A Phase 2a Crossover Trial Evaluating the Safety of and Adherence to a Vaginal Matrix Ring Containing Dapivirine and Oral Emtricitabine/Tenofovir Disoproxil Fumarate in an Adolescent and Young Adult Female Population
Overview
- Phase
- Phase 2
- Intervention
- Dapivirine vaginal ring
- Conditions
- HIV Infections
- Sponsor
- National Institute of Allergy and Infectious Diseases (NIAID)
- Enrollment
- 247
- Locations
- 4
- Primary Endpoint
- Number of Participants With Grade 2 or Higher Adverse Events (AEs)
- Status
- Completed
- Last Updated
- 2 years ago
Overview
Brief Summary
The purpose of this study is to evaluate the safety of and adherence to a vaginal matrix ring (VR) containing dapivirine and oral emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) in adolescent and young adult females.
Detailed Description
This study will evaluate the safety of and adherence to a vaginal matrix ring (VR) containing dapivirine and oral emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) in adolescent and young adult females. The study will enroll healthy, HIV-uninfected adolescent and young adult females between 16 and 21 years of age. Participants will be randomized to one of two sequences of one VR containing 25 mg of dapivirine to be inserted monthly for 24 weeks and one 200 mg FTC/300 mg TDF oral tablet taken daily for 24 weeks. After completing the randomized sequence of two study product use periods, participants will then select between the two study products to use in the final 24 weeks of the trial. Participants will be able to choose either or neither study product during the third product use period. The study includes approximately 76 weeks of follow-up per participant. Participants will attend monthly study visits, which may include behavioral assessments/counseling; physical and pelvic examinations; and blood, urine, and pelvic sample collection.
Investigators
Eligibility Criteria
Inclusion Criteria
- •Age 16 through 21 years (inclusive) at Enrollment, verified per site standard operating procedures (SOPs).
- •Able and willing to provide informed consent, and if under the legal age of consent be able to provide informed assent and obtain parental or guardian permission/consent, to be screened for and to enroll in MTN-034 (as specified in site SOP).
- •Able and willing to provide adequate locator information, as defined in site SOPs.
- •Able and willing to comply with all study procedural requirements.
- •Per participant report at Screening, post-menarche.
- •HIV-uninfected based on testing performed at Screening and Enrollment (per protocol algorithms found in the study protocol).
- •Per participant report at Screening, history of at least one episode of sexual intercourse in participant's lifetime.
- •Negative pregnancy test at Screening and Enrollment.
- •Per participant report, use of an effective method of contraception for at least two months prior to Enrollment, and intending to continue use of an effective method for the duration of study participation; effective methods include:
- •hormonal methods (except contraceptive ring).
Exclusion Criteria
- •Per participant report at Screening and Enrollment, intends to do any of the following during the study participation period:
- •become pregnant.
- •access and/or use oral PrEP outside the context of study participation.
- •relocate away from the study site.
- •travel away from the study site for a time period that would interfere with product resupply and study participation.
- •At Screening or Enrollment, has a positive HIV test.
- •Diagnosed with urinary tract infection (UTI), pelvic inflammatory disease (PID), sexually transmitted infection (STI) or reproductive tract infection (RTI) requiring treatment per World Health Organization (WHO) guidelines at Screening or Enrollment.
- •Note: Otherwise eligible participants diagnosed during screening with a UTI, PID or STI/RTI requiring treatment per WHO guidelines - other than asymptomatic bacterial vaginosis (BV) and asymptomatic candidiasis - are offered treatment consistent with WHO recommendations. If treatment is completed and symptoms have resolved within 70 days of obtaining informed assent/consent for screening, the participant may be enrolled. Genital warts requiring treatment also must be treated prior to enrollment. Genital warts requiring therapy are defined as those that cause undue burden or discomfort to the participant, including bulky size, unacceptable appearance, or physical discomfort.
