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COVID-19 Prophylaxis South Africa (COVER HCW) (COVER)

Primary Purpose

Covid19, SARS-CoV Infection

Status
Completed
Phase
Phase 2
Locations
South Africa
Study Type
Interventional
Intervention
Nitazoxanide
Sofosbuvir/Daclatasvir
Sponsored by
University of Witwatersrand, South Africa
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional prevention trial for Covid19 focused on measuring Nitazoxanide, Sofosbuvir/Daclatasvir, COVID-19, SARS-CoV-2

Eligibility Criteria

18 Years - 99 Years (Adult, Older Adult)All SexesAccepts Healthy Volunteers

Inclusion Criteria:

  1. Age ≥18 years of age, inclusive, at the time of signing the informed consent.
  2. Willing and able to provide informed consent via an electronic process.
  3. Healthcare worker employed at a participating institution that has been identified as high-risk for SARS-CoV-2 exposure (may include doctors, nurses, nurse aids, radiographers, physiotherapists, phlebotomists, technicians, porters, cleaners, laboratory or other personnel identified as being at high risk of exposure), CHW involved in the collection of samples for the identification of SARS-CoV-2 through PCR, and inner city inhabitants at high risk for SARS-CoV-2 exposure due to the nature of their work and frequent use of public transport (may include essential services employees such as fire fighters, law enforcement officers, grocery store employees; and non healthcare workers using public transport at least three times a week).
  4. Women of reproductive potential must be using a highly effective method of contraception prior to enrolment or must be willing to start a method at enrolment and continue its use throughout the duration of the study.
  5. Body weight ≥45 kg.
  6. Access to reliable video conference, telephone, direct/text messaging, or other device permitting real-time, reliable information transfer.

Exclusion Criteria:

  1. Pregnant or lactating women.
  2. PCR and/or serology confirmed SARS-Cov-2 infection at screening.
  3. Current symptoms of COVID-19 disease (including, but not limited to, fever or chills, cough, myalgia, sore throat, shortness of breath, or new onset of anosmia or ageusia, or diarrhea).
  4. Self-reported presence or history of any of the following conditions:

    • Chronic kidney disease (Stage IV or receiving dialysis)
    • Cirrhosis (Child-Pugh Class B or greater)
    • Porphyria cutanea tarda.
  5. Currently on treatment for epilepsy or other seizure disorder.
  6. Currently on treatment with a protease inhibitor-based antiretroviral regimen, or efavirenz, or on treatment with amiodarone, carbamazepine, phenobarbitone, phenytoin, primidone, rifampicin,St. John's wort or any herbal products which may potentially decrease the concentration of the IMP.
  7. Known hypersensitivity or specific contraindications to the use of any of the active drugs in the treatment arms or similar compounds.
  8. Current enrolment in another COVID-19 prevention trial.
  9. History of alcohol abuse within the last 6 months.
  10. Having history or have risk factors for brady-arrhythmias (those with undiagnosed cardiac conditions).
  11. History of malignancies in the last 5 years, excluding in-situ or non-invasive malignancies.
  12. Concurrent or recent (within 3 months) participation in other research with a compound likely to interfere with any of the investigational products.
  13. Any surgical or medical condition which might 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. The Investigator should make this determination in consideration of the volunteer's medical history.
  14. Inability or unwillingness to be followed up for the study period.
  15. Personnel (e.g. investigator, sub-investigator, research assistant, pharmacist, study coordinator or anyone mentioned in the delegation log) directly involved in the conduct of the study. (Personnel employed at a study site, but not directly involved in the conduct of the study, who would like to participate in the study, may only do so if they are enrolled in the study through a different site at which they are not employed.)
  16. 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.
  17. Confirmed vaccination against SARS-Cov-2.

Sites / Locations

  • Charlotte Maxeke Johannesburg Academic Hospital
  • Sunnyside Office Park

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

No Intervention

Active Comparator

Active Comparator

Arm Label

Arm A: No pharmacological intervention (PPE only)

Arm B: Nitazoxanide (NTZ)

Arm C: Sofosbuvir/daclatasvir (SOF/DCV).

Arm Description

No intervention

Nitozoxanide administered

Sofosbuvir/daclatasvir administered

Outcomes

Primary Outcome Measures

Number of SARS-CoV-2 infections
Number of SARS-CoV-2 infection (COVID-19) confirmed by PCR and/or serology.

Secondary Outcome Measures

Duration of symptoms
Duration of symptoms for each symptomatic infection
Maximum score on WHO Ordinal Scale
Maximum score on WHO Ordinal Scale for Clinical Improvement for each symptomatic infection. Score of 0 being uninfected and a score of 8 being dead.
Time to onset of SARS-CoV-2 infection
Time to onset of SARS-CoV-2 infection (COVID-19) confirmed by PCR and/or serology
Number of symptomatic SARS-CoV-2 infections
Number of symptomatic SARS-CoV-2 infection (COVID-19) confirmed by PCR and/or serology
Number of asymptomatic SARS-CoV-2 infections
Number of asymptomatic • Asymptomatic SARS-CoV-2 infection suggested by serological outcome
Peak score on modified Flu PRO
Peak score on modified Flu-PRO during each symptomatic infection. 37-item questionairre assessing the severity of flu like symptoms one a scale of 0 - not at all to 5 - very much.

