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The TAP Study: Treating People Who Inject Drugs in Community-Based Settings Using a Social Network Approach (TAP)

Primary Purpose

Hepatitis C, Drug Abuse, Intravenous

Status
Unknown status
Phase
Phase 3
Locations
Australia
Study Type
Interventional
Intervention
Sofosbuvir/ledispasvir fixed dose combination (SOF + LDP)
Sponsored by
Macfarlane Burnet Institute for Medical Research and Public Health Ltd
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Hepatitis C focused on measuring Hepatitis, Viral, Non-A, Non-B, Parenterally-Transmitted

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

SECONDARY PARTICIPANTS INCLUSION AND EXCLUSION CRITERIA

Study INCLUSION criteria for primary participants are as follows:

  • Current PWID (i.e., injected any drug at least once during the previous six months);
  • Evidence of chronic HCV infection (detectable plasma HCV RNA viral load above 1000 IU/ml on two occasions ≥ 6 months apart)
  • Willing and able to provide written informed consent.

Subjects must have the following laboratory parameters at screening:

  • ALT <10 times the upper limit of normal (ULN)
  • AST <10 times ULN
  • Haemoglobin ≥12g/dL for males, ≥11g/dL for female subjects
  • INR ≤1.5 times ULN unless is stable on an anticoagulant regimen affecting INR
  • Albumin ≥3g/dL
  • Direct bilirubin ≤1.5 times ULN
  • Creatinine clearance (CLcr) ≥60mL/min, as calculated by the Cockcroft-Gault Equation.

EXCLUSION criteria for all primary participants are as follows:

  • Testing positive for HIV
  • History of, or current, decompensated liver disease
  • Testing positive for HBsAg
  • HCC
  • Women who are pregnant or breastfeeding, or men with female partners who are pregnant at screening or baseline, or who were pregnant in the six months prior to screening
  • Already enrolled in the TAP Study as a secondary participant (see below)
  • Evidence of any condition, therapy, laboratory abnormality or other circumstance (current or prior) that may confound the study's results, or interfere with participation for the full duration of the study, such that it is not in the best interest of the participant;
  • Use of concomitant medications.

Additional EXCLUSION criteria for primary participants with HCV genotypes 2-6:

  • Increased baseline risk for anaemia (e.g., a history of thalassemia, spherocytosis, history of GI bleeding), or for whom anaemia would be medically problematic;
  • Documented or presumed coronary artery disease or cerebrovascular disease if, in the judgment of the investigator, an acute decrease in haemoglobin by up to 4g/dL (as may be seen with ribavirin therapy) would not be well-tolerated.

SECONDARY PARTICIPANTS INCLUSION AND EXCLUSION CRITERIA

The INCLUSION criteria for secondary participants are as follows:

  • Is nominated by a primary participant as a current injecting partner (i.e., has engaged in IDU with a primary participant in the previous six months)
  • Willing and able to provide written informed consent.

There are no exclusion criteria for secondary participants who are not receiving HCV therapy in this protocol:

EXCLUSION criteria for treated secondary participants (i.e., those in Group C who are HCV positive) are as follows:

  • History of, or current, decompensated liver disease
  • Women who are pregnant or breastfeeding, or men with female partners who are pregnant at screening or baseline, or who were pregnant in the six months prior to screening
  • Testing positive for HIV
  • Testing positive for HBsAg
  • HCC
  • Evidence of any condition, therapy, laboratory abnormality or other circumstance (current or prior) that may confound the study's results, or interfere with participation for the full duration of the study, such that it is not in the best interest of the participant
  • Use of concomitant medications.

Additional EXCLUSION criteria for secondary participants with HCV genotypes 2-6:

  • Increased baseline risk for anaemia (e.g. a history of thalassemia, spherocytosis, history of GI bleeding) or for whom anaemia would be medically problematic
  • Documented or presumed coronary artery disease or cerebrovascular disease if, in the judgment of the investigator, an acute decrease in haemoglobin by up to 4g/dL (as may be seen with ribavirin therapy) would not be well-tolerated.

Sites / Locations

  • Burnet InstituteRecruiting

Arms of the Study

Arm 1

Arm 2

Arm 3

Arm Type

No Intervention

Active Comparator

Active Comparator

Arm Label

Group A

Group B

Group C

Arm Description

Primary (n=40) and secondary (n=100) participants will receive supportive care only (includes a clinical review, questionnaire and blood sample collected at baseline and weeks 12, 24, 36, 48, 60, 72 and 84). Participants with HCV not allocated to treatment arms will receive deferred treatment at the end of the follow-up period.

