Linkage and Retention: A Randomized Trial to Optimize HIV/TB Care in South Africa

HIV Clinical Trial

— Sizanani  

Official title:

Linkage and Retention: A Randomized Trial to Optimize HIV/TB Care in South Africa

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01188941
• Other study ID #: 2006-P-001379/26
• Secondary ID: R01MH090326
• Status: Completed
• Phase: N/A
• First received: August 13, 2010
• Last updated: April 17, 2017
• Start date: August 2010
• Est. completion date: April 2015

Study information

• Verified date: April 2017
• Source: Massachusetts General Hospital
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to test the effects of a health system navigator intervention on rates of linkage to human immunodeficiency virus (HIV) and tuberculosis (TB) care among newly diagnosed HIV-infected outpatients in Durban, South Africa. Subjects will be approached in the outpatient department and enrolled prior to an HIV test. Subjects will then be randomized to the navigator arm or the standard of care arm. Subjects in the navigator arm will receive scheduled phone and short message service (SMS) contacts throughout the follow-up period to help guide them through the HIV and TB care pathways. The navigator will provide personalized support to help subjects overcome barriers they may face along the way.

Description:

This project is a randomized controlled trial of an intervention to improve linkage to HIV and TB care for South Africans undergoing HIV testing. Subjects undergoing HIV testing will be enrolled at three sites in the greater Durban area. These sites comprise two hospital-affiliated outpatient departments and primary health clinics served by a mobile health van. Routine TB screening, regardless of signs or symptoms, will be offered to all HIV-infected participants. HIV-infected participants will be randomized to determine whether they will be assigned to a health system navigator or will receive the current standard of care in Durban. Block randomization will be stratified by site and gender, with blocks of varying length.

The health system navigator will help patients identify barriers to entering care and devise solutions, optimize use of available resources, and serve as a trusted social supporter who is knowledgeable about the health care system but remains outside of it. The health system navigator will help subjects engage the HIV and TB care system through face-to-face contact, telephone conversations, and short messaging service SMS text reminders which are free for patients to receive. These phone contacts and SMS will follow a standardized protocol. We will evaluate the efficacy of the intervention, as measured by increased rates of antiretroviral therapy (ART) initiation and, for those with TB co-infection, TB treatment completion. We will also evaluate the cost and cost-effectiveness of this intervention.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 1899
• Est. completion date: April 2015
• Est. primary completion date: April 2014
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• English or Zulu speaking

• Presenting for outpatient care

• Voluntarily undergoing an HIV test

• Able to give informed consent

• Report no prior HIV test

• Willing to share HIV and TB test results with research staff

Exclusion Criteria:

• Pregnant

• Lying in a stretcher

• Not oriented to person, place and time

Related Conditions & MeSH terms

• HIV

Intervention

Behavioral:
• Health System Navigator
Subjects will be enrolled prior to an HIV test. Following TB screening, HIV infected subjects will meet with the health systems navigator who will administer a brief strengths-based interview. During this interview the participant and navigator will identify barriers to HIV and/or TB care and the resources and strengths that will be most helpful in overcoming these barriers. The health system navigator will stay in contact with participants for the next 4 months using phone calls and SMS on a standardized schedule. During the phone contacts the health system navigator will assess where the participant is on the care pathway. If the participant has not completed a step in his/her HIV or TB care, the health system navigator will help the participant draw on strengths identified in the initial interview and overcome any obstacles hindering him/her from accessing care.

Locations

Country	Name	City	State
South Africa	Mariannridge Clinic	Durban	KwaZulu-Natal
South Africa	McCord Hospital	Durban	KwaZulu-Natal
South Africa	St. Mary's Hospital	Durban	KwaZulu-Natal
South Africa	Tshelimnyama Clinic	Durban	KwaZulu-Natal

Sponsors (8)

Lead Sponsor	Collaborator
Massachusetts General Hospital	Boston University, Brigham and Women's Hospital, Children's Hospital Medical Center, Cincinnati, McCord Hospital, National Institute of Mental Health (NIMH), National Institutes of Health (NIH), St Mary's Hospital, London

Country where clinical trial is conducted

South Africa, 

References & Publications (12)

Bassett IV, Coleman SM, Giddy J, Bogart LM, Chaisson CE, Ross D, Flash MJ, Govender T, Walensky RP, Freedberg KA, Losina E. Barriers to Care and 1-Year Mortality Among Newly Diagnosed HIV-Infected People in Durban, South Africa. J Acquir Immune Defic Syndr. 2017 Apr 1;74(4):432-438. doi: 10.1097/QAI.0000000000001277. — View Citation

