Simplified Algorithm for Treatment Eligibility

HIV Clinical Trial

— SLATE  

Official title:

Randomized Evaluation of a Simplified Clinical Algorithm for Identifying Patients Eligible for Immediate Initiation of Antiretroviral Therapy for HIV

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02891135
• Other study ID #: H-35634
• Status: Completed
• Phase: N/A
• Start date: March 6, 2017
• Est. completion date: December 31, 2020

Study information

• Verified date: January 2021
• Source: Boston University
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

In its 2015 revision of the global guidelines for HIV care and treatment, the World Health Organization called for initiating lifelong antiretroviral treatment (ART) for all patients testing positive for HIV, regardless of CD4 cell count. As countries adopt the new recommendation, known as "treat all," millions of additional patients are becoming eligible for ART worldwide. In sub-Saharan Africa, where most of these patients are located, studies continue to document high losses of treatment-eligible patients from care before they receive their first dose of antiretroviral medications. Among facility-level reasons for these losses are treatment initiation protocols that require multiple clinic visits and long waiting times before a patient who tests positive for HIV is dispensed an initial supply of medications. Simpler, more efficient, accelerated algorithms for ART initiation will be needed if "treat all" is to realize the benefits expected.

Experts have proposed a simplified clinical algorithm to screen patients for eligibility for immediate ART initiation at a patient's first clinic visit, without the use of point-of-care laboratory test technologies. The Simplified Algorithm for Treatment Eligibility (SLATE) uses four screens to assess whether a patient is eligible for same-day treatment initiation: i) symptom report, ii) medical history, iii) brief physical examination; and iv) readiness assessment. SLATE is a pragmatic, individually randomized evaluation to determine the effectiveness of the algorithm in increasing ART initiation among non-pregnant adult patients. Approximately 960 HIV-infected adult patients not yet on ART will be enrolled during a routine clinic visit and randomized to receive the intervention or standard care. Patients in the intervention arm will be administered the SLATE screens; those found eligible under the algorithm will be offered immediate treatment initiation, while those who are not eligible will be referred for standard clinic care. Patients in the standard arm will be referred for ART initiation under standard clinic procedures. All care after the initial visit will be by the clinic under standard of care. If successful, SLATE will offer a standardized approach to collecting and interpreting a minimum set of patient data that will avoid delaying treatment initiation for the majority of patients who are eligible for immediate ART, while deferring initiation in the minority who should not start immediately.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 1077
• Est. completion date: December 31, 2020
• Est. primary completion date: April 23, 2018
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Adult patients (>18 years) (initiating children on ART is likely to require additional information, making the SLATE algorithm less applicable to pediatric populations)

• Confirmed HIV-positive test result at any time (may have been diagnosed previously)

• Not currently on ART (three-drug combination)

• Presented at the study clinic for any HIV-related reason, including an HIV test, pre-ART monitoring, or ART initiation

Exclusion Criteria:

• Pregnant (pregnancy is an exclusion criterion because treatment guidelines for pregnant women differ from those for non-pregnant adults; most pregnant women are diagnosed with HIV and initiated on ART in antenatal clinics, not general adult HIV clinics)

• Not intending to return to this clinic for further HIV care in the coming year (i.e. intends to seek further care somewhere else)

• Not physically, mentally, or emotionally able to participate in the study, in the opinion of the investigators or study staff

• Not willing or able to provide written informed consent to participate in the study

• Previously enrolled in the same study

Related Conditions & MeSH terms

• HIV

Intervention

Other:
• SLATE
Algorithm for collecting information required to determine if patient is eligible for immediate (same-day/same-visit) initiation of antiretroviral medications.

Locations

Country	Name	City	State
Kenya	Kenya Medical Research Institute/Walter Reed Projects	Kericho	Kericho County
South Africa	Health Economics and Epidemiology Research Office	Johannesburg	Gauteng

Sponsors (3)

Lead Sponsor	Collaborator
Boston University	Kenya Medical Research Institute, University of Witwatersrand, South Africa

Countries where clinical trial is conducted

Kenya,  South Africa, 

References & Publications (5)

Brennan AT, Maskew M, Larson BA, Tsikhutsu I, Bii M, Vezi L, Fox MP, Venter WD, Ehrenkranz P, Rosen S. Who is seeking antiretroviral treatment for HIV now? Characteristics of patients presenting in Kenya and South Africa in 2017-2018. J Int AIDS Soc. 2019 — View Citation

Fox MP, Rosen S. A new cascade of HIV care for the era of "treat all". PLoS Med. 2017 Apr 11;14(4):e1002268. doi: 10.1371/journal.pmed.1002268. eCollection 2017 Apr. — View Citation

Rosen S, Fox MP, Larson BA, Brennan AT, Maskew M, Tsikhutsu I, Bii M, Ehrenkranz PD, Venter WF. Simplified clinical algorithm for identifying patients eligible for immediate initiation of antiretroviral therapy for HIV (SLATE): protocol for a randomised evaluation. BMJ Open. 2017 May 28;7(5):e016340. doi: 10.1136/bmjopen-2017-016340. — View Citation

Rosen S, Fox MP, Larson BA, Sow PS, Ehrenkranz PD, Venter F, Manabe YC, Kaplan J; Models for Accelerating Treatment Initiation (MATI) Technical Consultation. Accelerating the Uptake and Timing of Antiretroviral Therapy Initiation in Sub-Saharan Africa: An Operations Research Agenda. PLoS Med. 2016 Aug 9;13(8):e1002106. doi: 10.1371/journal.pmed.1002106. eCollection 2016 Aug. — View Citation

Rosen S, Maskew M, Larson BA, Brennan AT, Tsikhutsu I, Fox MP, Vezi L, Bii M, Venter WDF. Simplified clinical algorithm for identifying patients eligible for same-day HIV treatment initiation (SLATE): Results from an individually randomized trial in South — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Patient preferences	Patient preferences on the speed and timing of ART initiation	Study enrollment
Other	Patient costs	Costs to patients of ART initiation under standard and intervention procedures	8 months
Other	Provider costs	Costs to providers of ART initiation under standard and intervention procedures	8 months
Primary	Treatment initiation	Proportion of patients initiated on ART within 28 days of study enrollment	28 days after study enrollment
Primary	Treatment initiation and retention	Proportion of patients who initiate ART within 28 days of study enrollment and are alive, in care, and retained on ART eight months after study enrollment	8 months after study enrollment
Secondary	Initiation within 14 days	Proportion of patients who initiate ART within 14 days of study enrollment	14 days after study enrollment
Secondary	Viral suppression	Proportion of patients who are virally suppressed according to local guidelines within 8 months of study enrollment	8 months after study enrollment
Secondary	One-year retention in care	Retention defined as > 1 month late for last scheduled visit	14 months after study enrollment
Secondary	One-year retention in care	Retention defined as > 3 months late for last scheduled visit	16 months after study enrollment
Secondary	SLATE eligibility	Proportions of HIV-positive patients presenting at study clinics and not yet on ART who are eligible and ineligible for immediate initiation using SLATE algorithm criteria	Study enrollment
Secondary	SLATE ineligibility reasons	Reasons for ineligibility for immediate initiation, among those found ineligible in the intervention arm	Study enrollment
Secondary	Time to initiation	Average time to ART initiation (days) for each arm	8 months

External Links

•   AIDS 2018 poster with primary outcome results for South Africa
•   CROI 2019 poster and video with primary outcome results for Kenya
•   CROI poster with preliminary results for South Africa