A Demonstration Project to Add Pre- or Post-exposure Prophylaxis to Combination HIV Prevention Services

Phase 4

Completed

• Conditions: HIV Prevention
• Interventions: Drug: emtricitabine 200mg/tenofovir 300mg

• Registration Number: NCT01781806
• Lead Sponsor: University of California, Los Angeles

Brief Summary

The purpose of this study is to evaluate the safety, acceptability and feasibility of delivery of Pre-Exposure Prophylaxis (PrEP) or Post-Exposure Prophylaxis) PEP as part of combination HIV prevention services for high-risk MSM and transgender women.

Detailed Description

Two community-based sites (LALGBT Center and The OASIS Clinic) will serve as facilities at which participants may present for screening for prevention services. At the sites, eligibility criteria will be assessed, HIV, Sexually Transmitted Disease (STD) and laboratory testing will be performed, and HIV prevention service referrals will be initiated. Follow-up will be on a monthly basis for the first three months, and then de-escalated to an every-3-month interval.

The program stratifies participants into two cohorts on the basis of sexual risk behavior: a low-moderate risk cohort (LM) and a high-risk cohort (H). Participants in the LM cohort will be provided a customized prevention package (CPP) including access to PEP for emergency HIV prevention in the event of unanticipated HIV exposure. Participants in the H cohort will be provided a CPP including daily Truvada-based PrEP. All participants will be followed for 48 weeks. Participants in the LM cohort who, on longitudinal sexual risk behavior surveillance, report increased levels of sexual risk-taking such that they meet enrollment criteria for the H-cohort will be transitioned to the H-cohort.

At each follow-up visit, a careful safety assessment will be made, including signs/symptoms and laboratory assessments. STD testing will be performed at 3 month intervals. An escalating-intensity adherence intervention will be implemented based on real-time plasma tenofovir levels. A computer-assisted self-interview (CASI) will be used to capture detailed sexual risk, adherence, and substance use behavior.

Basic Information
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Recruitment & Eligibility
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Study & Design
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Trial Locations

Study Timeline

• Study First Submitted: 2013-01-29
• Study First Submitted QC: 2013-01-30
• Study First Posted: 2013-02-01
• Study Start: 2013-05
• Primary Completion: 2016-05
• Study Completion: 2016-05
• Results First Submitted: 2017-08-24
• Results First Submitted QC: 2017-08-24
• Results First Posted: 2017-09-20
• Status Verified: 2018-04
• Last Update Submitted: 2018-04-04
• Last Update Posted: 2018-04-06

Recruitment & Eligibility

• Status: COMPLETED
• Sex: Male
• Target Recruitment: 328

Inclusion Criteria

• At least 18 years of age
• Able to understand and provide consent in English or Spanish
• Self identified MSM, MSM/W, or Transfemale
• At least one male sex partner for anal intercourse in the prior 12 months
• HIV negative by enzyme immunoassay (EIA) and viral load (VL)
• CrCl ≥ 60 ml/min (via Cockcroft-Gault formula)
• No signs or symptoms suggestive of primary HIV infection (PHI).

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Exclusion Criteria

• Participants <18 years of age
• Unable to understand and provide consent in English or Spanish
• Known or found on testing to be HIV positive
• Any condition, which in the opinion of the intake provider, will seriously compromise the participant's ability to comply with the protocol, including adherence to PEP or PrEP medication dosing
• Use of Antiretroviral therapy (ART) taken for any indication (i.e. PEP or PrEP) within 60 days of study entry
• Previous participation in an HIV vaccine trial. Participants that were documented to have received only placebo are not excluded.
• Signs or symptoms suspicious for PHI.

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Cohort LM (PEP)	emtricitabine 200mg/tenofovir 300mg	Participants who do not meet criteria for High Risk (Cohort H) will be assigned to the LM (low moderate) cohort and will receive a customized prevention package based on baseline assessments (in the same manner as the Cohort H Participants). In addition, they will receive education on the availability and use of post-exposure prophylaxis.
Cohort H (PrEP)	emtricitabine 200mg/tenofovir 300mg	Participants in the H cohort will be provided with a CPP, including daily oral emtricitabine/tenofovir-based PrEP. High Risk Cohort Criteria (one or more of the following has to be met): 1. No condom use during anal intercourse with ≥3 male sex partners who are HIV-positive or of unknown HIV status during the last three months. 2. STD diagnosis during the last 12 months. 3. Previous PEP use during the last 12 months (\* see exclusion criteria) 4. Has at least one HIV infected sexual partner for ≥4 weeks.

Primary Outcome Measures

Name	Time	Method
Number of Participants With a Grade 2 or Higher Adverse Event by Cohort	Baseline to 48 weeks	Number and frequency rate of clinical and laboratory AEs (Gr 2 and above), including SAEs by Cohort.

Secondary Outcome Measures

Name	Time	Method
Cohort H PrEP Engagement by Study Visit	Baseline to 48 weeks	Optimal adherence to daily oral emtricitabine/tenofovir disoproxil fumarate by study visit as measured by tenofovir diphosphate (TFV-DP) in dried blood spots (DBS). Optimal adherence is defined as TFV-DP levels great than or equal to 700 femtomoles per punch in DBS samples (approximately 4 or more doses a week over the past 60 days).

Trial Locations

Locations (2)

L.A. Gay and Lesbian Center; 🇺🇸 Los Angeles, California, United States

The OASIS Clinic; 🇺🇸 Los Angeles, California, United States