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Kitonsa J, Kamacooko O, Ruzagira E, Nambaziira F, Abaasa A, Serwanga J, Gombe B, Lunkuse J, Naluyinda H, Tukamwesiga N, Namata T, Kigozi A, Kafeero P, Basajja V, Joseph S, Pierce BF, Shattock R, Kaleebu P. A phase I COVID-19 vaccine trial among SARS-CoV-2 seronegative and seropositive individuals in Uganda utilizing a self-amplifying RNA vaccine platform: Screening and enrollment experiences. Hum Vaccin Immunother 2023; 19:2240690. [PMID: 37553178 PMCID: PMC10411305 DOI: 10.1080/21645515.2023.2240690] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/08/2023] [Accepted: 07/20/2023] [Indexed: 08/10/2023] Open
Abstract
We report the screening and enrollment process for a phase I vaccine trial in Masaka, Uganda that investigated the safety and immunogenicity of a self-amplifying SARS-CoV-2 RNA vaccine amongst individuals with and without antibodies to SARS-CoV-2. Participant screening and enrollment were conducted between December 2021 and April 2022. Individuals were eligible if they were aged between 18 and 45 years, healthy, and never vaccinated against COVID-19. SARS-CoV-2 antibody status was determined using two point-of-care rapid tests, i.e. Multi G (MGFT3) and Standard Q (Standard Q COVID-19 IgM/IgG Plus). Data were entered and managed in OpenClinica. Analyses were performed and presented descriptively. A total of 212 individuals were screened and 43(20.3%) enrolled. The most common reasons for exclusion were ≥ grade 1 laboratory abnormalities (39, 18.4%), followed by discordant SARS-CoV-2 antibody results (23, 10.9%). While the first 38 participants were quickly enrolled over a period of 9 weeks, it took another 9 weeks to enroll the remaining five, as antibody negative participants became scarce during the surge of the Omicron variant. The SARS-CoV-2 antibody positivity rate was determined to be 60.8% and 84.4% in each half of the 18 months of screening respectively. The mean age (±Standard Deviation, SD) of screened and enrolled participants was 27.7 (±8.1) and 30.2 (±8.3) years respectively. We demonstrated that it is feasible to successfully screen and enroll participants for COVID-19 vaccine trials in Uganda in the time of a pandemic. Our experiences may be useful for investigators planning to undertake similar work in Africa.
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Affiliation(s)
- Jonathan Kitonsa
- Medical Research Council/Uganda Virus Research Institute, London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Onesmus Kamacooko
- Medical Research Council/Uganda Virus Research Institute, London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Eugene Ruzagira
- Medical Research Council/Uganda Virus Research Institute, London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Florence Nambaziira
- Medical Research Council/Uganda Virus Research Institute, London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Andrew Abaasa
- Medical Research Council/Uganda Virus Research Institute, London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Jennifer Serwanga
- Medical Research Council/Uganda Virus Research Institute, London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Ben Gombe
- Medical Research Council/Uganda Virus Research Institute, London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Jane Lunkuse
- Medical Research Council/Uganda Virus Research Institute, London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Hadijah Naluyinda
- Medical Research Council/Uganda Virus Research Institute, London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Naboth Tukamwesiga
- Medical Research Council/Uganda Virus Research Institute, London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Tamara Namata
- Medical Research Council/Uganda Virus Research Institute, London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Antony Kigozi
- Medical Research Council/Uganda Virus Research Institute, London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Paddy Kafeero
- Medical Research Council/Uganda Virus Research Institute, London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Vincent Basajja
- Medical Research Council/Uganda Virus Research Institute, London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Sarah Joseph
- Department of Infectious Disease, Imperial College London, London, UK
| | | | - Robin Shattock
