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HIV InfectionsPhase 3AXISNCT06138600

Acceptability and Feasibility of Injectable Cabotegravir Pre-exposure Prophylaxis (PrEP) Versus Oral PrEP in Routine Care up to 15 Months in Private Pharmacies in South Africa

A Phase 3 study testing Cabotegravir Injection [Apretude] and Tenofovir disoproxil fumarate / emtricitabine (or lamivudine) in people with HIV Infections, run by University of Witwatersrand, South Africa at 1 site in South Africa.

Unknown status

Status not confirmed. The sponsor has not verified this record for over two years, so it may be out of date.

Official record
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Trial summary

This is a mixed methods study employing a convergence model triangulation design. Participants in the study will be sexually active young adults starting Pre-exposure Prophylaxis at private pharmacies, who will be offered either Cabotegravir Long-Acting Injectable, oral Pre-exposure Prophylaxis (TDF/FTC[3TC]), or… Read more about this study

Who is it for?
Ages 18 to 35 yearsHealthy volunteers can take part
Conditions the study is for
HIV Infections
What is being tested?
Cabotegravir Injection [Apretude] and Tenofovir disoproxil fumarate / emtricitabine (or lamivudine)
Could I receive a placebo?
No, everyone receives an active treatment
How many people
200 participants
Where
1 siteSouth Africa
Study dates
1 Nov 2023to 31 Jan 2026
Phase
Phase 3
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 18 to 35 years
  • All sexes
  • Healthy volunteers accepted
  • Adult

Who may be able to join

  • -
  • Each participant must meet all of the following criteria to be enrolled in this study:
  • Adult male or female (≥18 and ≤ 35 years old)
  • Is self-reported sexually active
  • HIV negative at the time of study enrolment (as determined by a rapid blood test for HIV 1)
  • Body weight ≥ 35 kilograms.
  • Creatinine clearance ≥ 60 mL/min.
  • Willingness to sign informed consent.

Who cannot join

  • -
  • Participants meeting the following criteria will be excluded from participating in the study:
  • Symptoms of HIV seroconversion (see Table 1).
  • Pregnant (participant must have a negative beta human chorionic gonadotrophin (b-hCG) urine test at screening) or lactating women, or women intending to become pregnant or breastfeed during the study.
  • Is in good health, with no surgical or medical condition which may significantly alter the absorption, distribution, metabolism, or excretion of drugs, or which may jeopardize the safety of the volunteer or the objectives of the study or impair their ability to comply with the dosing schedule and/or protocol evaluations. The Investigator should make this determination in consideration of the volunteer's medical history. This including, but not limited to, the following: a. History of severe hepatic impairment, history of liver cirrhosis with or without viral hepatitis co-infection.
  • Unstable or poorly controlled seizure disorder. c. History of coagulopathies, or current or anticipated need for chronic anticoagulation.
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  • Presence of a tattoo or other dermatological condition overlying the gluteus region which would realistically obstruct administration of an intramuscular injection.
  • Known hypersensitivity to or specific contraindications to the use of TDF or FTC/3TC or CABLA.
  • Hep B surface antigen positive or known active Hep B infection.
  • Is receiving or has received the following agents within 28 days prior to screening, and cannot discontinue their use for the duration of the study:
  • tuberculosis therapy (i.e., rifampicin, rifapentine, rifabutin)
  • anticoagulation agents;
  • anti-convulsants (e.g. carbamazepine, oxcarbazepine, phenobarbital, phenytoin);
  • herbal products (e.g. St John's Wort).
  • Concurrent use of PrEP from a different medical provider, other than the study site
  • Participant is judged by the Investigator to be at significant risk of failing to comply with the provisions of the protocol as to cause harm to self or seriously interfere with the validity of the study results.
  • Inability or unwillingness to be followed up for the study period, including plans to move out the study geographical area in the next 12 months or otherwise unable to participate in the study visits as determined by the PI.

Trial locations and contacts

1 site in 1 country.

South Africa1 site
  • Ezintsha, a division of Wits Health Consortium

    Johannesburg, Gauteng, 2193

Other trials in South Africa

About this study

This is a mixed methods study employing a convergence model triangulation design. Participants in the study will be sexually active young adults starting Pre-exposure Prophylaxis at private pharmacies, who will be offered either Cabotegravir Long-Acting Injectable, oral Pre-exposure Prophylaxis (TDF/FTC[3TC]), or Pre-exposure Prophylaxis deferment at each of their regular visits, with the option to switch between options for up to 15 months, with a final exit interview following the transition to standard-of-care. The number of study visits will vary, depending on participant Pre-exposure Prophylaxis choices. Those choosing oral Pre-exposure Prophylaxis will be seen 3 monthly from V2 onwards, but those choosing Cabotegravir Long-Acting Injectable will be seen 2 monthly from V2. A maximum of 9 visits is possible.

