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NCT03292432: TERA

Triggered Escalating Real-time Adherence (TERA) Intervention

Completed NA Results posted Last updated 11 March 2021
What this trial tests

NA trial testing TERA Intervention (TERA) in HIV Infections in 89 participants. Completed in 12 October 2020.

Timeline
12 April 2018
Primary endpoint
6 January 2020
12 October 2020

Quick facts

Lead sponsorUniversity of North Carolina, Chapel Hill
PhaseNA
StatusCompleted
Study typeINTERVENTIONAL
Allocationrandomized
Designparallel
Maskingnone
Primary purposesupportive care
Enrollment89
Start date12 April 2018
Primary completion6 January 2020
Estimated completion12 October 2020
Sites8 locations across United States

Drugs / interventions tested

Conditions studied

Sponsor

University of North Carolina, Chapel Hill

Who can join

Adults 13 to 24, any sex, with HIV Infections. Patients with the condition only — healthy volunteers not accepted.

Results — posted to ClinicalTrials.gov

Per-arm endpoint measurements with 95% confidence intervals where reported. Source: trial results section.

Percentage of Participants With Plasma Human Immunodeficiency Virus - Type I Ribonucleic Acid (HIV-1 RNA) Levels Less Than (<) 50 Copies/mL at Week 12 Primary · 12 weeks post enrollment

Participants with HIV-1 RNA \< 50 copies/mL within the week 12 window (+/- 14 days) are classified as successes. Participants with HIV-1 RNA \>= 50 copies/mL or with no HIV-1 RNA measurement within the week 12 window are classified as failures.

GroupValue95% CI
Standard of Care (SOC)24.4
TERA Intervention (TERA)20.9
Percentage of Participants With HIV-1 RNA < 200 Copies/mL at Week 12 Primary · 12 weeks post enrollment

Participants with HIV-1 RNA \< 200 copies/mL within the week 12 window (+/- 14 days) are classified as successes. Participants with HIV-1 RNA \>= 200 copies/mL or with no HIV-1 RNA measurement within the week 12 window are classified as failures.

GroupValue95% CI
Standard of Care (SOC)35.6
TERA Intervention (TERA)34.9
Percentage of Participants With HIV-1 RNA < 50 Copies/mL at Weeks 24, 36 and 48 Secondary · 24, 36 and 48 weeks post enrollment

Participants with HIV-1 RNA \< 50 copies/mL within each week window (+/- 28 days) are classified as successes. Participants with HIV-1 RNA \>= 50 copies/mL or who had the opportunity to reach the study visit week and with no HIV-1 RNA measurement within the week window are classified as failures.

Week 24
GroupValue95% CI
Standard of Care (SOC)36.4
TERA Intervention (TERA)23.3
Week 36
GroupValue95% CI
Standard of Care (SOC)15.6
TERA Intervention (TERA)19.4
Week 48
GroupValue95% CI
Standard of Care (SOC)24.0
TERA Intervention (TERA)27.6
Percentage of Participants With HIV-1 RNA < 200 Copies/mL at Weeks 24, 36 and 48 Secondary · 24, 36 and 48 weeks post enrollment

Participants with HIV-1 RNA \< 200 copies/mL within each week window (+/- 28 days) are classified as successes. Participants with HIV-1 RNA \>= 200 copies/mL or who had the opportunity to reach the study visit week and with no HIV-1 RNA measurement within the week window are classified as failures.

Week 24
GroupValue95% CI
Standard of Care (SOC)40.9
TERA Intervention (TERA)27.9
Week 36
GroupValue95% CI
Standard of Care (SOC)21.9
TERA Intervention (TERA)33.3
Week 48
GroupValue95% CI
Standard of Care (SOC)32.0
TERA Intervention (TERA)27.6
Percentage of Participants With HIV-1 RNA < 200 Copies/mL at 12 Weeks and Maintained Through 48 Weeks Secondary · 48 weeks post enrollment

Participants are classified as successes if both the week 12 (+/- 14 days) and week 48 (+/- 28 days) HIV-1 RNA measurements are \< 200 copies/mL and at least one of the week 24 (+/- 28 days) or week 36 (+/- 28 days) HIV-1 RNA measurements is \< 200 copies/mL. Otherwise, the participant is classified as a failure.

