children between the two primary health care monitoring arms
total and incremental costs of adding the 4 approaches for the provision of antiretrovirals to primary health care services in each study site
potential costs to the government of provincial and national based scale-up for the provision of antiretroviral therapy in the short, long and medium term and resulting net costs/savings of each approach as a national strategy
relative cost effectiveness of the introduction of the four alternative models of HAART provision versus no provision, using life-years gained and quality adjusted life-years gained
household preferences for various aspects of antiretroviral therapy provision program design, including assessing their relationship with adherence
personnel required for a nurse-based monitoring program, including the training process and implementation
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 18 Sep 2007.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
The record lists no contact. Use the official record to reach the sponsor.
2 sites in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Monitoring by HIV-trained primary care nurses, Community-based directly observed therapy (DOT) and stavudine in people with HIV Infections, run by National Institute of Allergy and Infectious Diseases (NIAID) at 2 sites in South Africa.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 0 inclusion and 11 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 18 Sep 2007. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 2 sites in South Africa. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Cumulative treatment failure rate, determined by comparing a primary health care level first line antiretroviral therapy regimen to a doctor monitored treatment regimen. The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 18 Sep 2007; AzTrials last refreshed its copy on 8 Nov 2026.