Protocol for a randomised feasibility study of Point-Of-care HIV viral load testing to Enhance Re-suppression in South Africa: the POwER study
Introduction Access to HIV viral load testing remains difficult for many people on antiretroviral therapy (ART) in low-income and middle-income countries. Weak laboratory and clinic systems often delay the detection and management of viraemia, which can lead to morbidity, drug resistance and HIV tra...
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BMJ Publishing Group
2021-02-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/11/2/e045373.full |
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| author | Sarah Tonkin-Crine Nigel Garrett Jienchi Dorward Hope Ngobese Lara Lewis Natasha Samsunder Paul K Drain Yukteshwar Sookrajh Richard Lessells Fathima Sayed Elliot Bulo P Moodley |
| author_facet | Sarah Tonkin-Crine Nigel Garrett Jienchi Dorward Hope Ngobese Lara Lewis Natasha Samsunder Paul K Drain Yukteshwar Sookrajh Richard Lessells Fathima Sayed Elliot Bulo P Moodley |
| author_sort | Sarah Tonkin-Crine |
| collection | DOAJ |
| description | Introduction Access to HIV viral load testing remains difficult for many people on antiretroviral therapy (ART) in low-income and middle-income countries. Weak laboratory and clinic systems often delay the detection and management of viraemia, which can lead to morbidity, drug resistance and HIV transmission. Point-of-care testing could overcome these challenges. We aim to assess whether it is feasible to conduct a randomised trial of point-of-care viral load testing to manage viraemia.Methods and analysis We will conduct an open-label, single-site, individually randomised, feasibility study of Point-Of-care HIV viral load testing to Enhance Re-suppression, in Durban, South Africa. We will enrol approximately 100 people living with HIV who are aged ≥18 years, receiving first-line ART but with recent viraemia ≥1000 copies/mL, and randomise them 1:1 to receive point-of-care viral load or standard laboratory viral load monitoring, after 12 weeks. All participants will continue to receive care from public sector healthcare workers following South African HIV management guidelines. Participants with persistent viraemia ≥1000 copies/mL will be considered for switching to second-line ART. We will compare the proportion in each study arm who achieve the primary outcome of viral suppression <50 copies/mL at 24 weeks after enrolment. Additional outcomes include proportions retained in the study, proportions with HIV drug resistance, time to viral load results and time to switching to second-line ART. We will assess implementation of point-of-care viral load testing using process evaluation data, and through interviews and focus groups with healthcare workers.Ethics and dissemination University of Oxford Tropical Research Ethics Committee and the Biomedical Research Ethics Committee of the University of KwaZulu-Natal have approved the study. We will present results to stakeholders, and through conferences and open-access, peer-reviewed journals.Trial registration number PACTR202001785886049. |
| format | Article |
| id | doaj-art-d0bb4f8c700b4900afd6bf83416b0ce9 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2021-02-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-d0bb4f8c700b4900afd6bf83416b0ce92024-11-17T13:10:11ZengBMJ Publishing GroupBMJ Open2044-60552021-02-0111210.1136/bmjopen-2020-045373Protocol for a randomised feasibility study of Point-Of-care HIV viral load testing to Enhance Re-suppression in South Africa: the POwER studySarah Tonkin-Crine0Nigel Garrett1Jienchi Dorward2Hope Ngobese3Lara Lewis4Natasha Samsunder5Paul K Drain6Yukteshwar Sookrajh7Richard Lessells8Fathima Sayed9Elliot Bulo10P Moodley11NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford in Partnership with Public Health England, Oxford, UKCentre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa, Durban, South AfricaNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK7 Prince Cyril Zulu Communicable Disease Centre, eThekwini Municipality, Durban, South Africa4 Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South AfricaCentre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa, Durban, South AfricaDepartment of Epidemiology, University of Washington, Seattle, Washington, USAeThekwini Municipality Health Unit, Durban, South Africa9 KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), University of KwaZulu-Natal, Durban, South AfricaCentre for the AIDS Programme of Research in South Africa, Durban, KwaZulu-Natal, South AfricaeThekwini Municipality Health Unit, Durban, South AfricaDepartment of Virology, University of KwaZulu-Natal, Durban, South AfricaIntroduction Access to HIV viral load testing remains difficult for many people on antiretroviral therapy (ART) in low-income and middle-income countries. Weak laboratory and clinic systems often delay the detection and management of viraemia, which can lead to morbidity, drug resistance and HIV transmission. Point-of-care testing could overcome these challenges. We aim to assess whether it is feasible to conduct a randomised trial of point-of-care viral load testing to manage viraemia.Methods and analysis We will conduct an open-label, single-site, individually randomised, feasibility study of Point-Of-care HIV viral load testing to Enhance Re-suppression, in Durban, South Africa. We will enrol approximately 100 people living with HIV who are aged ≥18 years, receiving first-line ART but with recent viraemia ≥1000 copies/mL, and randomise them 1:1 to receive point-of-care viral load or standard laboratory viral load monitoring, after 12 weeks. All participants will continue to receive care from public sector healthcare workers following South African HIV management guidelines. Participants with persistent viraemia ≥1000 copies/mL will be considered for switching to second-line ART. We will compare the proportion in each study arm who achieve the primary outcome of viral suppression <50 copies/mL at 24 weeks after enrolment. Additional outcomes include proportions retained in the study, proportions with HIV drug resistance, time to viral load results and time to switching to second-line ART. We will assess implementation of point-of-care viral load testing using process evaluation data, and through interviews and focus groups with healthcare workers.Ethics and dissemination University of Oxford Tropical Research Ethics Committee and the Biomedical Research Ethics Committee of the University of KwaZulu-Natal have approved the study. We will present results to stakeholders, and through conferences and open-access, peer-reviewed journals.Trial registration number PACTR202001785886049.https://bmjopen.bmj.com/content/11/2/e045373.full |
| spellingShingle | Sarah Tonkin-Crine Nigel Garrett Jienchi Dorward Hope Ngobese Lara Lewis Natasha Samsunder Paul K Drain Yukteshwar Sookrajh Richard Lessells Fathima Sayed Elliot Bulo P Moodley Protocol for a randomised feasibility study of Point-Of-care HIV viral load testing to Enhance Re-suppression in South Africa: the POwER study BMJ Open |
| title | Protocol for a randomised feasibility study of Point-Of-care HIV viral load testing to Enhance Re-suppression in South Africa: the POwER study |
| title_full | Protocol for a randomised feasibility study of Point-Of-care HIV viral load testing to Enhance Re-suppression in South Africa: the POwER study |
| title_fullStr | Protocol for a randomised feasibility study of Point-Of-care HIV viral load testing to Enhance Re-suppression in South Africa: the POwER study |
| title_full_unstemmed | Protocol for a randomised feasibility study of Point-Of-care HIV viral load testing to Enhance Re-suppression in South Africa: the POwER study |
| title_short | Protocol for a randomised feasibility study of Point-Of-care HIV viral load testing to Enhance Re-suppression in South Africa: the POwER study |
| title_sort | protocol for a randomised feasibility study of point of care hiv viral load testing to enhance re suppression in south africa the power study |
| url | https://bmjopen.bmj.com/content/11/2/e045373.full |
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