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| ID | Type | Description | Link |
|---|---|---|---|
| R01MH090326 | U.S. NIH Grant/Contract | View source |
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| Name | Class |
|---|---|
| National Institutes of Health (NIH) | NIH |
| National Institute of Mental Health (NIMH) | NIH |
| McCord Hospital | UNKNOWN |
| St Mary's Hospital, London |
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The purpose of this study is to test the effects of a health system navigator intervention on rates of linkage to human immunodeficiency virus (HIV) and tuberculosis (TB) care among newly diagnosed HIV-infected outpatients in Durban, South Africa. Subjects will be approached in the outpatient department and enrolled prior to an HIV test. Subjects will then be randomized to the navigator arm or the standard of care arm. Subjects in the navigator arm will receive scheduled phone and short message service (SMS) contacts throughout the follow-up period to help guide them through the HIV and TB care pathways. The navigator will provide personalized support to help subjects overcome barriers they may face along the way.
This project is a randomized controlled trial of an intervention to improve linkage to HIV and TB care for South Africans undergoing HIV testing. Subjects undergoing HIV testing will be enrolled at three sites in the greater Durban area. These sites comprise two hospital-affiliated outpatient departments and primary health clinics served by a mobile health van. Routine TB screening, regardless of signs or symptoms, will be offered to all HIV-infected participants. HIV-infected participants will be randomized to determine whether they will be assigned to a health system navigator or will receive the current standard of care in Durban. Block randomization will be stratified by site and gender, with blocks of varying length.
The health system navigator will help patients identify barriers to entering care and devise solutions, optimize use of available resources, and serve as a trusted social supporter who is knowledgeable about the health care system but remains outside of it. The health system navigator will help subjects engage the HIV and TB care system through face-to-face contact, telephone conversations, and short messaging service SMS text reminders which are free for patients to receive. These phone contacts and SMS will follow a standardized protocol. We will evaluate the efficacy of the intervention, as measured by increased rates of antiretroviral therapy (ART) initiation and, for those with TB co-infection, TB treatment completion. We will also evaluate the cost and cost-effectiveness of this intervention.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Standard of Care | No Intervention | ||
| Assigned a Health System Navigator | Experimental |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Health System Navigator | Behavioral | Subjects will be enrolled prior to an HIV test. Following TB screening, HIV infected subjects will meet with the health systems navigator who will administer a brief strengths-based interview. During this interview the participant and navigator will identify barriers to HIV and/or TB care and the resources and strengths that will be most helpful in overcoming these barriers. The health system navigator will stay in contact with participants for the next 4 months using phone calls and SMS on a standardized schedule. During the phone contacts the health system navigator will assess where the participant is on the care pathway. If the participant has not completed a step in his/her HIV or TB care, the health system navigator will help the participant draw on strengths identified in the initial interview and overcome any obstacles hindering him/her from accessing care. |
| Measure | Description | Time Frame |
|---|---|---|
| Linkage and Retention in Care: ART-eligible Patients | For ART-eligible HIV-infected patients, 3 months on ART as documented by ART initiation date in the electronic medical record. | 9 Months after Enrollment |
| Linkage and Retention in Care: TB Patients | For patients co-infected with TB, 6 months of TB treatment as documented by a written discharge of treatment outcome from a TB clinic. | 9 Months after Enrollment |
| Linkage and Retention in Care: ART-eligible HIV/TB Co-infected Patients | For HIV and TB co-infected patients who are ART-eligible, completion of either the ART or TB treatment outcome will be considered successful completion of the Primary Outcome Measure. | 9 Months after Enrollment |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Ingrid V Bassett, MD, MPH | Massachusetts General Hospital | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| St. Mary's Hospital | Durban | KwaZulu-Natal | 3605 | South Africa | ||
| McCord Hospital |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 20023438 | Background | Bassett IV, Regan S, Chetty S, Giddy J, Uhler LM, Holst H, Ross D, Katz JN, Walensky RP, Freedberg KA, Losina E. Who starts antiretroviral therapy in Durban, South Africa?... not everyone who should. AIDS. 2010 Jan;24 Suppl 1(Suppl 1):S37-44. doi: 10.1097/01.aids.0000366081.91192.1c. | |
