Assisted Partner Notification to Augment HIV Treatment and Prevention in Kenya

HIV Clinical Trial

— APS  

Official title:

Assisted Partner Notification to Augment HIV Treatment and Prevention in Kenya

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01616420
• Other study ID #: 43628
• Status: Completed
• Phase: N/A
• First received: June 7, 2012
• Last updated: April 6, 2017
• Start date: June 2012
• Est. completion date: August 2015

Study information

• Verified date: April 2017
• Source: University of Washington
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The main purpose of this implementation science study is to find out if providing aPS at 18 different Ministry of Health (MOH) VCT clinics in Kenya works and is cost-effective. This would enable co-investigators in the Kenyan MOH to justify funding to scale-up these services.

The primary aim of the study is to find out whether providing aPS to sexual partners of newly tested HIV-infected individuals can result in more sexual partners getting counseled and HIV tested and linked to HIV care programs for initiation of ART if appropriate. The investigators hypothesize that aPS will increase rates of case-finding, linkages to care, and ART initiation and will not result in social harm.

The second aim is whether aPS is cost-effective in the Kenyan setting. The investigators will estimate how much it costs (when compared to standard methods) to identify and link HIV-infected persons into care. The investigators will also determine how successful aPS is at preventing future HIV transmission events and other outcomes associated with untreated HIV infection. The investigators hypothesize that HIV prevalence among partners in the immediate aPS arm will be high enough to make this approach cost-effective from the payer and societal perspective.

Finally, with the Kenya MOH, the investigators want to establish a nationwide monitoring system to evaluate why Kenyans are testing for HIV. In the future, when aPS is rolled out nationally, this will help Kenyan public health officials define the contribution of aPS to HIV case-finding. The investigators hypothesize that the proportion of newly tested HIV-infected individuals who report testing because of known exposure to a person with HIV will represent a significant proportion of new cases and the investigators will be able to identify places in Kenya where aPS will have the greatest impact on HIV treatment and prevention.

Description:

Diagnosing HIV soon after infection can benefit individuals and also has important public health benefits. It has been shown that starting antiretroviral therapy (ART) before HIV has progressed results in a better response to treatment and gives the person a better chance of long-term survival with HIV. Treating HIV can also reduce the risk that someone will transmit HIV to his or her sexual partners. The first step in achieving these individual and population level benefits is testing people for HIV. Unfortunately, in many parts of the world, including Kenya where we plan to conduct this study, many people are not tested regularly and do not know that they are infected. This study involves providing a public health service, notification of an exposure to a communicable disease and HIV testing, to sexual partners of those who test HIV-positive at voluntary counseling and testing (VCT) clinics in Kenya. Sexual partners are identified voluntarily by the person who tests at the VCT. A public health provider then goes to the home of the sexual partners to offer them HIV counseling and testing. This process is called provision of assisted partner services (aPS).

We propose a cluster randomized clinical trial which will be conducted in collaboration with the Kenya Ministry of Health (MOH) at 18 rural and urban voluntary counseling and testing (VCT) facilities across Kenya. Proposed activities will assess the effectiveness and cost-effectiveness of providing aPS, improve capacity for program implementation in Kenya, and lay the foundation for evaluating the program's impact at the national level.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 2424
• Est. completion date: August 2015
• Est. primary completion date: August 2015
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Written informed consent is required of all participants. All participants must be 18 years or older.

• Index case participants must be HIV-seropositive, and willing and able to provide locator information for sexual partners in the past three years.

Exclusion Criteria:

• Index cases will be excluded from participation if they are pregnant, or have reported intimate partner violence during the last month. There is no exclusion criteria for partner participants.

Related Conditions & MeSH terms

• HIV

Intervention

Other:
• Assisted-partner notification services
Assisted-partner notification services (aPS) is a public health service which notifies the partners of those who test positive for a communicable disease of their exposure.

Locations

Country	Name	City	State
Kenya	Karuri VCT	Kiambu
Kenya	Kiambu Hospital VCT	Kiambu
Kenya	Kirwara VCT	Kiambu
Kenya	Chulaimbo Health Centre	Kisumu
Kenya	Joo Trh Vct	Kisumu
Kenya	Kisumu East District Hospital	Kisumu
Kenya	Kombewa VCT	Kisumu
Kenya	Maseno Mission	Maseno
Kenya	Baba Dogo VCT	Nairobi
Kenya	Casino VCT	Nairobi
Kenya	Huruma Lions	Nairobi
Kenya	Kariobangi VCT	Nairobi
Kenya	Kenyatta National Hospital (KNH) VCT	Nairobi
Kenya	Mama Lucy Kibaki VCT	Nairobi
Kenya	Mbagathi VCT	Nairobi
Kenya	Pumwani VCT	Nairobi
Kenya	Abidha Health Centre	Siaya
Kenya	Ongielo Health Centre	Siaya

Sponsors (3)

Lead Sponsor	Collaborator
University of Washington	Kenya Ministry of Health, University of Nairobi

Country where clinical trial is conducted

Kenya, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Number of partners testing for HIV	The number of partners of an index participant that were tested for HIV (offset will be the number of partners with locator information provided by the index participant).	6 week period following index case enrollment
Primary	Newly tested HIV-infected partners	The number of partners of an index participant identified as HIV-infected (offset will be the number of partners of that index participant who were HIV tested).	6 week period following index case enrollment
Primary	Number of partners linking to HIV care	The number of partners of an index participant who were linked to HIV care (offset will be the number of partners of an index participant identified as HIV-infected and analysis will be limited to index participants with at least one HIV-infected partner.)	6 week period following index case enrollment
Secondary	Incremental cost-effectiveness from payer and societal perspectives		6 week period following index case enrollment
Secondary	Proportion of individuals with newly diagnosed HIV infection who report testing because of known exposure to a person with HIV		6 week period after index case enrollment
Secondary	Costs of identifying >1 partner per index case		6 week period after index case enrollment