Primary participants (n=40) will be treated with 'Sofosbuvir/ledispasvir fixed dose combination (SOF + LDP) for 12 weeks. Secondary participants (n=100) will receive supportive care only. Participants with HCV not allocated to treatment arms will receive deferred treatment at the end of the follow-up period.

Primary (n=40) and secondary participants with chronic HCV infection (approx. n=50%*100) will be treated with 'Sofosbuvir/ledispasvir fixed dose combination (SOF + LDP) for 12 weeks. Participants in Group C who have evidence of HCV re-infection will be offered re-treatment with SOF + LDP for 12 weeks.

Outcomes

Primary Outcome Measures

The efficacy of treating PWID with HCV using 12 weeks of oral therapy via a community-based, nurse-led treatment model, as measured by SVR rates
The effectiveness of treating PWID on rates of HCV primary infection and reinfection among their social networks, as measured by HCV incidence rates among primary and secondary participants
Hypothesis: Offering HCV treatment to PWID will lead to a lower incidence of transmission of HCV from primary participants to their injecting partners, compared to not treating any PWID.
The effectiveness of treating PWID using a "bring your friends" strategy on rates of HCV primary infection and reinfection, as measured by HCV incidence rates among participants
The feasibility of treating PWID with HCV using 12 weeks of oral therapy via a community-based, nurse-led treatment model, as measured by SVR rates and participant retention

Secondary Outcome Measures

Changes in levels of injecting risk behaviours among participants following HCV treatment, as measured by self-reported frequency of risky injecting behaviours among participants
Changes to Quality of Life (QoL) among treated participants versus non-treated participants, as measured by self-reported responses to validated QoL scales
The prevalence of HCV resistance associated variants among treated participants who do not achieve SVR12
Changes in the level of transient liver elastography readings (measured using Fibroscan®) among treated participants versus non-treated participants

Full Information

First Posted
December 21, 2014
Last Updated
April 8, 2018
Sponsor
Macfarlane Burnet Institute for Medical Research and Public Health Ltd
Collaborators
St Vincent's Hospital Melbourne
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1. Study Identification

Unique Protocol Identification Number
NCT02363517
Brief Title
The TAP Study: Treating People Who Inject Drugs in Community-Based Settings Using a Social Network Approach
Acronym
TAP
Official Title
The Treatment And Prevention (TAP) Study: Treating People Who Inject Drugs (PWID) in Community-based Settings Using a Social Network Approach
Study Type
Interventional

2. Study Status

Record Verification Date
April 2018
Overall Recruitment Status
Unknown status
Study Start Date
February 2015 (Actual)
Primary Completion Date
December 2018 (Anticipated)
Study Completion Date
December 2019 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Macfarlane Burnet Institute for Medical Research and Public Health Ltd
Collaborators
St Vincent's Hospital Melbourne

4. Oversight

Data Monitoring Committee
Yes

5. Study Description

Brief Summary
This study will investigate the feasibility of treating people who inject drugs (PWID) with hepatitis C virus (HCV) in community-based settings with a 12-week course of oral therapy combination of sofosbuvir plus ledipasvir. It will also measure the effectiveness of using a social network-based approach to reduce HCV incidence among PWID.
Detailed Description
This study will investigate the feasibility of treating people who inject drugs (PWID) with hepatitis C virus (HCV) in community-based settings with a 12-week course of oral therapy combination of sofosbuvir plus ledipasvir (SOF + LDP). It will also measure the effectiveness of using a social network-based approach ("bring your friends") to reduce HCV incidence among PWID. Participants will initially be sourced from the Burnet Institute's existing SuperMIX cohort (N= 757). This cohort comprises PWID followed for between two and six years (median=1057 days), of whom 299 have chronic HCV infection. The HCV genotype distribution in the SuperMIX cohort is: HCV-1 (55%); HCV-3 (40%) and HCV-6 (<5%). Participants will be randomly allocated to three groups: Group 1: Primary (n=40) and secondary (n=100) participants will receive supportive care only. Group 2: Primary participants (n=40) will be treated with SOF + LDP for 12 weeks. Secondary participants (n=100) will receive supportive care only. Group 3: Primary (n=40) and secondary participants with chronic HCV infection (n=50%*100) will be treated with SOF + LDP for 12 weeks. Participants in Group C who have evidence of HCV re-infection will be offered re-treatment with SOF + LDP for 12 weeks. Treatment participants will have a clinical review, questionnaire and blood sample collected at baseline, weeks 4, 8 and 12 (end-of-treatment), and at weeks 12 (SVR12), 24 (SVR24), 36, 48, 60 and 72 post-treatment. Non-treatment participants will have a clinical review, questionnaire and blood sample collected at baseline and weeks 12, 24, 36, 48, 60, 72 and 84.