- Department of Infectious Disease, Imperial College London, London, UK
| | - Pontiano Kaleebu
- Medical Research Council/Uganda Virus Research Institute, London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
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Kamacooko O, Kitonsa J, Bahemuka UM, Kibengo FM, Wajja A, Basajja V, Lumala A, Kakande A, Kafeero P, Ssemwanga E, Asaba R, Mugisha J, Pierce BF, Shattock RJ, Kaleebu P, Ruzagira E. Knowledge, Attitudes, and Practices Regarding COVID-19 among Healthcare Workers in Uganda: A Cross-Sectional Survey. Int J Environ Res Public Health 2021; 18:7004. [PMID: 34208959 PMCID: PMC8297128 DOI: 10.3390/ijerph18137004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/23/2021] [Accepted: 06/24/2021] [Indexed: 01/12/2023]
Abstract
Healthcare workers (HCWs) are at high risk of COVID-19. However, data on HCWs' knowledge, attitudes, and practices (KAP) toward COVID-19 are limited. Between September and November 2020, we conducted a questionnaire-based COVID-19 KAP survey among HCWs at three hospitals in Uganda. We used Bloom's cut-off of ≥80% to determine sufficient knowledge, good attitude, and good practice, and multivariate Poisson regression with robust variance for statistical analysis. Of 717 HCWs invited to participate, 657 (91.6%) agreed and were enrolled. The mean age (standard deviation) of enrollees was 33.2 (10.2) years; most were clinical HCWs (64.7%) and had advanced secondary school/other higher-level education (57.8%). Overall, 83.9% had sufficient knowledge, 78.4% had a positive attitude, and 37.0% had good practices toward COVID-19. Factors associated with KAP were: Knowledge: being a clinical HCW (aRR: 1.12; 95% CI: 1.02-1.23) and previous participation in health research (aRR: 1.10; 95% CI: 1.04-1.17); Attitude: age > 35 years (aRR: 0.88; 95% CI: 0.79-0.98); Practice: being a clinical HCW (aRR: 1.91; 95% CI: 1.41-2.59). HCWs in Uganda have good knowledge and positive attitude but poor practices towards COVID-19. Differences in COVID-19 KAP between clinical and non-clinical HCWs could affect uptake of COVID-19 interventions including vaccination.
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Affiliation(s)
- Onesmus Kamacooko
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda; (J.K.); (U.M.B.); (F.M.K.); (A.W.); (V.B.); (A.K.); (P.K.); (J.M.); (P.K.); (E.R.)
| | - Jonathan Kitonsa
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda; (J.K.); (U.M.B.); (F.M.K.); (A.W.); (V.B.); (A.K.); (P.K.); (J.M.); (P.K.); (E.R.)
| | - Ubaldo M. Bahemuka
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda; (J.K.); (U.M.B.); (F.M.K.); (A.W.); (V.B.); (A.K.); (P.K.); (J.M.); (P.K.); (E.R.)
| | - Freddie M. Kibengo
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda; (J.K.); (U.M.B.); (F.M.K.); (A.W.); (V.B.); (A.K.); (P.K.); (J.M.); (P.K.); (E.R.)
| | - Anne Wajja
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda; (J.K.); (U.M.B.); (F.M.K.); (A.W.); (V.B.); (A.K.); (P.K.); (J.M.); (P.K.); (E.R.)
| | - Vincent Basajja
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda; (J.K.); (U.M.B.); (F.M.K.); (A.W.); (V.B.); (A.K.); (P.K.); (J.M.); (P.K.); (E.R.)
| | | | - Ayoub Kakande
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda; (J.K.); (U.M.B.); (F.M.K.); (A.W.); (V.B.); (A.K.); (P.K.); (J.M.); (P.K.); (E.R.)
| | - Paddy Kafeero
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda; (J.K.); (U.M.B.); (F.M.K.); (A.W.); (V.B.); (A.K.); (P.K.); (J.M.); (P.K.); (E.R.)
| | | | - Robert Asaba
- Our Lady of Consolata Kisubi Hospital, Entebbe P.O. Box 40, Uganda;
| | - Joseph Mugisha
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda; (J.K.); (U.M.B.); (F.M.K.); (A.W.); (V.B.); (A.K.); (P.K.); (J.M.); (P.K.); (E.R.)
| | - Benjamin F. Pierce
- Department of Infectious Disease, Imperial College London, Norfolk Place, London W2 1PG, UK; (B.F.P.); (R.J.S.)
| | - Robin J. Shattock
- Department of Infectious Disease, Imperial College London, Norfolk Place, London W2 1PG, UK; (B.F.P.); (R.J.S.)
| | - Pontiano Kaleebu
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda; (J.K.); (U.M.B.); (F.M.K.); (A.W.); (V.B.); (A.K.); (P.K.); (J.M.); (P.K.); (E.R.)
| | - Eugene Ruzagira
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe P.O. Box 49, Uganda; (J.K.); (U.M.B.); (F.M.K.); (A.W.); (V.B.); (A.K.); (P.K.); (J.M.); (P.K.); (E.R.)
