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Sponsored by: |
National Institute of Allergy and Infectious Diseases (NIAID) |
Information provided by: | National Institute of Allergy and Infectious Diseases (NIAID) |
ClinicalTrials.gov Identifier: | NCT00255840 |
The purpose of this study is to determine the effectiveness of several anti-HIV treatment strategies in resource-poor South African communities. The strategies being studied are using specially trained doctors or nurses to administer HIV care.
Condition | Intervention |
HIV Infections |
Behavioral: Monitoring by an HIV-trained medical doctor Behavioral: Monitoring by an HIV-trained primary care nurse Drug: Efavirenz Drug: Lamivudine Drug: Lopinavir/Ritonavir Drug: Nevirapine Drug: Stavudine |
MedlinePlus related topics: | AIDS |
Drug Information available for: | Lamivudine Stavudine Efavirenz Ritonavir Nevirapine Lopinavir |
Study Type: | Interventional |
Study Design: | Treatment, Randomized, Open Label, Active Control, Parallel Assignment, Safety/Efficacy Study |
Official Title: | "Safeguard the Household" - A Study of HIV Antiretroviral Therapy Treatment Strategies Appropriate for a Resource Poor Country |
Estimated Enrollment: | 1340 |
Study Start Date: | July 2006 |
Estimated Study Completion Date: | July 2008 |
Estimated Primary Completion Date: | July 2008 (Final data collection date for primary outcome measure) |
Arms | Assigned Interventions |
A: Active Comparator
Study-specified ART regimen under care of HIV-trained medical doctor
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Behavioral: Monitoring by an HIV-trained medical doctor
Participants will receive care from an HIV-trained medical doctor
Drug: Efavirenz
600 mg tablet taken orally daily
Drug: Lamivudine
150 mg tablet taken orally daily
Drug: Lopinavir/Ritonavir
400 mg lopinavir/100mg ritonavir tablet taken orally twice daily
Drug: Nevirapine
200 mg tablet taken orally for 14 days before taking a 200 mg tablet orally twice daily
Drug: Stavudine
Tablet taken orally daily. Dosage depends on weight.
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B: Active Comparator
Study-specified ART regimen under care of HIV-trained primary care nurse
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Behavioral: Monitoring by an HIV-trained primary care nurse
Participants will receive care from an HIV-trained primary care nurse
Drug: Efavirenz
600 mg tablet taken orally daily
Drug: Lamivudine
150 mg tablet taken orally daily
Drug: Lopinavir/Ritonavir
400 mg lopinavir/100mg ritonavir tablet taken orally twice daily
Drug: Nevirapine
200 mg tablet taken orally for 14 days before taking a 200 mg tablet orally twice daily
Drug: Stavudine
Tablet taken orally daily. Dosage depends on weight.
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The introduction of antiretroviral therapy (ART) for the treatment of HIV has dramatically improved morbidity and mortality for HIV infected people in the developed world. However, research data on the efficacy of ART regimens in developing countries, such as South Africa, are limited. There are an estimated 4.7 million HIV infected individuals in the South African population of about 40 million inhabitants. The greatest social impact may be achieved by treating an entire household affected by HIV to ensure maximum adherence to prescribed ART regimens and to minimize the sharing of antiretroviral drugs. This study will evaluate the effectiveness of ART given by an HIV-trained doctor compared to ART given by an HIV-trained primary health care nurse. Participants failing first-line therapy will receive a second-line regimen based on what medications are available at the clinic, with approval by the clinical safety team. Participants in this study will be recruited from resource-poor communities outside Johannesburg and Cape Town, South Africa.
This study will last 5 years. HIV infected people and other HIV infected members of their household 16 years of age and older will be enrolled. Study participants will receive first-line ART consisting of efavirenz (EFV) once daily, lamivudine (3TC) twice daily, and stavudine (d4T) twice daily. Women of childbearing potential who are unwilling to use acceptable forms of contraception and who have CD4 counts less than 250 cells/mm3 will receive 3TC twice daily; nevirapine (NVP) daily for 2 weeks, then twice daily; and d4T twice daily. Women who are pregnant at baseline, who become pregnant on study treatment, or who are unwilling to use acceptable methods of contraception and have CD4 counts of 250 cells/mm3 or more, or children who were previously exposed to NVP will receive 3TC twice daily, lopinavir/ritonavir (LPV/r) twice daily, and d4T twice daily. Participants will be randomly assigned to one of two arms. Arm 1 will receive ART under the monitoring care of an HIV-trained medical doctor, while Arm 2 will receive ART under the monitoring care of an HIV-trained primary health care nurse with training in HIV diagnosis and treatment. Participants who fail their first-line regimen will receive a second-line regimen but will remain in their treatment arms.
Study visits will occur at study entry; Weeks 2, 4, 8, and 12; and every 12 weeks thereafter. A physical exam, measurement of height and weight, tuberculosis (TB) and hepatitis B infection screening, blood collection, pill counts, and compliance/adherence and resource utilization counseling will occur at most visits. Participants will also be asked to complete quality of life and household cost questionnaires at selected visits. Study visits for participants who fail first-line treatment will occur at treatment failure, between Days 15 and 30, Week 4 post-treatment failure, every 4 weeks until Week 48 post-treatment failure, and every 12 weeks thereafter. A targeted physical exam, measurement of height and weight, TB infection screening, blood collection, pill counts, and compliance/adherence and resource utilization counseling will occur at most visits. Participants will also be asked to complete quality of life and household cost questionnaires at selected visits.
Ages Eligible for Study: | 16 Years and older |
Genders Eligible for Study: | Both |
Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Exclusion Criteria:
Principal Investigator: | James McIntyre, MBChB, MRCOG | Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital |
Principal Investigator: | Ian Sanne, MBChB | University of the Witwatersrand, Thembaletu Clinic, Helen Joseph Hospital |
Principal Investigator: | Robin Wood, MBChB, FCP (SA) | Department of Medicine, University of Cape Town |
Responsible Party: | DAIDS ( Rona Siskind ) |
Study ID Numbers: | CIPRA-ZA Project 1, CIPRA, Project 1, 3-U19-AI053217-03S1, 3-U19-AI053217-04S1, 3-U19-AI053217-04 |
First Received: | November 16, 2005 |
Last Updated: | May 28, 2008 |
ClinicalTrials.gov Identifier: | NCT00255840 |
Health Authority: | United States: Federal Government |
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