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Hepatitis C, Drug Abuse, Intravenous
Keywords
Hepatitis, Viral, Non-A, Non-B, Parenterally-Transmitted

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 3
Interventional Study Model
Parallel Assignment
Masking
None (Open Label)
Allocation
Randomized
Enrollment
420 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Group A
Arm Type
No Intervention
Arm Description
Primary (n=40) and secondary (n=100) participants will receive supportive care only (includes a clinical review, questionnaire and blood sample collected at baseline and weeks 12, 24, 36, 48, 60, 72 and 84). Participants with HCV not allocated to treatment arms will receive deferred treatment at the end of the follow-up period.
Arm Title
Group B
Arm Type
Active Comparator
Arm Description
Primary participants (n=40) will be treated with 'Sofosbuvir/ledispasvir fixed dose combination (SOF + LDP) for 12 weeks. Secondary participants (n=100) will receive supportive care only. Participants with HCV not allocated to treatment arms will receive deferred treatment at the end of the follow-up period.
Arm Title
Group C
Arm Type
Active Comparator
Arm Description
Primary (n=40) and secondary participants with chronic HCV infection (approx. n=50%*100) will be treated with 'Sofosbuvir/ledispasvir fixed dose combination (SOF + LDP) for 12 weeks. Participants in Group C who have evidence of HCV re-infection will be offered re-treatment with SOF + LDP for 12 weeks.
Intervention Type
Drug
Intervention Name(s)
Sofosbuvir/ledispasvir fixed dose combination (SOF + LDP)
Other Intervention Name(s)
Standard of care
Intervention Description
SOF + LDV tablets contain 400mg of SOF and 90mg of LDV.
Primary Outcome Measure Information:
Title
The efficacy of treating PWID with HCV using 12 weeks of oral therapy via a community-based, nurse-led treatment model, as measured by SVR rates
Time Frame
Change in sustained viral response rates at weeks 12 and 24 post-treatment. Participant retention rate at weeks 4, 8 and 12 (end of treatment).
Title
The effectiveness of treating PWID on rates of HCV primary infection and reinfection among their social networks, as measured by HCV incidence rates among primary and secondary participants
Description
Hypothesis: Offering HCV treatment to PWID will lead to a lower incidence of transmission of HCV from primary participants to their injecting partners, compared to not treating any PWID.
Time Frame
Changes in rates of HCV primary infection and reinfection at weeks 12, 24, 36, 48, 60, 72 and 84
Title
The effectiveness of treating PWID using a "bring your friends" strategy on rates of HCV primary infection and reinfection, as measured by HCV incidence rates among participants
Time Frame
Changes in rates of HCV primary infection and reinfection at weeks 12, 24, 36, 48, 60, 72 and 84
Title
The feasibility of treating PWID with HCV using 12 weeks of oral therapy via a community-based, nurse-led treatment model, as measured by SVR rates and participant retention
Time Frame
Change in participant retention rates at weeks 4, 8 and 12 (end of treatment)
Secondary Outcome Measure Information:
Title
Changes in levels of injecting risk behaviours among participants following HCV treatment, as measured by self-reported frequency of risky injecting behaviours among participants
Time Frame
Weeks 12, 24, 36, 48, 60, 72 and 84
Title
Changes to Quality of Life (QoL) among treated participants versus non-treated participants, as measured by self-reported responses to validated QoL scales
Time Frame
Weeks 12, 24, 36, 48, 60, 72 and 84
Title
The prevalence of HCV resistance associated variants among treated participants who do not achieve SVR12
Time Frame
At 12 weeks post-treatment (SVR12) and weeks 24 (SVR24), 36, 48, 60 and 72 post-treatment
Title
Changes in the level of transient liver elastography readings (measured using Fibroscan®) among treated participants versus non-treated participants
Time Frame
Up to 84 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
