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The Community PrEP Study to Assess the Acceptance of PrEP Delivered Through CBCT Platforms

F

Foundation for Professional Development (Pty) Ltd

Status

Completed

Conditions

Adolescence
HIV Prevention
PrEP
Cost-effectiveness

Treatments

Behavioral: Group-based Community Health Club
Behavioral: Individual-based Adherence Support

Study type

Interventional

Funder types

Other
NIH

Identifiers

NCT03977181
R01MH114648
1R01MH114648 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

The investigators aim to 1) speed up access to and delivery of PrEP to young women, and 2) compare interventions to support and maximize the prevention-effective use of PrEP. Specifically, the investigators aim to answer the following two questions: 1) how can the study use existing community-based platforms to identify and deliver PrEP to those in need? and 2) which adherence support interventions are most likely to engender effective use of PrEP? The investigators propose to answer these questions by leveraging existing community-based HIV testing platforms in South Africa and use a mixed methods approach to optimize the PrEP cascade and evaluate a community-based PrEP adherence program for young women.

Full description

Worldwide, about 1.9 million people became infected with HIV in 2015, most of whom live in Southern and East Africa. In South Africa, the HIV incidence rate among young women ages 15-24 (2.5%) is four times higher than their male counterparts (0.6%). Recent HIV prevention trials in South Africa documented incidence rates of 5-6% per year in 15-24 year old young women. Given this high incidence of HIV, implementing effective HIV prevention strategies - including PrEP - is crucial to controlling HIV globally.

The proposed study leverages existing community-based HIV counseling and testing platforms in South Africa and evaluates, using a mixed methods approach, a community-based PrEP adherence program for young women whilst optimizing the PrEP cascade. Numerous barriers have been described that delay or block young women from accessing clinic-based health services, especially reproductive health and HIV testing and prevention services. Consequently, reaching young women at large scale with HIV prevention services requires delivery platforms outside of clinic-based facilities. Community-based counseling and testing programs have shown the greatest coverage and potential to achieve high levels of knowledge of HIV serostatus and linkage to HIV care. Using community-based counseling and testing programs, this proposal will deliver PrEP as part of a population-level combination prevention program, which is necessary to substantially reduce HIV incidence.

The investigators propose to answer key research questions through the following; Specific Aims: 1) Assess young women's uptake of PrEP when delivered through large-scale community-based HIV counseling and testing platforms in urban and rural settings in South Africa, 2) Evaluate community-based scalable interventions to achieve prevention-effective adherence to PrEP among young women, and 3) Evaluate the cost per young woman initiated on PrEP and provided adherence support through community-based platforms, and the cost-effectiveness per incident HIV infection averted. In order to achieve Aim 1, the study will leverage from on-going, at-scale CBCT programs and platforms (mobile unit and systematic home-based testing) to identify and link young women to community-based PrEP initiation services. In order to achieve Aim 2, the study will perform a 3-arm randomized controlled trial, with participants randomized to one of the following arms: Arm 1) a group-based community health club akin to an ART adherence club; Arm 2) one-on-one adherence counseling and support; Arm 3) community-based medication dispensary.

Enrollment

480 patients

Sex

Female

Ages

16 to 25 years old

Volunteers

Accepts Healthy Volunteers

Inclusion criteria

  • Self-identified as female (regardless of assigned sex at birth)
  • 16 - 25 years of age.
  • HIV negative (confirmed during CBCT testing)
  • At risk for HIV acquisition
  • Express interest in taking PrEP

Exclusion criteria

  • Planning to relocate in the next 12 months
  • Positive HIV test at screening or enrolment
  • Pregnant
  • Breastfeeding
  • Current participation in other HIV prevention studies (clinical or behavioural)
  • Current use of ARV drugs for post-exposure prophylaxis (PEP)
  • Presence of any disease or health condition, self-reported or identified by initiation clinician, that may prevent participation.

Trial design

Primary purpose

Prevention

Allocation

Randomized

Interventional model

Parallel Assignment

Masking

None (Open label)

480 participants in 3 patient groups

Health Club
Experimental group
Description:
A group-based community health club akin to an ART adherence club
Treatment:
Behavioral: Group-based Community Health Club
One-on-one
Experimental group
Description:
One-on-one adherence counselling and support
Treatment:
Behavioral: Individual-based Adherence Support
Medication pick-up
No Intervention group
Description:
Community-based medication dispensary

Trial contacts and locations

1

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Data sourced from clinicaltrials.gov

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