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Kitonsa J, Kamacooko O, Bahemuka UM, Kibengo F, Kakande A, Wajja A, Basajja V, Lumala A, Ssemwanga E, Asaba R, Mugisha J, Pierce BF, Shattock R, Kaleebu P, Ruzagira E. Willingness to participate in COVID-19 vaccine trials; a survey among a population of healthcare workers in Uganda. PLoS One 2021; 16:e0251992. [PMID: 34043693 PMCID: PMC8158909 DOI: 10.1371/journal.pone.0251992] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/07/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Healthcare workers (HCWs) are at high risk of acquiring SARS-CoV-2 and COVID-19 and may therefore be a suitable population for COVID-19 vaccine trials. We conducted a survey to evaluate willingness-to-participate in COVID-19 vaccine trials in a population of HCWs at three hospitals in Uganda. METHODS The survey was conducted between September and November 2020. Using a standardised questionnaire, data were collected on socio-demographics, previous participation in health research, COVID-19 information sources, underlying health conditions, and willingness-to-participate in COVID-19 vaccine trials. Data were analysed descriptively and a binomial generalised linear model with a log link function used to investigate factors associated with unwillingness to participate. RESULTS 657 HCWs (female, 63%) were enrolled with a mean age of 33 years (Standard Deviation, 10). Overall willingness-to-participate was 70.2%. Key motivating factors for participation were: hope of being protected against COVID-19 (81.1%), altruism (73.3%), and the opportunity to get health care (26.0%). Selected hypothetical trial attributes reduced willingness-to-participate as follows: weekly-quarterly study visits over a 12-month period (70.2%-63.2%, P = 0.026); provision of approximately 50ml of blood at each study visit (70.2%-63.2%, P = 0.026); risk of mild-moderate local adverse reactions (70.2%-60.3%, P<0.001); chance of receiving candidate vaccine or placebo (70.2%-56.9%, P<0.001); and delay of pregnancy [Overall, 70.2%-57.1% P<0.001); Female, 62.8%-48.4% (P = 0.002); Male, 82.5%-71.5% (P = 0.003)]. Collectively, these attributes reduced willingness-to-participate from [70.2%-42.2% (P<0.001) overall; 82.5%-58.1% (P<0.001) in men; 62.8%-32.6% (P<0.001) in women]. Among individuals that were unwilling to participate, the commonest barriers were concerns over vaccine safety (54.6%) and fear of catching SARS-CoV-2 (31.6%). Unwillingness to participate was associated with being female (aRR 1.97, CI 1.46-2.67, P<0.001) and having university or other higher-level education (aRR 1.52, CI 1.05-2.2, P = 0.026). CONCLUSIONS Willingness-to-participate in COVID-19 vaccine trials among HCWs in Uganda is high but may be affected by vaccine trial requirements and concerns about the safety of candidate vaccines.
