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Safety and efficacy of Dolutegravir and EFV400 for pregnant and breastfeeding women - a randomized non-inferiority clinical trial

Project description

Better guidelines for HIV treatment during pregnancy

Treating HIV during pregnancy is vital to protect both mother and child, but evidence comparing commonly used first-line regimens in pregnant women is still limited. With this in mind, the PREGART project, Funded by the EU, is conducting a study in Ethiopia and Uganda. Specifically, researchers will check how well dolutegravir or a low dose of efavirenz (EFV 400 mg) works in mothers and their babies. Researchers will measure viral suppression at delivery, prevention of mother-to-child transmission, and overall pregnancy safety. The results will help shape World Health Organization and regional treatment guidelines for HIV in pregnancy. PREGART aims to improve care standards and expand safe treatment options for women worldwide.

Objective

PREGART is a multi-national Phase-4 randomized clinical trial aimed at identifying optimal antiretroviral treatment (ART) regimens by comparing the efficacy and safety of dolutegravir- versus low-dose efavirenz (EFV400mg-) based first-line cART regimens in 1156 HIV-infected pregnant women and infant pairs in Ethiopia and Uganda. The primary outcomes are undetectable viral load at delivery, prevention of mother-to-child transmission of HIV, and adverse pregnancy outcomes. The COVID-19 pandemic significantly hampered all trial activities, including patient enrollment, follow-up, regulatory approvals, and trial site initiation. All clinical trial activities were suspended to protect the safety of study participants (pregnant women and infants) following the stay-at-home orders during the initial wave (March - September 2020) and intermittently during the subsequent waves of COVID-19. Furthermore, the PREGART trial activity was affected by the civil war in northern Ethiopia (2021/22) and the Ebola disease outbreak in Uganda (2022/23). Efforts have been made to mitigate these challenges by opening new trial sites, adapting protocols, and utilizing decentralized trial approaches to increase the participant recruitment rate. To complete the PREGART clinical trial, we request another 36 months and 1.8 million euros to compensate for time and incurred financial loss due to the COVID-19 pandemic, the civil war in Ethiopia, and the Ebola outbreak in Uganda. Completion of clinical trial activities and data analysis will fulfill our obligation to protect the scientific quality and data integrity, ensuring our commitments to study participants and meet PREGART trial objectives - to provide comprehensive and statistically powered evidence for policymakers on the maternal and infant safety and efficacy of dolutegravir and EFV 400mg containing cART. The study will contribute towards optimizing WHO and regional ART guidelines for HIV-infected pregnant and breastfeeding women.

Fields of science (EuroSciVoc)

Keywords

Programme(s)

Topic(s)

Funding Scheme

HORIZON-JU-RIA - HORIZON JU Research and Innovation Actions

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Call for proposal

(opens in new window) HORIZON-JU-GH-EDCTP3-2023-01

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Coordinator

KAROLINSKA INSTITUTET
Net EU contribution
€ 500 000,00
Address
NOBELS VAG 5
171 77 STOCKHOLM
Sweden
Region
Östra Sverige Stockholm Stockholms län
Activity type
Higher or Secondary Education Establishments
Links
Total cost
€ 500 000,00

Participants (3)