An Adaptive Randomized Controlled Trial (ADAP-TIV)
Multi Drug Resistant Tuberculosis, HIV Infections
About this trial
This is an interventional supportive care trial for Multi Drug Resistant Tuberculosis
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
Sites / Locations
- King DinuZulu Hospital
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
No Intervention
Other
Other
Other
Enhanced standard of care
Psychosocial support
mHealth
mHealth and Psychosocial support
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.