Implementation Effectiveness and Safety of Tenofovir Gel Provision Through Family Planning Services

Centre for the AIDS Programme of Research in South Africa372 enrolled

Overview

The purpose of this study is to assess the effectiveness of an implementation model which integrates tenofovir gel provision into existing family planning services.

The CAPRISA 008 trial is a two-arm, open-label, randomized controlled trial that is being conducted at the CAPRISA eThekwini and CAPRISA Vulindlela Clinics and their neighboring public sector family planning services in KwaZulu-Natal, South Africa. Up to 700 consenting sexually active, HIV-uninfected women aged 18 years and older who previously participated in an antiretroviral (ARV) prevention study will be enrolled and followed for a maximum 30 months. All women will be provided with 1% tenofovir gel but will be randomised to either receive their gel through a public sector family planning services with 2-3 monthly provision (intervention arm) or through the CAPRISA research clinics with monthly provision (control arm). All women in the trial will be provided with the standard package of HIV prevention and reproductive health services. Participants in both study arms will be provided with a supply of single-use, pre-filled applicators of 1% tenofovir gel. While in the study, participants will be advised and supported to follow the CAPRISA 004 pre- and post-dosing strategy, namely BAT24, where the first dose of tenofovir gel is applied within 12 hours before anticipated coitus and a second dose as soon as possible but within 12 hours after coitus, with a maximum of two doses of gel in a 24-hour period. The primary objective of this trial is to assess the effectiveness of an implementation model for tenofovir gel provision through family planning services.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

NONE

Enrollment

372

Conditions

HIV

Interventions

1% tenofovir gelDRUG

Participants will be randomized to receive 1% tenofovir gel through either: * Public sector family planning services with 2-3 monthly provision and monitoring of 1% tenofovir gel and the use of QI methodology to promote reliable service delivery (intervention arm), or * The CAPRISA research clinics with monthly provision and monitoring of 1% tenofovir gel (control arm).

Eligibility

Sex: FEMALEMin age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Age 18 years and older * Women who previously participated in an ARV prevention study * Currently utilizing or agreeing to attend designated public sector family planning services * Able and willing to provide first person informed consent to be screened for, and to enroll in, the study * Able and willing to provide adequate locator information for study retention purposes * Sexually active (at least one coital act in the last 3 months prior to screening) * HIV negative (by HIV testing performed by study staff within 30 days of enrollment) * Negative pregnancy test performed by study staff within 21 days of enrollment * Agree to use a non-barrier form of contraceptive * Agree to adhere to study visits and procedures Exclusion Criteria: * Has a creatinine clearance \< 50ml/min * Has any other condition that, based on the opinion of the Investigator or designee, would preclude provision of informed consent, make participation in the study unsafe, complicate interpretation of study outcome data, or otherwise interfere with achieving the study objectives

Locations (2)

CAPRISA eThekwini Clinical Research Site

Durban, KwaZulu-Natal, South Africa

CAPRISA Vulindlela Clinical Research Site

Pietermaritzburg, KwaZulu-Natal, South Africa

Outcomes

Primary Outcomes

Mean Number of Returned Used Applicators Per Month (i.e in 30 Days)

The primary endpoint is the mean number of returned used applicators per month. Since participants in the intervention arm followed two and three monthly schedule (as opposed to monthly in the intervention arm), the number of returned used applicators per month for each participant will be estimated as the total number of returned applicators at that visit divided by the number of days since the previous visit, multiplied by 30. Thus a uniform distribution of gel use will be assumed in participants whom we did not see monthly. Intent to treat and per protocol analyses were carried out of this outcome. Intent to treat population includes all participants who were randomized, met pre-randomization eligibility criteria and who have post-enrollment follow-up data. The per protocol population is a subset of the intent to treat population.The per-protocol analysis excluded visits where no gel had been dispensed for \>120 days.

Time frame: Between 2012 to 2015, up to 28 months

Secondary Outcomes

HIV Incidence Rates

Time to HIV infection was calculated as the difference between estimated date of infection (midpoint between the last negative HIV test date and the first confirmed positive HIV test date) and enrolment date, plus one. Where a participant has a positive PCR and a negative rapid test on the same date, the date of infection is calculated as 14 days prior to this date. Women who do not become HIV positive before their last study visit will be censored on the day of their last negative HIV test. Their follow-up time will be calculated as the difference between date of censoring and enrolment date, plus one.

Time frame: Between 2012 and 2015, up to 28 months

Pregnancy Incidence Rates

Time to pregnancy, was as the difference between the estimated date of conception and the enrolment date, plus one. The date of conception was defined as 14 days after the last normal menstrual period or the estimated date of delivery minus 40 weeks if the first date of last normal menstrual period is not available or the midpoint between the date of the first positive pregnancy test and the date of the previous negative pregnancy test. The censoring time for a woman who did not become pregnant during the study equals the difference between the calculated censoring date and the enrolment date, plus one.

Data from ClinicalTrials.gov

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