ThiPhiSA: New Pathways to Prevention From Community TB Screening in South Africa

Last updated: July 21, 2025
Sponsor: University of Washington
Overall Status: Active - Not Recruiting

Phase

N/A

Condition

Hiv

Lung Disease

Treatment

TB preventive therapy (TPT)

Clinic-link TPT

TB preventive therapy (TPT) - 3 months weekly isoniazid plus rifapentine (3HP)

Clinical Study ID

NCT06214910
STUDY00018448
1R21AI179276-01
  • Ages > 18
  • All Genders

Study Summary

This study will compare community-delivered, multi-month dispensing of tuberculosis preventive therapy (TPT) to standard-of-care clinic-based TPT delivery in a population of South African adults who are recommended to receive TB preventive therapy.

We hypothesize that persons receiving multi-month dispensing of TPT in the community will have a higher rate of TPT completion at 3 months than persons receiving TPT via standard of care with monthly clinic-based refills.

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • ≥18 years of age

  • Living in the study catchment area

  • Eligible for TPT according to South African National guidelines(5), i.e. are a)living with HIV or b) are a close contact of a person with TB disease (defined by aperson that resides in the same house as a person with TB), c) and in either case

  • Have screened negative for TB disease in the last 6 months, through TB TRIAGE+Trial, other household contact tracing, or other community TB screening

  • Negative TB screening at enrolment (if TB TRIAGE+ screening was more than 3 monthsago)

  • Willing and able to provide written or verbal consent

  • Participants whom have not received TPT in the last 12 months; this was confirmedverbally with participants during the enrolment process.

Exclusion

Exclusion Criteria:

  • Less than 18 years of age.

  • Pregnant or planning on pregnancy within next three months

  • Planning on moving or relocating from the area within the next three months

  • Positive for active TB

  • Currently on TB treatment

Study Design

Total Participants: 540
Treatment Group(s): 4
Primary Treatment: TB preventive therapy (TPT)
Phase:
Study Start date:
February 20, 2024
Estimated Completion Date:
December 31, 2026

Study Description

The research objective is to understand and overcome key barriers to tuberculosis preventive therapy (TPT) delivery and completion in South Africa in the setting of 3HP scale-up. (3HP: short-course TPT consisting of 3 months weekly isoniazid[H] plus rifapentine [P]). The study will investigate these factors through a trial comparing community-delivered TPT, to clinic-based TPT and qualitative research investigating barriers to TPT completion and exploring task-shifted TPT delivery.

Aim 1: To determine the effect of community-based initiation and delivery of TPT on TPT completion.

Hypothesis: Community-delivered TPT will be associated with higher initiation and completion of TPT than standard of care clinic-based TPT.

Approach: Persons eligible for TPT will be identified through the Triage+ TB study and other community-based TB screening activities. Eligible persons will be randomized at the household level to 1) Immediate initiation of TPT & full 12 weeks delivery at once, or 2) Immediate initiation of TPT, 2-week supply, and referral to clinic for TPT completion. TPT adherence and completion will be measured by a combination of self-report, pill count, and serum drug level indicators.

Aim 2: To determine factors associated with TPT initiation and completion in people eligible for TPT identified in community settings.

Hypothesis: People with HIV (PWH) will have better rates of initiation and completion of TPT than people without HIV.

Approach: Participant interviews and surveys at baseline and end-of-study will assess willingness to take TPT, barriers and facilitators for individuals, experience taking TPT, and experience of interactions in clinic settings. Focus groups will be purposively selected based on end-of-study survey responses to elicit factors determining patient experience.

Aim 3: To determine feasibility and acceptability of differentiated service delivery (DSD) approaches, including task-shifting, for TPT delivery and scale-up.

Hypothesis: DSD TPT will be feasible and acceptable. Approach: Participatory qualitative research, and implementation science approaches including workflow mapping will be used to assess clinician-level barriers and inefficiencies in providing clinic-based TPT. In-depth interviews and focus groups will be conducted with pharmacy assistants, nurses, clinic operational managers, and district program managers to assess acceptability. Clinic flow will be mapped to determine effect of task-shifted pharmacy assistant TPT delivery on workflow and patient experience in the clinic.

Connect with a study center

  • Human Sciences Research Council

    Sweetwaters, KwaZulu-Natal
    South Africa

    Site Not Available

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