Prevention of HIV in "Île-de-France"
试验速览
- 阶段
- 不适用
- 状态
- 招募中
- 入组人数
- 3,257
- 试验地点
- 21
- 主要终点
- Reduction of new HIV diagnosis
研究概览
简要总结
Interventional HIV prevention strategy based on pre-exposure prophylaxis (PrEP) with Truvada® for people in the Île-de-France area (or Paris region) who don't have HIV but who are at high risk of becoming infected with HIV (men who have sex with men (MSM), transgender men and women, heterosexual men and women, sex workers, migrants) in combination with overall prevention services (communautary-based or educational counselling; addiction, social and psychological care; condoms and lubricating gel; clean injection equipment; sexually transmitted diseases (STD) screening and treatment; hepatitis A virus (HAV), hepatitis B virus (HBV) and hepatitis C virus (HCV) vaccinations and post-exposure treatment of HIV infection as soon as possible after diagnosis using an antiretroviral combination recommended by the French Guidelines on HIV treatment).
The individual benefit being already demonstrated in clinical trials, the aim is to demonstrate the public health impact of the interventional HIV prevention strategy by reducing the risk of getting HIV-1 infection of at least 15% of new diagnosis of HIV infections among MSM/transgender in the Ile-de-France area after a 3-year period.
详细描述
Assuming the PrEP efficacy of 80% and that 85% of included participants being MSM - the objective is to evidence a decrease of at least 15% of new diagnosis of HIV infections among MSM in Ile-de-France area. This objective is in the framework of a commitment of large cities against AIDS with the political support of the City of Paris for the "Paris sans SIDA" program and the commitment of the Île-de-France area.
Secondary Objectives:
- Prevalence of HIV infection at the screening visit (undiagnosed epidemic)
- Incidence of HIV infection according to back-calculation approach, and by key subgroups
Operational Objectives:
- Evaluate the origin of the recruitment according to the risk groups and the outreach actions
- Assess linkage to care for PrEP, retention in the study, reasons for consent withdrawal and satisfaction of the participants according to the screening site, the type of PrEP supply, the costs of global care, the key subgroups, the type of counselling, the time from STD testing to initiation of PrEP treatment in study sites
- Impact of a less intense counselling than the one provided in the ANRS IPERGAY trial, on adherence and efficacy of PrEP by comparing the incidence observed in MSM enrolled in the current study to that evidenced in the ANRS IPERGAY trial, with a method similar to that used in the Partner demonstration project in Kenya and Uganda.
- Impact of the communautary-based and educational counselling
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Age ≥ 18 years
- •Men/transgender men/women who have sex with men, heterosexual men and women, sex workers
- •Negative for HIV-1 and HIV-2 (with a fourth generation enzyme-linked immunosorbent assay (ELISA) assay)
- •Willing the geocoding of the postal address and to be contacted via telephone or email, on a regular basis
- •Willing to comply to visits schedule (every 3 months)
- •Health security program
- •Informed consent form signed
- •High risk of acquiring HIV infection:
- •For MSM and transgenders:
- •Anal sex with at least two different sexual partners and no consistent condom use over the last 6 months
- •And/or history of STD during the last 12 months (syphilis, gonorrhea , chlamydiae, HBV or HCV infection)
- •And/or history of non-occupational post-exposure prophylaxis (PEP) during the last 12 months
- •And/or using psycho-actives drugs during sexual intercourses (cocaine, gammahydroxybutyric acid (GHB), Methylenedioxymethamphetamine (MDMA), mephedrone)
- •And/or having an HIV-infected sexual partner with a detectable plasma viral load (> 50 copies (cp)/milliliter (ml))
- •For heterosexual:
- •Sexual intercourse with 1 partner originating from regions with high prevalence of HIV infection (> 1%) (South America, Sub-Saharan Africa, South-East Asia, Eastern Europe, French Guyana) and no consistent condom use
- •and/or sex workers
- •and/or having a sexual partner who is an intravenous drug users sharing injection material
- •and/or having an HIV-infected sexual partner with a detectable plasma viral load (> 50 cp/ml)
排除标准
- •Stable and exclusive relationship with an HIV-negative partner, or with an HIV-positive partner on antiretroviral therapy (ART) with a plasma viral load < 50 cp/ml
- •Positive HIV infection
- •Clinical signs of positive HIV infection
- •Consistent condom use during sexual intercourse
- •Expected trip abroad for 3 consecutive months
- •Creatinine clearance lower than 50ml/min
- •History of chronic renal disease, osteoporosis or osteopenia
- •Receiving an investigational drug
- •Receiving or will receive potentially nephrotoxic treatments
- •Gastro-intestinal condition that could limit drug absorption
- •Potentially non compliant participants
- •Breastfeeding
- •Hypersensitivity to TDF/FTC
- •Positive HBs antigen or isolated anti hepatitis B core (HBc) antibodies if not willing to take daily PrEP
- •Severe condition (lymphoma, other cancers, cardio-vascular disease, end-stage renal failure, uncontrolled diabetes)
研究组 & 干预措施
PrEP with Truvada®
On demand PrEP (only for MSM - with the possibility of dosing schedule switching): 2 pills of Truvada within 24 to 2 hours prior first sexual intercourse, then 1 pill every 24 hours during the period of sexual activity with one pill after the last sexual intercourse, and one last pill 24 hours later
Continuous PrEP: 1 pill every 24 hours, at least 7 days before the first sexual intercourse. When PrEP is to be discontinued, 2 pills 24 hours apart after the last sexual intercourse then stop PrEP. If PrEP is to be resumed, 1 pill every 24 hours, started at least 7 days before the first sexual intercourse or 2 pills at least 2 hours before the first sexual intercourse and then 1 pill every 24 hours.
干预措施: PrEP with Truvada® (Drug)
结局指标
主要结局
Reduction of new HIV diagnosis
时间窗: three years
Number of new HIV infections
次要结局
- Number of recent infections(three years)
- Retention in the study(two years)
- Counselling(three years)
- Type of counselling(three years)
- Incidence of HIV infection(three years)
- Integration of PrEP in the daily routine of participants(three years)
- Care Providers Behavior(three years)
- Cost-effectiveness(three years)
- Post-exposure prophylaxis(three years)
- Social epidemiology(three years)
- Prevalence of HIV-infection at the screening visit (undiagnosed epidemic)(two years)
- Safety and tolerability(three years)
- Adherence to PrEP(three years)
- PrEP dosing schedule(three years)
- Incident HIV infections(three years)
- Participants Behavior(three years)