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An Adaptive Randomized Controlled Trial (ADAP-TIV)

Primary Purpose

Multi Drug Resistant Tuberculosis, HIV Infections

Status
Not yet recruiting
Phase
Not Applicable
Locations
South Africa
Study Type
Interventional
Intervention
Adherence support intevention
Sponsored by
Columbia University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional supportive care trial for Multi Drug Resistant Tuberculosis

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria: Culture or molecular test positive for MTB Molecular test positive for HIV or a documented HIV positive history Drug-susceptibility testing by molecular (i.e. GeneXpert MTB/RIF) or conventional testing consistent with at least rifampicin-resistant TB, Initiating treatment with a Bedaquiline -containing TB regimen within 4 weeks of enrollment and first-time being treated with BDQ On treatment with Antiretroviral Therapy (ART) regimen, including dolutegravir-containing combination Antiretroviral Therapy regimen (i.e. Tenofovir-Lamivudine-Dolutergravir), or starting within 4 weeks of enrollment, Capacity for informed consent in either isiZulu or English Exclusion Criteria: Pregnancy Prisoners Discretion of IOR or clinician

Sites / Locations

  • King DinuZulu Hospital

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm 4

Arm Type

No Intervention

Other

Other

Other

Arm Label

Enhanced standard of care

Psychosocial support

mHealth

mHealth and Psychosocial support

Arm Description

Care from trained and supported physicians, nurses, and social workers who have received repeated trainings from study staff on medical and behavioral aspects of DR-TB HIV care, which will be documented in terms of date, attendance, and content All participants who receive care as inpatients will receive an orientation to DR-TB treatment in form of a group session designed to impart key behavioral information and health knowledge about the disease, treatment, and skills to obtain optimal outcome. Discharge counselling session will be conducted prior to discharge. Study participants will complete study assessments at baseline (enrollment) and monthly for the first six months.

In addition to Arm 1 Participants will participate in individual counseling aligned with their monthly clinic visit. Individual counseling will use motivational interviewing (MI) techniques, based on the 4-part engaging, focusing, evoking and planning approach for each participant. Home visits will be conducted (if warranted/consented for by the participant) by the same trained counselors known to patients. Adherence support groups will be facilitated by counselors trained in group facilitation methods; group curriculum will include 6 sessions (monthly, gender specific, structured adherence support groups) that focus on practical topics. Discharge planning (if inpatient) Community treatment planning (if outpatient)

In addition to Arm 1 Participants will receive x 2 portable Wisepill devices. (x1 for MDR-TB treatment and x1 for ART). A Wisepill device is an RT2000 cellular-enabled electronic pill boxes using 2G/3G cellular network. Participants will select a text message reminder from a guided menu of choices and receive a weekly text message encouraging adherence. Participants will receive a study call to support regular adherence. Participants will be assessed weekly. Less than 85% observed/expected doses will be considered at risk for non-adherence and the intervention will be increased.

Combination of Arm 2 and Arm 3.

Outcomes

Primary Outcome Measures

Biological outcome
TB culture conversion
Clinical outcome
Survival
Biological outcome
HIV viral load
Clinical outcome
Retention in care
Biological outcome
TB culture conversion

Secondary Outcome Measures

Full Information

First Posted
November 21, 2022
Last Updated
November 21, 2022
Sponsor
Columbia University
Collaborators
Centre for the AIDS Programme of Research in South Africa
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1. Study Identification

Unique Protocol Identification Number
NCT05633056
Brief Title
An Adaptive Randomized Controlled Trial
Acronym
ADAP-TIV
Official Title
Adaptive Evaluation of mHealth and Conventional Adherence Support Interventions to Optimize Outcome With New Treatment Regimens for Drug-resistant Tuberculosis and HIV in South Africa
Study Type
Interventional

2. Study Status

Record Verification Date
November 2022
Overall Recruitment Status
Not yet recruiting
Study Start Date
February 2023 (Anticipated)
Primary Completion Date
February 2025 (Anticipated)
Study Completion Date
February 2027 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Columbia University
Collaborators
Centre for the AIDS Programme of Research in South Africa

4. Oversight

Studies a U.S. FDA-regulated Drug Product
No
Studies a U.S. FDA-regulated Device Product
No
Data Monitoring Committee
No

5. Study Description

Brief Summary
This is a prospective, adaptive, randomized controlled trial comparing the effectiveness of 4 intervention arms on a combined endpoint in adults with confirmed MDR-TB HIV initiating Bedaquiline-containing MDR-TB treatment regimens and on ART (integrase strand transfer inhibitor (INSTI)-based fixed dose combination therapy) in KwaZulu-Natal, South Africa. Interventions arms include: enhanced standard of care; psychosocial support; mHealth using cellular-enabled electronic dose monitoring; combined mHealth psychosocial support. Level of support will be adjusted using a differentiated service delivery (DSD)- informed assessment of treatment support needs.
Detailed Description
This study will follow a 4-arm Bayesian, adaptive trial design. As patients are enrolled, they will be randomized into one of the four arms. The study will be carried out within a common structure to allow for efficient enrollment and analysis. The overall structure is a 4-arm adaptive platform of mHealth and psychosocial adherence support interventions informed by a differentiated service delivery (DSD) approach. Aim 1 is an adaptive study of mHealth and psychosocial adherence support interventions using a Bayesian adaptive design to allow comparison of elements of the intervention separately and in combination. Aim 1 participants will be randomized into one of 4 arms and followed monthly through the 6 months of intervention, then through the end of treatment telephonically, with an additional in-person visit to establish the primary outcome. Primary outcome is a combined clinical/biological outcome at 12 months described below. Hypothesis 1a utilizes all participants while 1b utilizes only those in the mHealth intervention arms (3+4) since granular EDM-measured adherence is required.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Multi Drug Resistant Tuberculosis, HIV Infections