GroupValue95% CI
Standard of Care (SOC)8.0
TERA Intervention (TERA)13.8
Percentage of Days With Dose Taken From Weeks 0-12, >12-24, >24-36 and >36-48 Secondary · Enrollment through 48 weeks

For each participant and each 12-week period, the percentage is calculated as the number of days with dose taken divided by the number of days with data reported in the Electronic Monitoring Device (EDM).

Weeks 0 - 12
GroupValue95% CI
Standard of Care (SOC)41.020.5 – 59.0
TERA Intervention (TERA)72.146.5 – 89.2
Weeks >12 - 24
GroupValue95% CI
Standard of Care (SOC)14.31.2 – 32.1
TERA Intervention (TERA)40.510.7 – 70.2
Weeks >24 - 36
GroupValue95% CI
Standard of Care (SOC)2.40.0 – 14.3
TERA Intervention (TERA)17.22.3 – 40.5
Weeks >36 - 48
GroupValue95% CI
Standard of Care (SOC)1.20.0 – 7.4
TERA Intervention (TERA)1.20.0 – 30.0
Percentage of Days With Dose Taken Within Defined Acceptable Window (+/- 4 Hours) From Weeks 0-12, >12-24, >24-36 and >36-48 Secondary · Enrollment through 48 weeks

For each participant and each 12-week period, the percentage is calculated as the number of days with dose taken within acceptable window divided by the number of days with data reported in the EDM.

Weeks 0 - 12
GroupValue95% CI
Standard of Care (SOC)21.48.4 – 38.6
TERA Intervention (TERA)62.730.1 – 84.3
Weeks >12 - 24
GroupValue95% CI
Standard of Care (SOC)7.10.0 – 16.7
TERA Intervention (TERA)27.47.1 – 57.1
Weeks >24 - 36
GroupValue95% CI
Standard of Care (SOC)2.40.0 – 9.5
TERA Intervention (TERA)10.70.0 – 35.7
Weeks >36 - 48
GroupValue95% CI
Standard of Care (SOC)0.00.0 – 4.8
TERA Intervention (TERA)1.20.0 – 22.5
Incidence Rate of 7-day Gaps Between Dosing for Weeks 0-12, >12-24, >24-36 and >36-48 Secondary · Enrollment through 48 weeks

For each participant, the incidence rate during each 12 week interval is calculated as the ratio of the number of 7-day gaps between doses relative to the number of weeks with data reported, times 12. Consecutive gaps of more than 7 days increase the gap count by one, e.g., missing 20 days counts as 2 gaps.

Weeks 0 - 12
GroupValue95% CI
Standard of Care (SOC)4.173.61 – 4.82
TERA Intervention (TERA)1.661.31 – 2.11
Weeks >12 - 24
GroupValue95% CI
Standard of Care (SOC)6.916.16 – 7.75
TERA Intervention (TERA)4.433.81 – 5.15
Weeks >24 - 36
GroupValue95% CI
Standard of Care (SOC)8.197.28 – 9.21
TERA Intervention (TERA)6.655.84 – 7.57
Weeks >36 - 48
GroupValue95% CI
Standard of Care (SOC)9.548.37 – 10.89
TERA Intervention (TERA)8.817.76 – 10.00
Percentage of Participants With HIV-1 RNA < 200 Copies/mL at Week 48 Secondary · 48 weeks post enrollment

Participants with HIV-1 RNA \< 200 copies/mL at Week 48 are classified as successes. Participants with HIV-1 RNA \>= 200 copies/mL or with no HIV-1 RNA measurement after 44 weeks follow-up are classified as failures.

GroupValue95% CI
Standard of Care (SOC)23.3
TERA Intervention (TERA)25.6
Percentage of Participants With HIV-1 RNA < 200 Copies/mL at 12 Weeks and Maintained Through 48 Weeks Secondary · 12, 24, 36, and 48 weeks post enrollment

Participants are classified as successes if both the week 12 (+/- 14 days) and week 48 (+/- 28 days) HIV-1 RNA measurements are \< 200 copies/mL and at least one of the week 24 (+/- 28 days) or week 36 (+/- 28 days) HIV-1 RNA measurements is \< 200 copies/mL. Otherwise, the participant is classified as a failure.

GroupValue95% CI
Standard of Care (SOC)7.0
TERA Intervention (TERA)11.6

Adverse events — posted to ClinicalTrials.gov

Time frame: From study entry to study completion (approximately 48 weeks). Reporting threshold: 0%. Adverse-event reports describe events observed during the trial — not all are caused by the drug.

