A randomized trial to optimize HIV/TB care in South Africa: design of the Sizanani trial
1 Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA
2 Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
3 Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
4 Harvard Medical School, Boston, MA, USA
5 Harvard University Center for AIDS Research, Harvard University, Cambridge, MA, USA
6 McCord Hospital, Durban, South Africa
7 Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA
8 St. Mary’s Hospital, Mariannhill, Durban, South Africa
9 Division of General Pediatrics, Department of Medicine, Boston, Children’s Hospital, Boston, MA, USA
10 Department of Epidemiology and Biostatistics, Boston University School of Public Health, Boston, MA, USA
11 Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA
12 Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
13 Division of Rheumatology, Brigham and Women’s Hospital, Boston, MA, USA
14 Division of Infectious Disease, Brigham and Women’s Hospital, Boston, MA, USA
15 Department of Biostatistics, Boston University School of Public Health, Boston MA, USA
BMC Infectious Diseases 2013, 13:390 doi:10.1186/1471-2334-13-390Published: 26 August 2013
Despite increases in HIV testing, only a fraction of people newly diagnosed with HIV infection enter the care system and initiate antiretroviral therapy (ART) in South Africa. We report on the design and initial enrollment of a randomized trial of a health system navigator intervention to improve linkage to HIV care and TB treatment completion in Durban, South Africa.
We employed a multi-site randomized controlled trial design. Patients at 4 outpatient sites were enrolled prior to HIV testing. For all HIV-infected participants, routine TB screening with sputum for mycobacterial smear and culture were collected. HIV-infected participants were randomized to receive the health system navigator intervention or usual care. Participants in the navigator arm underwent a baseline interview using a strengths-based case management approach to assist in identifying barriers to entering care and devising solutions to best cope with perceived barriers. Over 4 months, participants in the navigator arm received scheduled phone and text messages. The primary outcome of the study is linkage and retention in care, assessed 9 months after enrollment. For ART-eligible participants without TB, the primary outcome is 3 months on ART as documented in the medical record; participants co-infected with TB are also eligible to meet the primary outcome of completion of 6 months of TB treatment, as documented by the TB clinic. Secondary outcomes include mortality, receipt of CD4 count and TB test results, and repeat CD4 counts for those not ART-eligible at baseline. We hypothesize that a health system navigator can help identify and positively affect modifiable patient factors, including self-efficacy and social support, that in turn can improve linkage to and retention in HIV and TB care.
We are currently evaluating the clinical impact of a novel health system navigator intervention to promote entry to and retention in HIV and TB care for people newly diagnosed with HIV. The details of this study protocol will inform clinicians, investigators, and policy makers of strategies to best support HIV-infected patients in resource-limited settings.
Clinicaltrials.gov. unique identifier: NCT01188941.