| 20209059 | Background | Losina E, Bassett IV, Giddy J, Chetty S, Regan S, Walensky RP, Ross D, Scott CA, Uhler LM, Katz JN, Holst H, Freedberg KA. The "ART" of linkage: pre-treatment loss to care after HIV diagnosis at two PEPFAR sites in Durban, South Africa. PLoS One. 2010 Mar 4;5(3):e9538. doi: 10.1371/journal.pone.0009538. |
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| OTHER |
| Brigham and Women's Hospital | OTHER |
| Children's Hospital Medical Center, Cincinnati | OTHER |
| Boston University | OTHER |
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| Durban |
| KwaZulu-Natal |
| 4001 |
| South Africa |
| Mariannridge Clinic | Durban | KwaZulu-Natal | South Africa |
| Tshelimnyama Clinic | Durban | KwaZulu-Natal | South Africa |
| 23383147 | Background | Drain PK, Losina E, Parker G, Giddy J, Ross D, Katz JN, Coleman SM, Bogart LM, Freedberg KA, Walensky RP, Bassett IV. Risk factors for late-stage HIV disease presentation at initial HIV diagnosis in Durban, South Africa. PLoS One. 2013;8(1):e55305. doi: 10.1371/journal.pone.0055305. Epub 2013 Jan 28. |
| 23626808 | Background | Regan S, Losina E, Chetty S, Giddy J, Walensky RP, Ross D, Holst H, Katz JN, Freedberg KA, Bassett IV. Factors associated with self-reported repeat HIV testing after a negative result in Durban, South Africa. PLoS One. 2013 Apr 23;8(4):e62362. doi: 10.1371/journal.pone.0062362. Print 2013. |
| 23972276 | Background | Bassett IV, Giddy J, Chaisson CE, Ross D, Bogart LM, Coleman SM, Govender T, Robine M, Erlwanger A, Freedberg KA, Katz JN, Walensky RP, Losina E. A randomized trial to optimize HIV/TB care in South Africa: design of the Sizanani trial. BMC Infect Dis. 2013 Aug 26;13:390. doi: 10.1186/1471-2334-13-390. |
| 27842535 | Background | Drain PK, Losina E, Coleman SM, Giddy J, Ross D, Katz JN, Bassett IV. Rapid urine lipoarabinomannan assay as a clinic-based screening test for active tuberculosis at HIV diagnosis. BMC Pulm Med. 2016 Nov 14;16(1):147. doi: 10.1186/s12890-016-0316-z. |
| 28060226 | Background | Bassett IV, Coleman SM, Giddy J, Bogart LM, Chaisson CE, Ross D, Flash MJ, Govender T, Walensky RP, Freedberg KA, Losina E. Barriers to Care and 1-Year Mortality Among Newly Diagnosed HIV-Infected People in Durban, South Africa. J Acquir Immune Defic Syndr. 2017 Apr 1;74(4):432-438. doi: 10.1097/QAI.0000000000001277. |
| 26213142 | Background | Drain PK, Losina E, Coleman SM, Bogart L, Giddy J, Ross D, Katz JN, Bassett IV. Social support and mental health among adults prior to HIV counseling and testing in Durban, South Africa. AIDS Care. 2015;27(10):1231-40. doi: 10.1080/09540121.2015.1046417. Epub 2015 Jul 25. |
| 25415288 | Background | Drain PK, Losina E, Coleman SM, Giddy J, Ross D, Katz JN, Bassett IV. Value of urine lipoarabinomannan grade and second test for optimizing clinic-based screening for HIV-associated pulmonary tuberculosis. J Acquir Immune Defic Syndr. 2015 Mar 1;68(3):274-80. doi: 10.1097/QAI.0000000000000436. |
| 24571362 | Background | Drain PK, Losina E, Coleman SM, Giddy J, Ross D, Katz JN, Walensky RP, Freedberg KA, Bassett IV. Diagnostic accuracy of a point-of-care urine test for tuberculosis screening among newly-diagnosed HIV-infected adults: a prospective, clinic-based study. BMC Infect Dis. 2014 Feb 26;14:110. doi: 10.1186/1471-2334-14-110. |
| 25314255 | Background | Cohen GM, Drain PK, Noubary F, Cloete C, Bassett IV. Diagnostic delays and clinical decision making with centralized Xpert MTB/RIF testing in Durban, South Africa. J Acquir Immune Defic Syndr. 2014 Nov 1;67(3):e88-93. doi: 10.1097/QAI.0000000000000309. |
| 27632145 | Result | Bassett IV, Coleman SM, Giddy J, Bogart LM, Chaisson CE, Ross D, Jacobsen MM, Robine M, Govender T, Freedberg KA, Katz JN, Walensky RP, Losina E. Sizanani: A Randomized Trial of Health System Navigators to Improve Linkage to HIV and TB Care in South Africa. J Acquir Immune Defic Syndr. 2016 Oct 1;73(2):154-60. doi: 10.1097/QAI.0000000000001025. |
| 33138630 | Derived | Bassett IV, Xu A, Giddy J, Bogart LM, Boulle A, Millham L, Losina E, Parker RA. Changing contextual factors from baseline to 9-months post-HIV diagnosis predict 5-year mortality in Durban, South Africa. AIDS Care. 2021 Dec;33(12):1543-1550. doi: 10.1080/09540121.2020.1837338. Epub 2020 Nov 2. |
| 32956380 | Derived | Platt L, Xu A, Giddy J, Bogart LM, Boulle A, Parker RA, Losina E, Bassett IV. Identifying and predicting longitudinal trajectories of care for people newly diagnosed with HIV in South Africa. PLoS One. 2020 Sep 21;15(9):e0238975. doi: 10.1371/journal.pone.0238975. eCollection 2020. |
| 30611192 | Derived | Bajema KL, Bassett IV, Coleman SM, Ross D, Freedberg KA, Wald A, Drain PK. Subclinical tuberculosis among adults with HIV: clinical features and outcomes in a South African cohort. BMC Infect Dis. 2019 Jan 5;19(1):14. doi: 10.1186/s12879-018-3614-7. |