HIV InfectionsPhase 3NCT00203749
Community Mobilization, Mobile Testing, Same-Day Results, and Post-Test Support for HIV in Sub-Saharan Africa and Thailand
A Phase 3 study testing Community-Based HIV VCT and Standard clinic-based VCT in people with HIV Infections, run by University of California, Los Angeles at 5 sites in 4 countries.
Trial summary
This study will evaluate the effectiveness of a combination of clinic- and community-based voluntary counseling and testing programs in preventing HIV in African and Thai communities. Read more about this study
- Who is it for?
- Ages 16 years and olderHealthy volunteers can take part
- Conditions the study is for
- HIV Infections
- What is being tested?
- Community-Based HIV VCT and Standard clinic-based VCT
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 192,814 participants
- Where
- 5 sitesin 4 countries
- Study dates
- Dec 2004to Sep 2011
- Phase
- Phase 3
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 16 years and older
- All sexes
- Healthy volunteers accepted
- Child, Adult, Older adult
Who may be able to join
- Baseline Assessment:
- Persons may be included in the baseline behavioral assessment if they meet all of the following criteria:
- Reside in a community selected for the study
- Are randomly selected and invited to participate from households that are themselves randomly selected and invited to participate
- Aged 18-32 years
- Has lived in the community at least 4 months in the past year
Show all 34Show fewer
- Sleeps regularly in their household at least 2 nights per week
- Able and willing to provide verbal informed consent
- Qualitative Cohort:
- Persons may be included in the qualitative cohort if they meet all of the following criteria:
- Participated in the baseline behavioral assessment
- Aged 18-32 years at enrollment
- Have not been away from the community for more than two months at a time in the last two years
- Able and willing to provide written informed consent
- Intervention:
- Persons may access community-based counseling and testing (in CBVCT communities) through the study if they meet all of the following criteria:
- >16 years of age
- Able and willing to provide verbal informed consent
- Persons may access post-test support through the study if they meet all of the following criteria:
- >16 years of age
- Able and willing to provide verbal informed consent
- Proof of having been tested for HIV at a Project Accept CBVCT venue, irrespective of test result
- Control:
- Persons may access standard clinic-based counseling and testing (in both SVCT and CBVCT communities) through the study if they meet all of the following criteria:
- >16 years of age
- Able and willing to provide verbal informed consent
- Post-Intervention Assessment:
- Persons may be included in the post-intervention assessment if they meet all of the following criteria:
- Reside in a community selected for the study
- Are randomly selected to be offered to participate from households that are themselves randomly selected to be offered to participate
- Aged 18-32 years
- Has lived in the community at least 4 months in the past year
- Sleeps regularly in their household at least 2 nights per week
- Able and willing to provide informed consent (written for biological assessment; verbal for behavioral assessment)
Who cannot join
- Baseline Assessment:
- Persons will be excluded from the baseline behavioral assessment if they meet any of the following criteria:
- Are not a member of the study community or are not randomly selected to be offered to participate
- Are below 18 or above 32 years of age
- Has not lived in the community at least 4 months in the past year
- Does not sleep regularly in their household at least 2 nights per week
Show all 31Show fewer
- Have an obvious psychological/psychiatric disorder that would invalidate the informed consent process or otherwise contraindicate participation in the assessment
- Qualitative Cohort:
- Persons will be excluded from the qualitative cohort if they meet any of the following criteria:
- Not a participant in the baseline behavioral assessment
- Less than 18 or greater than 32 years of age at enrollment
- Have been away from the community for more than two months at a time in the last two years
- Demonstrate signs of being visibly distraught, emotionally unstable, or under the influence of psychoactive agents that would invalidate the consent process or otherwise contraindicate participation in the qualitative assessment
- Have concrete plans to leave the community, thus removing possibility of follow up
- Intervention:
- Persons will be excluded from accessing counseling and testing (CBVCT) through the study (and will be referred to existing alternate services) if they meet any of the following criteria:
- <16 years of age
- Have an obvious psychological/psychiatric disorder that would invalidate the informed consent process or otherwise contraindicate participation
- Persons will be excluded from accessing post-test support through the study (and will be referred to existing alternate services) if they meet any of the following criteria:
- <16 years of age
- Have an obvious psychological/psychiatric disorder that would invalidate the informed consent process or otherwise contraindicate participation
- Control:
- <16 years of age
- Have an obvious psychological/psychiatric disorder that would invalidate the informed consent process or otherwise contraindicate participation
- Post-Intervention Assessment:
- Persons will be excluded from the post-intervention assessment if they meet any of the following criteria:
- Are not a member of the study community or are not randomly selected to be offered to participate
- Are below 18 or above 32 years of age
- Has not lived in the community at least 4 months in the past year
- Does not sleep regularly in their household at least 2 nights per week
- Have an obvious psychological/psychiatric disorder that would invalidate the informed consent process or otherwise contraindicate participation in the assessment
Trial locations and contacts
5 sites in 4 countries.
