DRug Use & Infections in ViEtnam - Hepatitis C (DRIVE-C)

Sponsor

ANRS, Emerging Infectious Diseases (Other)

Overall Status

Completed

CT.gov ID

NCT03537196

Collaborator

(none)

979

Enrollment

Locations

Arms

24.6

Actual Duration (Months)

489.5

Patients Per Site

19.9

Patients Per Site Per Month

Study Details

Study Description

Brief Summary

The study aims to assess the effectiveness of a model of hepatitis C screening and integrated care, targeting people who inject drugs (PWIDs) in Hai Phong, Vietnam. In a wider perspective, this model linked to mass screening through repeated Respondent Driven Sampling (RDS) surveys, to simplified treatment protocol, and to large community-based support to improve referral to care, retention in care, adherence to treatment and prevention of reinfection, may have the potential to eliminate HCV among PWIDs in this city.

Condition or Disease	Intervention/Treatment	Phase
Hepatitis C Drug Use Viral Hepatitis C	Drug: Sofosbuvir 400 mg and Daclatasvir 60 mg Drug: Sofosbuvir 400 mg and Daclatasvir 90 mg Drug: Ribavirin Drug: Sofosbuvir and Daclatasvir for 24 weeks	Phase 4

Detailed Description

Objectives :

The primary objective of this study is to assess the effectiveness of a model of hepatitis C screening and integrated care targeting PWIDs in Hai Phong, Vietnam.

This model will encompass all steps involved in achieving HCV cure among PWIDs:

Mass detection of hepatitis C infection among PWIDs: in the community through a large community-based Respondent Driven Sampling survey (RDS); and in HIV out-patient clinics and methadone treatment centers where serological testing should have been made, but not HCV RNA to confirm hepatitis C infection.
a community-based support to improve referral to specific care for those with hepatitis C infection; iii) a HCV care system delivery integrated within the existing health system with a simplified treatment protocol taking into account PWIDs specificities such as frequent HIV co-infection and methadone treatment; iv) an optimized treatment adherence through a combination of health care therapeutic education and CBO support; v) an increase in harm reduction activities to encompass HCV risk transmission and to prevent HCV reinfection.

Secondary objectives are:

to assess all steps of the hepatitis C cascade of care (Hepatitis C infection diagnosis; HCV care enrolment; HCV treatment initiation; HCV treatment success);
to assess the occurrence of adverse events (death, morbidity) and drug-related side-effects;
to evaluate adherence to HCV treatment;
to determine factors associated with treatment failure defined by a positive HCV RNA 12 weeks after the end of HCV treatment;
to estimate the reinfection rate at the end of the study and to identify risk factors of HCV reinfection;
to project the impact and cost-effectiveness of the implemented HCV treatment intervention.

Study design : the effectiveness-implementation hybrid study type 1 design will simultaneously allow assessing the effectiveness of Direct-Acting Antivirals (DAA) care strategy among PWIDs in Vietnam, and the potential obstacles to widespread implementation.

The strategy of care includes a large community-based mass screening, a simplified treatment protocol based on a combination of DAAs, taking into account co-morbidities (addiction, HIV), physician training and important support of Community Based Organizations (CBO's) for linkage to care after screening, treatment adherence and prevention of reinfection after cure.

In addition, 2 others components are included in the study:

A modeling exercise to assess the impact of the intervention at the population level,
A cost-effectiveness analysis to further inform policy-makers.

Patients will be followed for 48 weeks after initiating HCV treatment. The estimated enrolment is 1050 participants.

Study population: people who currently inject drugs or who have recently started opioid substitution treatment.

Implementation: The study is linked to the NIDA RO1 DA041978 / ANRS 12353 DRIVE project. Participant recruitment will take place through DRIVE RDS survey and DRIVE cohort follow-up visit in two community sites managed by peer-groups in Hai Phong. All participants with positive HCV serology will be screened for hepatitis C and positive HCV RNA will be proposed for DAA treatment in 3 hospital-based HCV clinics. All participants will attend 9 study visits, comprising of clinical examination, blood collection for side effects and viral load assessment, therapeutic education, questionnaires on alcohol use, on sexual, drug use and other behaviors focusing on HCV infection risks or HCV reinfection risks and on quality of life, and harm reduction activities with the support of CBOs.

Study Design

Study Type:

Interventional

Actual Enrollment :

979 participants

Allocation:

Non-Randomized

Intervention Model:

Single Group Assignment

Intervention Model Description:

All patients with detectable HCV RNA, eligible for treatment, will receive Direct Acting Antiviral drugs.All patients with detectable HCV RNA, eligible for treatment, will receive Direct Acting Antiviral drugs.

Masking:

None (Open Label)

Primary Purpose:

Treatment

Official Title:

Towards HCV Elimination: Evaluation of an Integrated Model of HCV Care Targeting People Who Inject Drugs in Hai Phong, Vietnam

Actual Study Start Date :

Nov 13, 2018

Actual Primary Completion Date :

Nov 30, 2020

Actual Study Completion Date :