Full Information

First Posted
September 21, 2020
Last Updated
June 6, 2022
Sponsor
University of Witwatersrand, South Africa
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1. Study Identification

Unique Protocol Identification Number
NCT04561063
Brief Title
COVID-19 Prophylaxis South Africa (COVER HCW)
Acronym
COVER
Official Title
A Multi-center, Randomised, Open Label Study of Nitazoxanide (NTZ), or Sofosbuvir and Daclatasvir (SOF/DCV), Compared to no Pharmacological Intervention for the Prevention of COVID-19 Disease in Healthcare Workers and Inner City Inhabitants at High Risk of Exposure to SARS-CoV-2
Study Type
Interventional

2. Study Status

Record Verification Date
June 2022
Overall Recruitment Status
Completed
Study Start Date
December 8, 2020 (Actual)
Primary Completion Date
February 28, 2022 (Actual)
Study Completion Date
February 28, 2022 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
University of Witwatersrand, 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
Yes

5. Study Description

Brief Summary
This is a randomised, multi-center, open label, adaptive, exploratory trial to assess the efficacy of two different drug regimens in terms of preventing symptomatic COVID-19 disease in healthcare workers at high risk of exposure to SARS-CoV-2. The trial will compare two different experimental medication arms to the control arm comprising the use of standard personal protective equipment (PPE) with no additional pharmacological intervention.
Detailed Description
This is a randomised, multi-center, open label, adaptive, exploratory trial to assess the efficacy of two different drug regimens in terms of preventing symptomatic COVID-19 disease in healthcare workers at high risk of exposure to SARS-CoV-2. The trial will compare two different experimental medication arms to the control arm comprising the use of standard personal protective equipment (PPE) with no additional pharmacological intervention. Volunteers will be recruited from participating institutions and community healthcare workers (CHWs) that are responsible for collecting swabs for PCR detection of SARS-CoV-2. Up to 1950 (or 2130 pending funding) eligible participants will be randomised in a 1:1:1 ratio to one of the investigational arms. Participants will be followed until 65 PCR and serology-confirmed, SARS-CoV-2 infections are identified in the control arm (or 165 in the entire study cohort). For each episode of PCR-confirmed COVID-19 disease, data on self-reported symptoms (modified Flu-PRO) and their duration, and an investigator-assessed severity score (WHO Ordinal Scale for Clinical Improvement) will be recorded. Data on self-reported symptoms and duration will also be collected for other all-cause acute respiratory illnesses. Safety and tolerability of each arm will be assessed through adverse event reporting. Participants who develop COVID-19 disease will have their IMP discontinued but will be followed up in the study until the completion of the trial, where possible. Multiple, discrete occurrences of COVID-19 disease could therefore be identified in a single participant. Additional arms may be added, or existing ones substituted, should new potential agents be identified or other combinations for prophylaxis be proposed. A formal amendment will be documented should this be considered.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Covid19, SARS-CoV Infection
Keywords
Nitazoxanide, Sofosbuvir/Daclatasvir, COVID-19, SARS-CoV-2

7. Study Design

Primary Purpose
Prevention
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
1950 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Arm A: No pharmacological intervention (PPE only)
Arm Type
No Intervention
Arm Description
No intervention
Arm Title
Arm B: Nitazoxanide (NTZ)
Arm Type
Active Comparator
Arm Description
Nitozoxanide administered
Arm Title
Arm C: Sofosbuvir/daclatasvir (SOF/DCV).
Arm Type
Active Comparator
Arm Description
Sofosbuvir/daclatasvir administered
Intervention Type
Drug
Intervention Name(s)
Nitazoxanide
Intervention Description
Nitozoxanide 1 tablet (500 mg) taken 12-hourly with food for the first week, followed by 2 tablets (1000 mg) taken 12-hourly with food thereafter. (Participants that fail to tolerated the 1000 mg 12-hourly dose may revert back to the lower dose.)
Intervention Type
Drug
Intervention Name(s)
Sofosbuvir/Daclatasvir
Intervention Description
Sofosbuvir/daclatasvir 400mg/60 mg sofosbuvir/daclatasvir fixed dose combination 1 tablet daily
Primary Outcome Measure Information:
Title
Number of SARS-CoV-2 infections
Description
Number of SARS-CoV-2 infection (COVID-19) confirmed by PCR and/or serology.
Time Frame
6 months
Secondary Outcome Measure Information:
Title
Duration of symptoms
Description
Duration of symptoms for each symptomatic infection
Time Frame
6 months
Title
Maximum score on WHO Ordinal Scale
Description
Maximum score on WHO Ordinal Scale for Clinical Improvement for each symptomatic infection. Score of 0 being uninfected and a score of 8 being dead.
Time Frame
6 months
Title
Time to onset of SARS-CoV-2 infection
Description
Time to onset of SARS-CoV-2 infection (COVID-19) confirmed by PCR and/or serology
Time Frame
6 months
Title
Number of symptomatic SARS-CoV-2 infections
Description
Number of symptomatic SARS-CoV-2 infection (COVID-19) confirmed by PCR and/or serology
Time Frame
6 months
Title
Number of asymptomatic SARS-CoV-2 infections
Description
Number of asymptomatic • Asymptomatic SARS-CoV-2 infection suggested by serological outcome
Time Frame
6 months
Title
Peak score on modified Flu PRO
Description
Peak score on modified Flu-PRO during each symptomatic infection. 37-item questionairre assessing the severity of flu like symptoms one a scale of 0 - not at all to 5 - very much.
Time Frame
6 months