5 sites in 4 countries
South Africa2 sites
Human Sciences Research Council
Pietermaritzburg, KwaZulu-Natal
University of the Witwatersrand
Soweto, Johannesburg, Gauteng
About this study
Official title: NIMH Project Accept: A Phase III Randomized Controlled Trial of Community Mobilization, Mobile Testing, Same-Day Results, and Post-Test Support for HIV in Sub-Saharan Africa and Thailand
This study will evaluate the effectiveness of a combination of clinic- and community-based voluntary counseling and testing programs in preventing HIV in African and Thai communities.
Read the detailed description
NIMH Project Accept is an HIV prevention trial in which 48 communities (10 in Tanzania [Kisarawe], 8 in Zimbabwe [Mutoko], 8 in South Africa/Vulindlela, 8 in South Africa/Soweto and 14 in Thailand [Chiang Mai]) are being randomized to receive either a community-based HIV voluntary counseling and testing (CBVCT) intervention plus standard clinic-based VCT (SVCT), or SVCT alone. The CBVCT intervention has three major strategies: (1) to make VCT more available in community settings; (2) to engage the community through outreach; and (3) to provide post-test support. These strategies are designed to change community norms and reduce risk for HIV infection among all community members, irrespective of whether they participated directly in the intervention.
A community-level intervention based on modifying community norms can change the environmental context in which people make decisions about HIV risk, and has the potential to alter the course of the HIV epidemic in developing countries. This is the first international randomized controlled Phase III trial to determine the efficacy of a behavioral/social science intervention with an HIV incidence endpoint.
- Conditions
- HIV Infections
- Being tested
- Community-Based HIV VCT, Standard clinic-based VCT
- Keywords
- HIV, Testing, Counseling
- Medical subject headings
- HIV Infections
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Community-Based HIV VCTBehavioural
COMMUNITY MOBILIZATION. This component of the intervention uses community outreach to enhance the uptake of VCT, thus increasing the rate of HIV testing and frequency of discussions about HIV and reducing stigma through community education and mobilization.
EASY ACCESS TO VCT. This component is designed to remove practical barriers and increase safety of VCT. Mobile vans or temporary units set up at local community sites will provide free, anonymous VCT in specific, chosen sites where people gather, such as market areas, shopping centers, and community centers.
POST-TEST SUPPORT SERVICES. This component is designed to build psychosocial support to improve the quality of life for individuals diagnosed with HIV. The expected outcomes include a reduction in social harm, an increase in social support through disclosure to those most likely to provide support, and a reduction in internalized stigma. Social support should also decrease the behavioral risk of further transmission.
Standard clinic-based VCTBehavioural
Control communities will receive Standard Clinic-Based VCT (SVCT) instead of the community-based VCT (CBVCT) intervention. Each of these communities will have access to SVCT that reflects local access to health care. The training for VCT counselors will be the same in the CBVCT and SVCT communities; however, no active recruitment for participation in the SVCT services will be made beyond the standard procedures of each clinic for informing patients of services (e.g., telling individual patients that VCT is available, posting of a flyer in the clinic announcing VCT availability, etc). As such, no active outreach or community mobilization will be conducted by the study staff in the SVCT settings (although it is possible that such activities will occur due to local initiative).
| Study group | Role | What they receive |
|---|---|---|
| 1 | Experimental | Intervention communities will receive the community-based VCT intervention community mobilization, mobile VCT, and post-test support services), as well as standard clinic-based VCT Receives: Behavioral: Community-Based HIV VCT |
| 2 | Active comparator | Comparison communities will receive standard clinic-based VCT Receives: Behavioral: Standard clinic-based VCT |
What is being measured
The primary outcome is the main question the study is designed to answer.