Standard of Care (SOC)
Serious: 3/45 (7%)
Deaths: 2/45
TERA Intervention (TERA)
Serious: 4/43 (9%)
Deaths: 1/43

Serious adverse events (10 terms)

ReactionSystemStandard of Care (SOC)TERA Intervention (TERA)
Cardiac eventCardiac disorders
Esophageal candidiasis and pelvic inflammatory diseaseInfections and infestations
Gunshot wound to headInjury, poisoning and procedural complications
Axillary abscessInfections and infestations
Pneumothorax acute recurrent with shortness of breath, hypoxia and hypokalemiaRespiratory, thoracic and mediastinal disorders
PneumothoraxRespiratory, thoracic and mediastinal disorders
HSV proctitisInfections and infestations
PneumoniaRespiratory, thoracic and mediastinal disorders
Facial cellulitis and MRSA positive wound of the tragusInfections and infestations
AIDSInfections and infestations
Other adverse events (1 terms — click to expand)

ReactionSystemStandard of Care (SOC)TERA Intervention (TERA)
Suicidal ideationPsychiatric disorders

Most-reported serious reactions: Cardiac event, Esophageal candidiasis and pelvic inflammatory disease, Gunshot wound to head, Axillary abscess, Pneumothorax acute recurrent with shortness of breath, hypoxia and hypokalemia, Pneumothorax, HSV proctitis, Pneumonia.

Data from ClinicalTrials.gov NCT03292432 adverse events section.

Sponsor's own description

Youth Living with HIV (YLWH) often face unique challenges achieving high and sustained rates of adherence to their antiretroviral therapy (ART). Poor adherence can lead to unsuppressed virus, more advanced HIV disease and poorer health outcomes, eventually exhausting treatment options. To date however, there are few demonstrated interventions for youth failing first line therapy. This study evaluated a novel intervention that used remote coaching through video enabled counseling sessions, an Electronic Dose Monitoring (EDM) pill bottle that notified an adherence coach when youth failed to open/close the device around dose time, and problem solving outreach by the coach in response to not dosing from the EDM. This intensive 'boot camp' strategy was implemented for 12 weeks followed by observation through 48 weeks.

Publications & conference data

7 peer-reviewed publications reference this trial (live from Europe PMC):

  1. Adherence Measurements in HIV: New Advancements in Pharmacologic Methods and Real-Time Monitoring.
    Castillo-Mancilla JR, Haberer JE. · · 2018 · cited 116× · PMID 29380227 · DOI 10.1007/s11904-018-0377-0
  2. Accuracy of measures for antiretroviral adherence in people living with HIV.
    Smith R, Villanueva G, Probyn K, Sguassero Y, et al · · 2022 · cited 34× · PMID 35871531 · DOI 10.1002/14651858.cd013080.pub2
  3. Antiretroviral adherence for adolescents growing up with HIV: understanding real life, drug delivery and forgiveness.
    Foster C, Ayers S, Fidler S. · · 2020 · cited 30× · PMID 32523693 · DOI 10.1177/2049936120920177
  4. Randomized Controlled Trial of a Remote Coaching mHealth Adherence Intervention in Youth Living with HIV.
    Amico KR, Lindsey JC, Hudgens M, Dallas R, et al · · 2022 · cited 24× · PMID 35670987 · DOI 10.1007/s10461-022-03717-2
  5. Triggered Escalating Real-Time Adherence Intervention to Promote Rapid HIV Viral Suppression Among Youth Living With HIV Failing Antiretroviral Therapy: Protocol for a Triggered Escalating Real-Time Adherence Intervention.
    Amico KR, Dunlap A, Dallas R, Lindsey J, et al · · 2019 · cited 12× · PMID 30882360 · DOI 10.2196/11416
  6. Correlates of High HIV Viral Load and Antiretroviral Therapy Adherence Among Viremic Youth in the United States Enrolled in an Adherence Improvement Intervention.
    Amico KR, Crawford J, Ubong I, Lindsey JC, et al · · 2021 · cited 9× · PMID 33960843 · DOI 10.1089/apc.2021.0005
  7. Electronic Dose Monitoring Device Patterns in Youth Living With HIV Enrolled in an Adherence Intervention Clinical Trial.
    Lindsey JC, Hudgens M, Gaur AH, Horvath KJ, et al · · 2023 · cited 1× · PMID 36730762 · DOI 10.1097/qai.0000000000003126

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