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
99 Years
Accepts Healthy Volunteers
Accepts Healthy Volunteers
Eligibility Criteria
Inclusion Criteria: Age ≥18 years of age, inclusive, at the time of signing the informed consent. Willing and able to provide informed consent via an electronic process. Healthcare worker employed at a participating institution that has been identified as high-risk for SARS-CoV-2 exposure (may include doctors, nurses, nurse aids, radiographers, physiotherapists, phlebotomists, technicians, porters, cleaners, laboratory or other personnel identified as being at high risk of exposure), CHW involved in the collection of samples for the identification of SARS-CoV-2 through PCR, and inner city inhabitants at high risk for SARS-CoV-2 exposure due to the nature of their work and frequent use of public transport (may include essential services employees such as fire fighters, law enforcement officers, grocery store employees; and non healthcare workers using public transport at least three times a week). Women of reproductive potential must be using a highly effective method of contraception prior to enrolment or must be willing to start a method at enrolment and continue its use throughout the duration of the study. Body weight ≥45 kg. Access to reliable video conference, telephone, direct/text messaging, or other device permitting real-time, reliable information transfer. Exclusion Criteria: Pregnant or lactating women. PCR and/or serology confirmed SARS-Cov-2 infection at screening. Current symptoms of COVID-19 disease (including, but not limited to, fever or chills, cough, myalgia, sore throat, shortness of breath, or new onset of anosmia or ageusia, or diarrhea). Self-reported presence or history of any of the following conditions: Chronic kidney disease (Stage IV or receiving dialysis) Cirrhosis (Child-Pugh Class B or greater) Porphyria cutanea tarda. Currently on treatment for epilepsy or other seizure disorder. Currently on treatment with a protease inhibitor-based antiretroviral regimen, or efavirenz, or on treatment with amiodarone, carbamazepine, phenobarbitone, phenytoin, primidone, rifampicin,St. John's wort or any herbal products which may potentially decrease the concentration of the IMP. Known hypersensitivity or specific contraindications to the use of any of the active drugs in the treatment arms or similar compounds. Current enrolment in another COVID-19 prevention trial. History of alcohol abuse within the last 6 months. Having history or have risk factors for brady-arrhythmias (those with undiagnosed cardiac conditions). History of malignancies in the last 5 years, excluding in-situ or non-invasive malignancies. Concurrent or recent (within 3 months) participation in other research with a compound likely to interfere with any of the investigational products. Any surgical or medical condition which might 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. The Investigator should make this determination in consideration of the volunteer's medical history. Inability or unwillingness to be followed up for the study period. Personnel (e.g. investigator, sub-investigator, research assistant, pharmacist, study coordinator or anyone mentioned in the delegation log) directly involved in the conduct of the study. (Personnel employed at a study site, but not directly involved in the conduct of the study, who would like to participate in the study, may only do so if they are enrolled in the study through a different site at which they are not employed.) 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. Confirmed vaccination against SARS-Cov-2.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Simiso Sokhela
Organizational Affiliation
Ezintsha
Official's Role
Principal Investigator
Facility Information:
Facility Name
Charlotte Maxeke Johannesburg Academic Hospital
City
Johannesburg
State/Province
Gauteng
ZIP/Postal Code
2196
Country
South Africa
Facility Name
Sunnyside Office Park
City
Johannesburg
State/Province
Gauteng
Country
South Africa

12. IPD Sharing Statement

Citations:
PubMed Identifier
34473343
Citation
Kreuzberger N, Hirsch C, Chai KL, Tomlinson E, Khosravi Z, Popp M, Neidhardt M, Piechotta V, Salomon S, Valk SJ, Monsef I, Schmaderer C, Wood EM, So-Osman C, Roberts DJ, McQuilten Z, Estcourt LJ, Skoetz N. SARS-CoV-2-neutralising monoclonal antibodies for treatment of COVID-19. Cochrane Database Syst Rev. 2021 Sep 2;9(9):CD013825. doi: 10.1002/14651858.CD013825.pub2.
Results Reference
derived

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COVID-19 Prophylaxis South Africa (COVER HCW)

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