Prevalence of recent HIV infection
Measured: Measured at Year 3
Secondary outcomes (7)
Less HIV risk behavior
Measured: Measured at Year 3
Higher rates of HIV testing
Measured: Measured at Year 3
More favorable social norms regarding HIV testing
Measured: Measured at Year 3
More frequent discussions about HIV
Measured: Measured at Year 3
More frequent disclosure of HIV status
Measured: Measured at Year 3
Less HIV-related stigma
Measured: Measured at Year 3
Fewer HIV-related life events
Measured: Measured at Year 3
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted20 Sep 2005 (estimated)
- Study startDec 2004
- Primary completionSep 2011
- Study completionSep 2011
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (4)Papers the sponsor has linked to this study.
- Other trials for HIV InfectionsStudies of the same condition, open and under way.
- More trials run by University of California, Los AngelesThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase 3
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 192,814 participants (actual)
Sponsor and investigators
- Lead sponsor
- University of California, Los Angeles
- Sponsor type
- University, hospital or other
- Collaborators
- National Institute of Mental Health (NIMH), HIV Prevention Trials Network
- Responsible party
- Principal investigator, Thomas J. Coates, University of California, Los Angeles
- Investigators
- David Celentano, ScD, MHS, Principal investigator, Johns Hopkins UniversityThomas J Coates, PhD, Principal investigator, University of California, Los AngelesStephen F Morin, PhD, Principal investigator, University of California, San FranciscoMichael Sweat, PhD, Principal investigator, Medical University of South CarolinaMichal Kulich, PhD, Principal investigator, Charles University, Czech RepublicDeborah Donnell, PhD, Principal investigator, SCHARP, Fred Hutchinson Cancer Research CenterLinda Richter, PhD, Principal investigator, Human Sciences Research CouncilGlenda Gray, MBBCH, FCPaeds(SA), Principal investigator, University of Witwatersrand, South Africa
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT00203749
- Sponsor's protocol ID
- U01MH066701
- Other IDs
- U01MH066701, U01MH066687, U01MH066688, U01MH066702, DAHBR 9A-ASPG
- Status last verified
- Dec 2013
- First submitted
- 13 Sep 2005
- Last updated
- 12 Dec 2013
- Results posted
- No
- Data monitoring committee
- Yes
Publications
Coates TJ, Kulich M, Celentano DD, Zelaya CE, Chariyalertsak S, Chingono A, Gray G, Mbwambo JK, Morin SF, Richter L, Sweat M, van Rooyen H, McGrath N, Fiamma A, Laeyendecker O, Piwowar-Manning E, Szekeres G, Donnell D, Eshleman SH; NIMH Project Accept (HPTN 043) study team. Effect of community-based voluntary counselling and testing on HIV incidence and social and behavioural outcomes (NIMH Project Accept; HPTN 043): a cluster-randomised trial. Lancet Glob Health. 2014 May;2(5):e267-77. doi: 10.1016/S2214-109X(14)70032-4. Epub 2014 Apr 8.
PubMed 25103167Laeyendecker O, Piwowar-Manning E, Fiamma A, Kulich M, Donnell D, Bassuk D, Mullis CE, Chin C, Swanson P, Hackett J Jr, Clarke W, Marzinke M, Szekeres G, Gray G, Richter L, Alexandre MW, Chariyalertsak S, Chingono A, Celentano DD, Morin SF, Sweat M, Coates T, Eshleman SH. Estimation of HIV incidence in a large, community-based, randomized clinical trial: NIMH project accept (HIV Prevention Trials Network 043). PLoS One. 2013 Jul 11;8(7):e68349. doi: 10.1371/journal.pone.0068349. Print 2013.
PubMed 23874597Piwowar-Manning E, Fiamma A, Laeyendecker O, Kulich M, Donnell D, Szekeres G, Robins-Morris L, Mullis CE, Vallari A, Hackett J Jr, Mastro TD, Gray G, Richter L, Alexandre MW, Chariyalertsak S, Chingono A, Sweat M, Coates T, Eshleman SH. HIV surveillance in a large, community-based study: results from the pilot study of Project Accept (HIV Prevention Trials Network 043). BMC Infect Dis. 2011 Sep 24;11:251. doi: 10.1186/1471-2334-11-251.
PubMed 21943026Sweat M, Morin S, Celentano D, Mulawa M, Singh B, Mbwambo J, Kawichai S, Chingono A, Khumalo-Sakutukwa G, Gray G, Richter L, Kulich M, Sadowski A, Coates T; Project Accept study team. Community-based intervention to increase HIV testing and case detection in people aged 16-32 years in Tanzania, Zimbabwe, and Thailand (NIMH Project Accept, HPTN 043): a randomised study. Lancet Infect Dis. 2011 Jul;11(7):525-32. doi: 10.1016/S1473-3099(11)70060-3. Epub 2011 May 3.