- •At Enrollment, has a clinically apparent Grade 2 or higher pelvic exam finding.
- •Note: Cervical friability bleeding associated with speculum insertion and/or specimen collection judged to be within the range of normal according to the clinical judgment of the Investigator of Record (IoR)/designee is considered expected non-menstrual bleeding and is not exclusionary.
Arms & Interventions
Sequence A: Dapivirine vaginal ring + FTC/TDF
Participants will receive one 25 mg dapivirine vaginal ring inserted vaginally each month for 24 weeks, followed by one FTC/TDF oral tablet taken by mouth daily for 24 weeks, followed by participant's choice of either or neither study product for 24 weeks.
Intervention: Dapivirine vaginal ring
Sequence A: Dapivirine vaginal ring + FTC/TDF
Participants will receive one 25 mg dapivirine vaginal ring inserted vaginally each month for 24 weeks, followed by one FTC/TDF oral tablet taken by mouth daily for 24 weeks, followed by participant's choice of either or neither study product for 24 weeks.
Intervention: FTC/TDF
Sequence B: FTC/TDF + Dapivirine vaginal ring
Participants will receive one FTC/TDF oral tablet taken by mouth daily for 24 weeks, followed by one 25 mg dapivirine vaginal ring inserted vaginally each month for 24 weeks, followed by participant's choice of either or neither study product for 24 weeks.
Intervention: Dapivirine vaginal ring
Sequence B: FTC/TDF + Dapivirine vaginal ring
Participants will receive one FTC/TDF oral tablet taken by mouth daily for 24 weeks, followed by one 25 mg dapivirine vaginal ring inserted vaginally each month for 24 weeks, followed by participant's choice of either or neither study product for 24 weeks.
Intervention: FTC/TDF
Outcomes
Primary Outcomes
Number of Participants With Grade 2 or Higher Adverse Events (AEs)
Time Frame: Study periods 1 and 2
During participants' first year on study (i.e., during first and second product use periods) participants were randomized to use either the dapivirine vaginal ring for 6 months followed by FTC/TDF for 6 months or vice versa. All AEs were reported as per the Division of AIDS Table for Grading the Severity of Adult and Pediatric Adverse Events. AEs that were graded as at least Grade 2 (i.e., "moderate" or higher) were classified into the two periods based on reported date of AE onset, with AEs occurring between the participant's randomization date and the date 30 days after their Week 24 visit classified into Period 1, and AEs occurring between their Week 24 visit and the date 30 days after their Week 48 visit classified into Period 2. AEs occurring within 30 days of the Week 24 visit were counted in both periods. This is the number of participant-periods with at least one grade 2 or higher AE by product (combining the two product use periods).
Number of Participant-Visits With No Product Use
Time Frame: Study periods 1 and 2
During the study period where participants were randomized to use FTC/TDF they were assessed for FTC/TDF adherence by dried blood spot (DBS) at monthly visits. Results that were below the lower limit of detection (\< 16.6 fmol/punch) were classified as no use of FTC/TDF during the preceding month, and detectable results (\>= 16.6 fmol/punch) classified as at least some FTC/TDF use. During the study period where participants were randomized to use the dapivirine vaginal ring (VR) they were assessed for ring adherence by residual drug levels in returned VRs. Results that were less than or equal to a rate of 0.9mg dapivirine released per month were classified as no use of the VR during that month, and results greater than 0.9mg dapivirine release per month classified as at least some VR use.
Secondary Outcomes
- Number of Participant-Visits Reporting Acceptability of Study Product(Study periods 1 and 2)
- Number of Participant-Visits With No Product Use(Study period 3 (Weeks 49-72))
- Number of Participants Selecting Each Study Product(Study period 3 (Weeks 49-72))
- Percentage of Participants Reporting Preference for Dapivirine VR as Compared to FTC/TDF Oral Tablets(All three study periods (enrollment, month 12, and month 18 study visits))