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Affiliation(s)
- Jonathan Kitonsa
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Onesmus Kamacooko
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Ubaldo Mushabe Bahemuka
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Freddie Kibengo
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Ayoub Kakande
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Anne Wajja
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Vincent Basajja
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | | | | | - Robert Asaba
- Our Lady of Consolata Kisubi Hospital, Wakiso District, Uganda
| | - Joseph Mugisha
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Benjamin F. Pierce
- Department of Infectious Disease, Imperial College London, Norfolk Place, London, United Kingdom
| | - Robin Shattock
- Department of Infectious Disease, Imperial College London, Norfolk Place, London, United Kingdom
| | - Pontiano Kaleebu
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Eugene Ruzagira
- Medical Research Council / Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
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Kitonsa J, Ggayi AB, Anywaine Z, Kisaakye E, Nsangi L, Basajja V, Nyantaro M, Watson-Jones D, Shukarev G, Ilsbroux I, Robinson C, Kaleebu P. Implementation of accelerated research: strategies for implementation as applied in a phase 1 Ad26.ZEBOV, MVA-BN-Filo two-dose Ebola vaccine clinical trial in Uganda. Glob Health Action 2021; 13:1829829. [PMID: 33073737 PMCID: PMC7594841 DOI: 10.1080/16549716.2020.1829829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background The 2013–2016 Ebola epidemic in West Africa is the worst ever caused by Ebolaviruses with over 28,000 human cases and 11,325 deaths. The World Health Organisation (WHO) declared the epidemic a public health crisis that required accelerated development of novel interventions including vaccines. The Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit (MRC/UVRI & LSHTM Uganda Research Unit) was among the African research sites that implemented the VAC52150EBL1004 Ebola vaccine trial. Objective We report on the strategies utilised by the Unit and sponsor in ensuring expedited clinical trial approval and accelerated conduct. Methods Janssen Vaccines and Prevention B.V. conducted a phase 1 trial to evaluate the safety, tolerability, and immunogenicity of heterologous two-dose vaccination regimens using Ad26.ZEBOV and MVA-BN-Filo, in healthy adults in Africa. Accelerated implementation strategies are hereby presented. Results Strategies included: holding the African Vaccine Regulatory Forum (AVAREF) joint review meeting; expedited review by institutional ethics and country-specific regulatory bodies; competitive recruitment between sites; electronic data capture (EDC); frequent study monitoring schedule; involvement of a community advisory board (CAB); and utilization of a ‘phased’ study information-sharing approach in community engagement and participant recruitment. These strategies enabled the site to acquire approvals within 2 months and enrol 47 participants within a spurn of five. The same milestone is usually acquired in at least 1 year without accelerated implementation. Conclusion The use of well-thought strategies by sponsors and research sites can enable the implementation of accelerated research. We recommend the use of similar strategies in other settings.
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Affiliation(s)
- Jonathan Kitonsa
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit , Entebbe, Uganda
| | - Abu-Baker Ggayi
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit , Entebbe, Uganda
| | - Zacchaeus Anywaine
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit , Entebbe, Uganda
| | - Eva Kisaakye
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit , Entebbe, Uganda
| | - Laura Nsangi
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit , Entebbe, Uganda
| | - Vincent Basajja
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit , Entebbe, Uganda
| | - Mary Nyantaro
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit , Entebbe, Uganda
| | | | - Georgi Shukarev
- Janssen Vaccines and Prevention B.V., Clinical Development , Leiden, The Netherlands
| | - Ine Ilsbroux
- Janssen Research & Development, Portfolio Delivery Operations, Global Development , Beerse, Belgium
| | - Cynthia Robinson
- Janssen Vaccines and Prevention B.V., Clinical Development , Leiden, The Netherlands
| | - Pontiano Kaleebu
- Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit , Entebbe, Uganda