Read the detailed description

In the ATLAS study participants were asked, after they had transitioned back to conventional oral antiretroviral therapy, whether they preferred injectable or oral treatment. Their feedback on their preference overwhelming favoured injectables9. Women and men will be recruited from existing Ezintsha programs operating within the pharmacies, using current government criteria for Pre-exposure Prophylaxis initiation. Pre-exposure Prophylaxis will be initiated and monitored according to these and the Pharmacist-Initiated Management of Antiretroviral Therapy guidelines. Pre-exposure Prophylaxis, through these programs, will be offered free of charge. The study is designed to be as "real-world" as possible. Adaptations to routine Pre-exposure Prophylaxis guidelines have been made to accommodate visit-based HIV testing (based on the injectable regimens, which require more frequent access to the clinic). Participant reimbursement will therefore be for the baseline, mid and end-of-study interviews in participants consenting to these interviews. The maximum amount of time a participant in the study can be on either Cabotegravir Long-Acting Injectable or oral Pre-exposure Prophylaxis, or a combination, or, indeed, on neither drug, is therefore 15 months (and an additional three months on oral Pre-exposure Prophylaxis during the transition, as standard of care).

The Investigator anticipates that participants will favour Cabotegravir Long-Acting Injectable, but also anticipates that there may be interesting patterns of use when they learn that they may defer access to Cabotegravir Long-Acting Injectable or oral Pre-exposure Prophylaxis. Participants may favour Pre-exposure Prophylaxis, as they may prefer three monthly visits over the two monthly injection requirements. The Investigator may see participants initially choosing oral Pre-exposure Prophylaxis, and then moving to Cabotegravir Long-Acting Injectable, or even vice versa. The Investigator is unclear on what men may favour versus women. The Investigator will endeavor to recruit at least 20 men in the study, appreciating that not much is known about this group in the sub-Saharan Africa context. One of the most important analyses that will flow from information collected when assessing for Pre-exposure Prophylaxis eligibility is the risk profile of the participants taking up Pre-exposure Prophylaxis, a key issue when assessing cost-effectiveness. Finally, the investigator is not excluding women or men who defer Pre-exposure Prophylaxis initially. These various combinations will provide interesting quantitative, but more importantly, qualitative data on preferences, and on how services may be improved to accommodate participants' choices.

Conditions
HIV Infections
Being tested
Cabotegravir Injection [Apretude], Tenofovir disoproxil fumarate / emtricitabine (or lamivudine)
Keywords
Pre-Exposure Prophylaxis (PrEP), Long Acting Injectable, Cabotegravir
Medical subject headings
HIV Infections

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Cabotegravir Injection [Apretude]Drug

    Also called Apretude

    White to slightly pink free flowing suspension suspension for injection contained in a brown coloured vial. Each vial is for single use and does not require dilution prior to administration.

  • Tenofovir disoproxil fumarate / emtricitabine (or lamivudine)Drug

    Also called Tenemine

    TDF/FTC is currently available as standard of care for PrEP in the public sector as per the department of health guidelines.

Study groups in NCT06138600
Study groupRoleWhat they receive
Cabotegravir Long Acting InjectableActive comparatorInvestigational Product: Cabotegravir Dosage Formulation: 600 mg suspension for injection Route of Administration: Intra-muscular injection Dosing Instructions: 1 vial (600 mg) injected monthly for the initial visit (Month 1 and 2), then every 2 months thereafter (from Month 2 onwards)
Receives: Drug: Cabotegravir Injection [Apretude]
Tenofovir disoproxil fumarate + Emtricitabine/Lamivudine (TDF/FTC[3TC])Active comparatorInvestigational Product: Tenofovir disoproxil fumarate / emtricitabine (or lamivudine) Dosage Formulation: 300 mg / 200 mg (300mg) fixed dose combination tablet Route of Administration: Oral Dosing Instructions: 1 tablet (300/200/ TDF/FTC) daily or (300/300/TDF/3TC) daily
Receives: Drug: Tenofovir disoproxil fumarate / emtricitabine (or lamivudine)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. To describe acceptability of CAB-LA (Long-Acting Cabotegravir) PrEP, amongst different PrEP modalities, including PrEP deferment, in eligible men and women.