Bassett IV, Coleman SM, Giddy J, Bogart LM, Chaisson CE, Ross D, Jacobsen MM, Robine M, Govender T, Freedberg KA, Katz JN, Walensky RP, Losina E. Sizanani: A Randomized Trial of Health System Navigators to Improve Linkage to HIV and TB Care in South Afric — View Citation

Bassett IV, Giddy J, Chaisson CE, Ross D, Bogart LM, Coleman SM, Govender T, Robine M, Erlwanger A, Freedberg KA, Katz JN, Walensky RP, Losina E. A randomized trial to optimize HIV/TB care in South Africa: design of the Sizanani trial. BMC Infect Dis. 2013 Aug 26;13:390. doi: 10.1186/1471-2334-13-390. — View Citation

Bassett IV, Regan S, Chetty S, Giddy J, Uhler LM, Holst H, Ross D, Katz JN, Walensky RP, Freedberg KA, Losina E. Who starts antiretroviral therapy in Durban, South Africa?... not everyone who should. AIDS. 2010 Jan;24 Suppl 1:S37-44. doi: 10.1097/01.aids.0000366081.91192.1c. — View Citation

Cohen GM, Drain PK, Noubary F, Cloete C, Bassett IV. Diagnostic delays and clinical decision making with centralized Xpert MTB/RIF testing in Durban, South Africa. J Acquir Immune Defic Syndr. 2014 Nov 1;67(3):e88-93. doi: 10.1097/QAI.0000000000000309. — View Citation

Drain PK, Losina E, Coleman SM, Bogart L, Giddy J, Ross D, Katz JN, Bassett IV. Social support and mental health among adults prior to HIV counseling and testing in Durban, South Africa. AIDS Care. 2015;27(10):1231-40. doi: 10.1080/09540121.2015.1046417. Epub 2015 Jul 25. — View Citation

Drain PK, Losina E, Coleman SM, Giddy J, Ross D, Katz JN, Bassett IV. Rapid urine lipoarabinomannan assay as a clinic-based screening test for active tuberculosis at HIV diagnosis. BMC Pulm Med. 2016 Nov 14;16(1):147. — View Citation

Drain PK, Losina E, Coleman SM, Giddy J, Ross D, Katz JN, Bassett IV. Value of urine lipoarabinomannan grade and second test for optimizing clinic-based screening for HIV-associated pulmonary tuberculosis. J Acquir Immune Defic Syndr. 2015 Mar 1;68(3):274-80. doi: 10.1097/QAI.0000000000000436. — View Citation

Drain PK, Losina E, Coleman SM, Giddy J, Ross D, Katz JN, Walensky RP, Freedberg KA, Bassett IV. Diagnostic accuracy of a point-of-care urine test for tuberculosis screening among newly-diagnosed HIV-infected adults: a prospective, clinic-based study. BMC Infect Dis. 2014 Feb 26;14:110. doi: 10.1186/1471-2334-14-110. — View Citation

Drain PK, Losina E, Parker G, Giddy J, Ross D, Katz JN, Coleman SM, Bogart LM, Freedberg KA, Walensky RP, Bassett IV. Risk factors for late-stage HIV disease presentation at initial HIV diagnosis in Durban, South Africa. PLoS One. 2013;8(1):e55305. doi: 10.1371/journal.pone.0055305. Epub 2013 Jan 28. — View Citation

Losina E, Bassett IV, Giddy J, Chetty S, Regan S, Walensky RP, Ross D, Scott CA, Uhler LM, Katz JN, Holst H, Freedberg KA. The "ART" of linkage: pre-treatment loss to care after HIV diagnosis at two PEPFAR sites in Durban, South Africa. PLoS One. 2010 Mar 4;5(3):e9538. doi: 10.1371/journal.pone.0009538. — View Citation

Regan S, Losina E, Chetty S, Giddy J, Walensky RP, Ross D, Holst H, Katz JN, Freedberg KA, Bassett IV. Factors associated with self-reported repeat HIV testing after a negative result in Durban, South Africa. PLoS One. 2013 Apr 23;8(4):e62362. doi: 10.1371/journal.pone.0062362. Print 2013. — View Citation

* Note: There are 12 references in all — Click here to view all references

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Linkage and Retention in Care: ART-eligible Patients	For ART-eligible HIV-infected patients, 3 months on ART as documented by ART initiation date in the electronic medical record.	9 Months after Enrollment
Primary	Linkage and Retention in Care: TB Patients	For patients co-infected with TB, 6 months of TB treatment as documented by a written discharge of treatment outcome from a TB clinic.	9 Months after Enrollment
Primary	Linkage and Retention in Care: ART-eligible HIV/TB Co-infected Patients	For HIV and TB co-infected patients who are ART-eligible, completion of either the ART or TB treatment outcome will be considered successful completion of the Primary Outcome Measure.	9 Months after Enrollment