SECONDARY PARTICIPANTS INCLUSION AND EXCLUSION CRITERIA Study INCLUSION criteria for primary participants are as follows: Current PWID (i.e., injected any drug at least once during the previous six months); Evidence of chronic HCV infection (detectable plasma HCV RNA viral load above 1000 IU/ml on two occasions ≥ 6 months apart) Willing and able to provide written informed consent. Subjects must have the following laboratory parameters at screening: ALT <10 times the upper limit of normal (ULN) AST <10 times ULN Haemoglobin ≥12g/dL for males, ≥11g/dL for female subjects INR ≤1.5 times ULN unless is stable on an anticoagulant regimen affecting INR Albumin ≥3g/dL Direct bilirubin ≤1.5 times ULN Creatinine clearance (CLcr) ≥60mL/min, as calculated by the Cockcroft-Gault Equation. EXCLUSION criteria for all primary participants are as follows: Testing positive for HIV History of, or current, decompensated liver disease Testing positive for HBsAg HCC Women who are pregnant or breastfeeding, or men with female partners who are pregnant at screening or baseline, or who were pregnant in the six months prior to screening Already enrolled in the TAP Study as a secondary participant (see below) Evidence of any condition, therapy, laboratory abnormality or other circumstance (current or prior) that may confound the study's results, or interfere with participation for the full duration of the study, such that it is not in the best interest of the participant; Use of concomitant medications. Additional EXCLUSION criteria for primary participants with HCV genotypes 2-6: Increased baseline risk for anaemia (e.g., a history of thalassemia, spherocytosis, history of GI bleeding), or for whom anaemia would be medically problematic; Documented or presumed coronary artery disease or cerebrovascular disease if, in the judgment of the investigator, an acute decrease in haemoglobin by up to 4g/dL (as may be seen with ribavirin therapy) would not be well-tolerated. SECONDARY PARTICIPANTS INCLUSION AND EXCLUSION CRITERIA The INCLUSION criteria for secondary participants are as follows: Is nominated by a primary participant as a current injecting partner (i.e., has engaged in IDU with a primary participant in the previous six months) Willing and able to provide written informed consent. There are no exclusion criteria for secondary participants who are not receiving HCV therapy in this protocol: EXCLUSION criteria for treated secondary participants (i.e., those in Group C who are HCV positive) are as follows: History of, or current, decompensated liver disease Women who are pregnant or breastfeeding, or men with female partners who are pregnant at screening or baseline, or who were pregnant in the six months prior to screening Testing positive for HIV Testing positive for HBsAg HCC Evidence of any condition, therapy, laboratory abnormality or other circumstance (current or prior) that may confound the study's results, or interfere with participation for the full duration of the study, such that it is not in the best interest of the participant Use of concomitant medications. Additional EXCLUSION criteria for secondary participants with HCV genotypes 2-6: Increased baseline risk for anaemia (e.g. a history of thalassemia, spherocytosis, history of GI bleeding) or for whom anaemia would be medically problematic Documented or presumed coronary artery disease or cerebrovascular disease if, in the judgment of the investigator, an acute decrease in haemoglobin by up to 4g/dL (as may be seen with ribavirin therapy) would not be well-tolerated.
Central Contact Person:
First Name & Middle Initial & Last Name or Official Title & Degree
Dr Joseph Doyle
Phone
+61392822111
Email
j.doyle@burnet.edu.au
First Name & Middle Initial & Last Name or Official Title & Degree
Dr Brendan Quinn
Phone
+61392822111
Email
brendanq@burnet.edu.au
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Prof Margaret Hellard
Organizational Affiliation
Burnet Institute
Official's Role
Principal Investigator
First Name & Middle Initial & Last Name & Degree
Prof Alexander Thompson
Organizational Affiliation
St Vincent's Hospital Melbourne
Official's Role
Principal Investigator
Facility Information:
Facility Name
Burnet Institute
City
Melbourne
State/Province
Victoria
ZIP/Postal Code
3004
Country
Australia
Individual Site Status
Recruiting

12. IPD Sharing Statement

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The TAP Study: Treating People Who Inject Drugs in Community-Based Settings Using a Social Network Approach

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