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Joseph S, Kaleebu P, Ruzagira E, Hansen CH, Seeley J, Basajja V, Weber J, Fox J, Kingsley C, Aboud S, Lyamuya E, Maganga L, Pamba D, Ramjee G, Yssel J, Viegas E, Jani I, Priddy F, Nilsson C, Kroidl A, Pantaleo G, Robb M, Crook A, Dunne D, Mccormack S. OC 8491 PREPVACC: A PHASE III, MAMS ADAPTIVE PROPHYLACTIC HIV VACCINE TRIAL WITH A SECOND RANDOMISATION TO COMPARE F/TAF WITH TDF/FTC PREP. BMJ Glob Health 2019. [DOI: 10.1136/bmjgh-2019-edc.23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BackgroundThere remains an urgent need for a prophylactic HIV vaccine to control generalised epidemics. PrEP has demonstrated effectiveness of 86% and is recommended by WHO; uptake is generally high, but retention is disappointing in some settings. The EDCTP2 project PrEPVacc will assess the efficacy of two combination prophylactic vaccine regimens (DNA, MVA and Env protein/adjuvant) each compared to placebo and the proportion of infections averted by F/TAF in comparison to TDF/FTC. A Registration Cohort, recruiting HIV negative volunteers at risk of HIV will precede the trial.MethodsThe PrEPVacc partnership agreed that 70% vaccine efficacy had public health relevance. The trial uses nstage software for multi-arm, multi-stage designs (MAMS) and the averted infections ratio (AIR) methodology with participants randomised (i) 1:1:1 to active product or placebo (ii) 1:1 to TDF/FTC : F/TAF until week 26 (presumed peak immunogenicity). Access to PrEP in the Registration Cohort and after week 26 will be standard of care. HIV seroconversions occurring between weeks 0–26 will inform the PrEP analysis, incorporating HIV incidence amongst those who do not take up PrEP locally in the Registration Cohort. Seroconversions after week 26 will inform vaccine analyses.ResultsUp to 556 participants per group affords 92% power to detect vaccine efficacy of 70% at the final analysis, assuming incidence of 4/100-person years and 10% loss with 81% and 97% power to conclude that F/TAF can avert half or more of the infections prevented by TDF/FTC if effectiveness of TDF/FTC is 70% and 80%, respectively.ConclusionPrEPVacc adopts a pragmatic approach to uncertainties around HIV incidence in settings where PrEP is increasingly available. This innovative adaptive trial design uses validated software to determine vaccine efficacy and a novel methodology to evaluate a new PrEP agent, overcoming the challenge of demonstrating non-inferiority when adherence to TDF/FTC is high and the number of outcome events very low.
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Terris-Prestholt F, Kumaranayake L, Foster S, Kamali A, Kinsman J, Basajja V, Nalweyso N, Quigley M, Kengeya-Kayondo J, Whitworth J. The role of community acceptance over time for costs of HIV and STI prevention interventions: analysis of the Masaka Intervention Trial, Uganda, 1996-1999. Sex Transm Dis 2006; 33:S111-6. [PMID: 16505738 DOI: 10.1097/01.olq.0000175389.10289.ba] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study is to estimate the annual costs of information, education, and communication (IEC), both community- and school-based; strengthened public and private sexually transmitted infections treatment; condom social marketing (CSM); and voluntary counseling and testing (VCT) implemented in Masaka, Uganda, over 4 years, and to explore how unit costs change with varying population use/uptake. STUDY Total economic provider's costs and intervention outputs were collected annually to estimate annual unit costs between 1996 and 1999. RESULTS In early intervention years, uptake of all activities grew dramatically and continued to grow for public STI treatment, CSM, and VCT. Attendance at IEC performances started to drop in year 4. Unit costs dropped rapidly with increasing uptake of and participation in interventions. CONCLUSIONS When implementing long-term community-based interventions, it is important to take into account that it takes time for communities to scale up their participation, since this can lead to large variations in unit costs.
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Kinsman J, Kamali A, Kanyesigye E, Kamulegeya I, Basajja V, Nakiyingi J, Schenk K, Whitworth J. Quantitative process evaluation of a community-based HIV/AIDS behavioural intervention in rural Uganda. Health Educ Res 2002; 17:253-265. [PMID: 12036239 DOI: 10.1093/her/17.2.253] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This paper describes the implementation of a large community-based HIV/AIDS behavioural intervention in rural Uganda and presents 4 years' worth of quantitative process data. The intervention involved 560 field-based workers (57% male, 76% subsistence farmers, mean age 35 years), supervised by six central staff. Intervention channels included drama and video shows, Community Educators (CEs), as well as leaflet and condom distribution. Activities focused on one or more of 16 key topics. In total, 392 000 attendances (51% female) were recorded--a mean of over 6 for each of the 64 000 target adults--at 81 000 activities, with CEs attracting 71% of the total attendance; 164 000 leaflets and 242 000 condoms were also distributed. The annual cost of the intervention per target individual was approximately US$1.76. Our voluntary workforce experienced an annual attrition rate of 11%, with 'stable' workers more likely to be older, married or opinion leaders in their community than those who dropped out. We calculate that even a significant increase in the proportion of female field workers would have made little difference either to the sex ratio of attendees or to overall attendance. In spite of some initial resistance to the intervention, particularly in relation to condoms, we have demonstrated that people in rural Africa can accept and actively participate in the dissemination of HIV/AIDS prevention messages throughout their own communities.
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Affiliation(s)
- J Kinsman
- MRC Programme on AIDS, Uganda Virus Research Institute, Entebbe
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