    Acceptability of CAB-LA (Long-Acting Cabotegravir) as determined by qualitative and quantitative assessment using piloted and validated semi-structured questionnaires for acceptability. (Quantitative data will be expressed as ratios)

    Measured: 15 Months

  2. To describe acceptability of CAB-LA (Long-Acting Cabotegravir) PrEP, amongst different PrEP modalities, including PrEP deferment, in eligible men and women.

    Acceptability of Intervention Measure (AIM)/ Intervention Appropriateness Measure/ (IAM), at 12 months and end of study. (Expressed as ratios where applicable)

    Measured: 12 Months

Secondary outcomes (10)
  1. To describe feasibility of CAB-LA (Long-Acting Cabotegravir) PrEP implementation, amongst different PrEP modalities, including PrEP deferment, in eligible men and women.

    Feasibility of CAB-LA (Long-Acting Cabotegravir) as determined by qualitative and quantitative assessment using piloted or validated semi-structured questionnaires and on feasibility conducted with participants and healthcare workers.

    Measured: 15 Months

  2. To describe feasibility of CAB-LA (Long-Acting Cabotegravir) PrEP implementation, amongst different PrEP modalities, including PrEP deferment, in eligible men and women.

    Feasibility of Intervention Measure (FIM) completed by healthcare workers at exit and participants at 12 months and end of study.

    Measured: 12 Months

  3. To describe the association of socio-demographic factors, reported sexual behaviour, PrEP knowledge and previous PrEP use on PrEP choice.

    Tests of association between PrEP choice and selected predictor variables.

    Measured: 15 Months

  4. To describe the association of socio-demographic factors, reported sexual behaviour, PrEP knowledge and previous PrEP use on PrEP choice.

    Proportion of individuals who are using each type of PrEP collected at study start, month 12 and end of study.

    Measured: 12 Months

  5. To describe the uptake, persistence and patterns of transition on each form of PrEP.

    Attending all study visits/retention extracted from participant EDC (Electronic Data Capture) visit forms.

    Measured: 15 Months

  6. To describe a risk profile of those taking up both PrEP regimens, as well as those deferring PrEP.

    Willingness to take CAB-LA (Long-Acting Cabotegravir) for the entire study duration extracted from participant EDC forms

    Measured: 15 Months

  7. To describe a risk profile of those taking up both PrEP regimens, as well as those deferring PrEP.

    Willingness to take CAB-LA post study stop collected at end of study using semi-structured interviews.

    Measured: 15 Months

  8. To describe operational suggestions from the participants regarding how health services could be improved regarding better/more comfortable/faster/cheaper/other add-on sexual reproductive services.

    Extent to which the study staff could easily administer CAB-LA (Long-Acting Cabotegravir).

    Measured: 15 Months

  9. To describe the provider experiences and perceptions of CAB-LA (Long-Acting Cabotegravir) PrEP implementation, amongst different PrEP modalities, including PrEP deferment, in eligible men and women.

    Healthcare worker perspectives on maintenance, demand creation and service delivery post study completion collected during a focus group discussion conducted at the end of the study.

    Measured: 15 Months

  10. To describe participant willingness-to-pay for PrEP services at the end of the study.

    Willingness to pay for CAB-LA (Long-Acting Cabotegravir) collected at the end of the study using semi-structured interviews.

    Measured: 15 Months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted18 Nov 2023
  2. Study start1 Nov 2023
  3. Primary completion31 Oct 2025 (estimated)
  4. Study completion31 Jan 2026 (estimated)

Resources

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 3
Primary purpose
Prevention
Allocation
Non-randomised
Intervention model
Parallel groups
Model description
Adult (≥18 and ≤ 35 years old) male or female willing to access PrEP at the same pharmacy for up to 2 years
Masking
None (open label)
Enrolment
200 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT06138600
Sponsor's protocol ID
EZ-FV-035
Acronym
AXIS
Status last verified
Jun 2024
First submitted
17 Oct 2023
Last updated
21 Jun 2024
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: The data that will be shared is all of the individual participant data collected during the trial, after deidentification.

Questions about this trial

What is this clinical trial studying?

A Phase 3 study testing Cabotegravir Injection [Apretude] and Tenofovir disoproxil fumarate / emtricitabine (or lamivudine) in people with HIV Infections, run by University of Witwatersrand, South Africa at 1 site 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 8 inclusion and 17 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: status not confirmed, as of the sponsor's last update on 21 Jun 2024. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site 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.

What does this phase mean?

Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Results are not available in the source record.

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?

To describe acceptability of CAB-LA (Long-Acting Cabotegravir) PrEP, amongst different PrEP modalities, including PrEP deferment, in eligible men and women. (time frame: 15 Months). 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 21 Jun 2024.

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