7. Study Design

Primary Purpose
Supportive Care
Study Phase
Not Applicable
Interventional Study Model
Parallel Assignment
Model Description
An adaptive, randomized controlled trial comparing the effectiveness of 4 adherence support intervention arms. Interventions arms include: enhanced standard of care; psychosocial support; mHealth using cellular-enabled electronic dose monitoring; combined mHealth psychosocial support. Level of support will be adjusted using a differentiated service delivery (DSD)- informed assessment of treatment support needs.
Masking
None (Open Label)
Allocation
Randomized
Enrollment
360 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Enhanced standard of care
Arm Type
No Intervention
Arm Description
Care from trained and supported physicians, nurses, and social workers who have received repeated trainings from study staff on medical and behavioral aspects of DR-TB HIV care, which will be documented in terms of date, attendance, and content All participants who receive care as inpatients will receive an orientation to DR-TB treatment in form of a group session designed to impart key behavioral information and health knowledge about the disease, treatment, and skills to obtain optimal outcome. Discharge counselling session will be conducted prior to discharge. Study participants will complete study assessments at baseline (enrollment) and monthly for the first six months.
Arm Title
Psychosocial support
Arm Type
Other
Arm Description
In addition to Arm 1 Participants will participate in individual counseling aligned with their monthly clinic visit. Individual counseling will use motivational interviewing (MI) techniques, based on the 4-part engaging, focusing, evoking and planning approach for each participant. Home visits will be conducted (if warranted/consented for by the participant) by the same trained counselors known to patients. Adherence support groups will be facilitated by counselors trained in group facilitation methods; group curriculum will include 6 sessions (monthly, gender specific, structured adherence support groups) that focus on practical topics. Discharge planning (if inpatient) Community treatment planning (if outpatient)
Arm Title
mHealth
Arm Type
Other
Arm Description
In addition to Arm 1 Participants will receive x 2 portable Wisepill devices. (x1 for MDR-TB treatment and x1 for ART). A Wisepill device is an RT2000 cellular-enabled electronic pill boxes using 2G/3G cellular network. Participants will select a text message reminder from a guided menu of choices and receive a weekly text message encouraging adherence. Participants will receive a study call to support regular adherence. Participants will be assessed weekly. Less than 85% observed/expected doses will be considered at risk for non-adherence and the intervention will be increased.
Arm Title
mHealth and Psychosocial support
Arm Type
Other
Arm Description
Combination of Arm 2 and Arm 3.
Intervention Type
Behavioral
Intervention Name(s)
Adherence support intevention
Intervention Description
Compare the effects of adherence support interventions on clinical and biological endpoints using an adaptive randomized platform.
Primary Outcome Measure Information:
Title
Biological outcome
Description
TB culture conversion
Time Frame
06 months
Title
Clinical outcome
Description
Survival
Time Frame
12 months
Title
Biological outcome
Description
HIV viral load
Time Frame
12 months
Title
Clinical outcome
Description
Retention in care
Time Frame
12 months
Title
Biological outcome
Description
TB culture conversion
Time Frame
12 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Culture or molecular test positive for MTB Molecular test positive for HIV or a documented HIV positive history Drug-susceptibility testing by molecular (i.e. GeneXpert MTB/RIF) or conventional testing consistent with at least rifampicin-resistant TB, Initiating treatment with a Bedaquiline -containing TB regimen within 4 weeks of enrollment and first-time being treated with BDQ On treatment with Antiretroviral Therapy (ART) regimen, including dolutegravir-containing combination Antiretroviral Therapy regimen (i.e. Tenofovir-Lamivudine-Dolutergravir), or starting within 4 weeks of enrollment, Capacity for informed consent in either isiZulu or English Exclusion Criteria: Pregnancy Prisoners Discretion of IOR or clinician
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Kogieleum Naidoo, Prof
Phone
+27 31 260 4687
Email
Kogie.Naidoo@caprisa.org
First Name & Middle Initial & Last Name or Official Title & Degree
Max O'Donnell, Prof
Email
mo2130@columbia.edu
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Max O'Donnell, Prof
Organizational Affiliation
University of Columbia
Official's Role
Principal Investigator
Facility Information:
Facility Name
King DinuZulu Hospital
City
Durban
State/Province
KwaZulu-Natal
ZIP/Postal Code
4001
Country
South Africa

12. IPD Sharing Statement

Plan to Share IPD
No
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Links:
URL
https://www.who.int/teams/global-tuberculosis-programme/the-end-tb-strategy
Description
WHO World Health Organization. The end of TB strategy.2015

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