Expanding Options for HIV Prevention Through Pre-exposure Prophylaxis in Hhohho Region, Swaziland
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- HIV Negative People Identified at Substantial Risk for HIV Infection
- Sponsor
- Clinton Health Access Initiative Inc.
- Enrollment
- 517
- Locations
- 6
- Primary Endpoint
- Uptake
- Status
- Completed
- Last Updated
- 6 years ago
Overview
Brief Summary
This stepped-wedge cluster-randomized trial is embedded in an 18-month observational cohort study that has the aim to assess the operationalization of oral Pre-Exposure Prophylaxis (PrEP) in Swaziland as an additional HIV combination prevention method among individuals at high risk of HIV infection. The trial aims to determine the effect of a healthcare facility-based PrEP promotion package on the number of clients who take up PrEP.
Detailed Description
The study will assess who will be reached with an introduction to and an offer of PrEP - and who will take up PrEP - when PrEP becomes available through different delivery points in the public-sector health system, including outpatient department (OPD), antenatal care (ANC), postnatal care (PNC) , family planning (FP) , and following HIV counseling and testing (VCT). In addition to PrEP reach and PrEP uptake, the study aims to establish PrEP retention and average costs per client, by different health systems delivery points and to assess the effectiveness of a feasible and low-cost PrEP Promotion Package (PPP). The exact composition of PPP will be informed by findings from in-depth- interviews with clients, providers, and PrEP stakeholders. The effect of the PPP on the monthly number of clients who are initiated on PrEP will be studied using a stepped-wedge cluster-randomized design. Specifically, the trial will have two sequences with three healthcare facilities in each sequence, and three periods. In the first period, all healthcare facilities will be in the control phase; in the second period three healthcare facilities will implement the PPP; and in the third period all six healthcare facilities will implement the PPP.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Confirmed HIV negative by rapid antibody test following the National HIV testing services (HTS) algorithm on the day of PrEP initiation
- •\> 16 years of age
- •Willing and able to provide written informed consent
- •Identified at substantial risk of acquiring HIV infection
- •No current or recent illness (within past month) consistent with acute HIV infection in combination with a preceding high risk exposure for HIV
- •No contraindications to the use of Tenofovir(TDF)/Lamivudine (3TC)
- •Ready to adhere to PrEP and willing to attend the follow up evaluations including repeat HIV testing and monitoring for side-effects
Exclusion Criteria
- •Younger than 16 years of age
- •Currently having symptoms of acute HIV infection
- •Suspicion of window period following a potential exposure to HIV
- •Body weight \< 40 kg
- •Creatinine clearance \<60 ml/min
- •Using other nephrotoxic drugs (e.g. aminoglycosides)
- •Not willing to come for follow up visits every 3 months which will include HIV testing and counselling and monitoring for side-effects.
Outcomes
Primary Outcomes
Uptake
Time Frame: 18 months
The monthly number of clients who was initiated on PrEP
Secondary Outcomes
- Substantial risk(18 months)
- Risk assessment(18 months)
- Acceptance conditional on risk(18 months)
- Linkage(12 months)
- HIV incidence(18 month)
- Retention at 6 months(6 months)