Nov 30, 2020

Arms and Interventions

Arm	Intervention/Treatment
Other: All patients All patients will receive sofosbuvir 400-mg and daclatasvir 60-mg (1 tablet each per day) during 12 weeks.	Drug: Sofosbuvir 400 mg and Daclatasvir 60 mg All patients will receive sofosbuvir 400-mg and daclatasvir 60-mg (1 tablet each per day) during 12 weeks.
Other: HIV/HCV co-infected patients For HIV/HCV co-infected patients receiving efavirenz or nevirapine, daclatasvir dose will be increased to 90-mg per day (sofosbuvir 400 mg and daclatasvir 90 mg)	Drug: Sofosbuvir 400 mg and Daclatasvir 90 mg For HIV/HCV co-infected patients receiving efavirenz or nevirapine, daclatasvir dose will be increased to 90-mg per day.
Other: Cirrhosis In case of cirrhosis : ribavirin will be added to sofosbuvir / daclatasvir 12 weeks	Drug: Ribavirin In case of cirrhosis: Ribavirin will be added to sofosbuvir/daclatasvir during the 12 weeks of treatment. The dose will be adapted to the patient weight although the vast majority of patients (weight < 75 kg) will receive 500 mg x 2/day. In case of ribavirin contra-indication or side effects leading to ribavirin discontinuation, sofosbuvir/daclatasvir will be used 24 weeks.
Other: Cirrhosis with ribavirin contra-indication In case of cirrhosis with ribavirin contra-indication : sofosbuvir and daclatasvir for 24 weeks	Drug: Sofosbuvir and Daclatasvir for 24 weeks In case of cirrhose and of ribavirin contra-indication or side effects leading to ribavirin discontinuation, sofosbuvir/daclatasvir will be used 24 weeks.

Outcome Measures

Primary Outcome Measures

Proportion of all patients in success of the model of care [Week 48]
Proportion of patients with HCV RNA < 15 IU/mL at the end of the study among patients who have signed the informed consent.

Secondary Outcome Measures

Proportion of patients with detectable HCV RNA [Screening pre-inclusion]
Proportion of patients with HCV RNA > 15 IU/mL among those with positive HCV Ab
Proportion of patients enrolled in care [Pre-inclusion visit]
Proportion of patients with HCV RNA > 15 IU/mL who attended the pre inclusion visit at HCV clinic among those with hepatitis C infection;
Proportion of patients initiating DAA treatment [Initiation treatment visit]
Proportion of patients who initiate the treatment among patients enrolled in care and eligible for treatment
Proportion of patients cured [Week 24]
Number of patients with HCV RNA < 15 IU/mL among those initiating the treatment eligible
Rate of reinfection [Week 48]
Number of patients with HCV RNA ≥ 15 IU/mL at the end of the study among cured patients
Rate of mortality [Week 48]
Rate of deaths among all participants with hepatitis C infection
Frequency, type and time to grade 3 or 4 adverse clinical or biological events. [Week 48]
All adverse events will be graded according to the ANRS adverse events grading table
Frequency, type and time to drug-related clinical or biological adverse reactions [Week 48]
All drug-related clinical or biological adverse reactions of grade 3 or 4 or leading to treatment interruption
Adherence assessment [Week 12]
Self-questionnaire on DAA drug intake and drug accountability for DAA
Factors associated with HCV treatment failure [Week 24]
Socio-demographic, co-infection, virological, adherence, behavioral, psychiatric disorders, intervention contact, recent incarceration, homelessness factors
Factors associated with HCV reinfection [Week 48]
Socio-demographic, co-infection, virological, adherence, behavioral, psychiatric disorders, intervention contact, recent incarceration, homelessness factors
Effect of the HCV treatment intervention [Week 48]
Estimation of the impact of the intervention on HCV infections and DALYs averted, QALYs saved, HCV incidence and prevalence as projected by the model under various scenarios
Incremental cost-effectiveness ratio (ICER) [Week 48]
Estimation of the mean ICER which will be compared against standard thresholds for intervention's being cost-effective in LMIC settings

Eligibility Criteria

Criteria

Ages Eligible for Study:

18 Years and Older

Sexes Eligible for Study:

All

Accepts Healthy Volunteers:

INCLUSION CRITERIA

Participants of the ANRS 12353/NIDA ROI DA 041978 DRIVE study (age > 18 years; positive urine test for heroin an/o methamphetamine & skin marks of injection ) who either participated to the DRIVE RDS3 survey, or to the HIV-positive and HIV-negative DRIVE cohorts;
Hepatitis C infection defined by a positive HCV RNA
Signed informed consent form

EXCLUSION CRITERIA

Severe associated diseases requiring specific treatment (including all specific AIDS defining illnesses, any severe sepsis, severe decompensated cirrhosis, suspicion of hepatocellular carcinoma);
Any condition which might, in the investigator's opinion, compromise the safety of the patient by participating in the study including very severe clinical condition;
Previous history of DAA use;
Contraindication for treatment with sofosbuvir or daclatasvir;
For women of childbearing potential i.e. women of childbearing age who are not menopausal, or permanently sterilized or not refraining from sexual activity:
Pregnancy and breastfeeding
Refusal to use a contraceptive method
Renal failure with creatinine clearance ≤ 30 milliliter per minute;
Person deprived of freedom by a judicial or administrative decision;
Person who plan to move out from Hai Phong in the next 12 months;
Person unable to understand the study;

Contacts and Locations

Locations

	Site	City	State	Country	Postal Code
1	Hai Phong University of Medicine and Pharmacy	Hai Phong		Vietnam
2	Viet Tiep Hospital	Hải Phòng		Vietnam

Sponsors and Collaborators

ANRS, Emerging Infectious Diseases

Investigators

Principal Investigator: KHUE M. PHAM, MD, PhD, Hai Phong University of Medicine and Pharmacy, Vietnam
Principal Investigator: DIDIER LAUREILLARD, MD, Nîmes University Hospital, France
Study Director: NICOLAS NAGOT, MD, PhD, Pathogenesis and Control of Chronic Infections (PCCI) UMR 1058 - INSERM, Univ Montpellier, EFS, Montpellier, France