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Clinical Trial Details — Status: Enrolling by invitation

Administrative data

NCT number NCT06062979
Other study ID # ViiV-219548
Secondary ID
Status Enrolling by invitation
Phase
First received
Last updated
Start date November 1, 2023
Est. completion date June 30, 2025

Study information

Verified date April 2024
Source Whitman-Walker Institute
Contact n/a
Is FDA regulated No
Health authority
Study type Observational [Patient Registry]

Clinical Trial Summary

The purpose of this study is to assess adherence to home-delivered long-acting injectable rilpivirine/cabotegravir (Cabenuva) among people living with HIV enrolled in the Mobile Outreach Retention and Engagement (MORE) program at Whitman-Walker Health due to significant barriers to being retained in care; the MORE program provides supportive services including dedicated care navigation, transportation assistance, and mobile/home-delivered care. The investigators will examine the equivalence of treatment outcomes among patients receiving injectable treatment within the MORE program as compared to those of patients receiving Cabenuva in standard care at Whitman-Walker Health.


Description:

Advances in HIV treatment could promote better health and racial equity to address the gaps seen across the HIV care continuum nationally and locally. In Washington DC, HIV viral load suppression among People Living With HIV (PLWH) lies at 66%. Whitman-Walker Clinic, Inc., d/b/a Whitman-Walker Health (WWH), is a Federally Qualified Health Center ("FQHC") affiliated with Whitman-Walker Institute, Inc. ("Institute"). Institute is uniquely capable of addressing gaps with Cabenuva through WWH's existing MORE program, which includes supportive navigation and wrap-around services paired with home-based HIV care. However, there are many implementation knowledge gaps to identify with implementing Cabenuva injection protocols for PLWH who face significant barriers to retention in care and who may significantly benefit from integrating Cabenuva within the context of the MORE program. The investigators propose a home-delivered Cabenuva HIV care program in Washington, D.C. to address the local HIV care continuum gaps. The investigative team has over five years of experience and lessons learned from our Mobile Outreach, Retention and Engagement (MORE) home-based HIV care program and plan to integrate Cabenuva therapy. MORE utilizes NP/PA providers and an HIV care navigator to deliver care to over 130 HIV-infected clients, who have a history of having fallen out of care, in their homes. The investigators envision that the inclusion of injectable treatment can expand the current program by geographic reach and the number of PWLH served by coupling Cabenuva with our ability to deliver patient-centered care outside of the traditional clinic. This proposal is critical to gathering early insights in Cabenuva implementation in Washington, D.C. and other EHE territories in FQHC clinic and affiliated non-clinic settings. Moreover, the data collected will demonstrate the extent to which a population experiencing significant barriers to retention in care-for whom Cabenuva would otherwise likely be counterindicated-can be supported via the MORE program to achieve comparable adherence and outcomes to typical patients receiving standard of care Cabenuva. WWH is currently providing Cabenuva treatment as a treatment option for eligible patients. The purpose of the proposed study is to further investigate the delivery of Cabenuva among two subpopulations of WWH patients. Cabenuva within standard clinical care at WWH: The majority of WWH patients receiving HIV treatment are offered and receive Cabenuva within the standard clinical setting. Among these patients, the proposed study will gather EMR-based data to characterize retention and HIV outcomes and to compare these and other relevant implementation factors with the MORE group. Medical providers identify eligible patients for Cabenvua based on a WWH protocol devised by medical leadership and a Cabenuva workgroup. Eligibility is viral load < 100,000 copies, no medication contraindications, no co-existing Hepatitis B infection, and no RAMs for rilpivirine or cabotegravir. Medical providers explain the risk and benefits and if the patient desires Cabeuva, the prescription is sent to the WWH onsite pharmacy at WWH sites MRC or 1525. The patient's case is sent via the EHR to the Cabenuva injection clinic admin lead at WWH. Patient appointment reminders and medication attainment are coordinated through SMS and phone call communication with patients. Cabenuva within MORE-based clinical care at WWH: To address the unique structural and psychosocial factors that create significant barriers to engagement and retention in care for a subset of patients with a history of non-retention, the MORE program was developed. MORE's primary features include home-based care delivery, dedicated care navigation, transportation support, and wrap-around supportive services. WWH is currently expanding the MORE program to provide injectable Cabenuva to these patients for whom, without the intensive support of the MORE program, treatment with Cabenuva would likely be counterindicated. More follows a stepped-care approach to support that includes a customized combination of its services to each patient based on need and preferences.


Recruitment information / eligibility

Status Enrolling by invitation
Enrollment 180
Est. completion date June 30, 2025
Est. primary completion date June 30, 2025
Accepts healthy volunteers
Gender All
Age group 18 Years and older
Eligibility Inclusion Criteria: - HIV-infected individuals, aged 18 years or older, who are eligible to receive Cabenuva as standard of care at Whitman-Walker Health - For those participants who will be prospectively enrolled via informed consent and offered survey and qualitative interviews, participants will be those receiving HIV-related treatment via the MORE program Exclusion Criteria: - HIV-uninfected individuals

Study Design


Related Conditions & MeSH terms


Intervention

Drug:
rilpivirine/cabotegravir
WWH is currently providing Cabenuva treatment as a treatment option for eligible patients. The purpose of the proposed study is to use an observational, prospective cohort design to further investigate the delivery of Cabenuva among two subpopulations of WWH patients.

Locations

Country Name City State
United States Whitman-Walker 1525 Clinic Washington District of Columbia
United States Whitman-Walker Max Robinson Center Washington District of Columbia

Sponsors (2)

Lead Sponsor Collaborator
Whitman-Walker Institute ViiV Healthcare

Country where clinical trial is conducted

United States, 

Outcome

Type Measure Description Time frame Safety issue
Other Implementation Feasibility (qualitative) Participants will be asked, "How easy was it to receive Cabenuva injections at home?" 6 months
Other Implementation Acceptability (qualitative) Participants will be asked, "How do you like receiving an injection at home?" 6 months
Other Adoption Rate # of providers who referred their patients to receive home-delivered Cabenuva among total number of providers 12 months
Primary 4-month adherence rate % of patients initiated who received each injection in the +/- 7 day window period for 4 months 4 months
Secondary 10-month adherence rate % of patients who received each injection in the +/- 7 day window period for 10 months 10 months
Secondary Virologic suppression (200 copies/mL) % of patients with virologic suppression (measured twice within 4 weeks and both values <200 copies/mL) 1 through 12 months following first injection
Secondary Virologic suppression (50 copies/mL) % of patients with virologic suppression (measured twice within 4 weeks and both values <50 copies/mL) 1 through 12 months following first injection
Secondary Resistance associated viral mutations % of patients with detection of resistance associated mutations 1 through 12 months following first injection
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