PubMed 21546309
Study at a glance
From the registry record, last updated by the sponsor on 12 Dec 2013. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- NIMH Project Accept: A Phase III Randomized Controlled Trial of Community Mobilization, Mobile Testing, Same-Day Results, and Post-Test Support for HIV in Sub-Saharan Africa and Thailand
- ClinicalTrials.gov ID
- NCT00203749
- Acronym / sponsor ID
- U01MH066701
- Conditions
- HIV Infections
- Keywords
- HIV, Testing, Counseling
- Phase
- Phase 3
- Study type
- Interventional
- Recruitment status
- Completed
- Enrolment
- 192,814 participants (actual)
- Lead sponsor
- University of California, Los AngelesUniversity, hospital or other
- Collaborators
- National Institute of Mental Health (NIMH), HIV Prevention Trials Network
- Study start
- Dec 2004
- Primary completion
- Sep 2011 (actual)
- Study completion
- Sep 2011 (actual)
- First posted
- 20 Sep 2005 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study will evaluate the effectiveness of a combination of clinic- and community-based voluntary counseling and testing programs in preventing HIV in African and Thai communities.
Detailed description
NIMH Project Accept is an HIV prevention trial in which 48 communities (10 in Tanzania [Kisarawe], 8 in Zimbabwe [Mutoko], 8 in South Africa/Vulindlela, 8 in South Africa/Soweto and 14 in Thailand [Chiang Mai]) are being randomized to receive either a community-based HIV voluntary counseling and testing (CBVCT) intervention plus standard clinic-based VCT (SVCT), or SVCT alone. The CBVCT intervention has three major strategies: (1) to make VCT more available in community settings; (2) to engage the community through outreach; and (3) to provide post-test support. These strategies are designed to change community norms and reduce risk for HIV infection among all community members, irrespective of whether they participated directly in the intervention.
A community-level intervention based on modifying community norms can change the environmental context in which people make decisions about HIV risk, and has the potential to alter the course of the HIV epidemic in developing countries. This is the first international randomized controlled Phase III trial to determine the efficacy of a behavioral/social science intervention with an HIV incidence endpoint.
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| 1 | Experimental | Behavioral: Community-Based HIV VCTIntervention communities will receive the community-based VCT intervention community mobilization, mobile VCT, and post-test support services), as well as standard clinic-based VCT |
| 2 | Active comparator | Behavioral: Standard clinic-based VCTComparison communities will receive standard clinic-based VCT |
Who may qualify
- Ages
- 16 years and older
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (34 listed)
- Persons may be included in the baseline behavioral assessment if they meet all of the following criteria:
- Reside in a community selected for the study
- Are randomly selected and invited to participate from households that are themselves randomly selected and invited to participate
- Aged 18-32 years
- Has lived in the community at least 4 months in the past year
Key exclusion criteria (31 listed)
- Persons will be excluded from the baseline behavioral assessment if they meet any of the following criteria:
- Are not a member of the study community or are not randomly selected to be offered to participate
- Are below 18 or above 32 years of age
- Has not lived in the community at least 4 months in the past year
- Does not sleep regularly in their household at least 2 nights per week
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Community-Based HIV VCTCOMMUNITY MOBILIZATION. This component of the intervention uses community outreach to enhance the uptake of VCT, thus increasing the rate of HIV testing and frequency of discussions about HIV and reducing stigma through community education and mobilization. EASY ACCESS TO VCT. This component is designed to remove practical barriers and increase safety of VCT. Mobile vans or temporary units set up at local community sites will provide free, anonymous VCT in specific, chosen sites where people gather, such as market areas, shopping centers, and community centers. POST-TEST SUPPORT SERVICES. This component is designed to build psychosocial support to improve the quality of life for individuals diagnosed with HIV. The expected outcomes include a reduction in social harm, an increase in social support through disclosure to those most likely to provide support, and a reduction in internalized stigma. Social support should also decrease the behavioral risk of further transmission. | Behavioural | 1 |
| Standard clinic-based VCTControl communities will receive Standard Clinic-Based VCT (SVCT) instead of the community-based VCT (CBVCT) intervention. Each of these communities will have access to SVCT that reflects local access to health care. The training for VCT counselors will be the same in the CBVCT and SVCT communities; however, no active recruitment for participation in the SVCT services will be made beyond the standard procedures of each clinic for informing patients of services (e.g., telling individual patients that VCT is available, posting of a flyer in the clinic announcing VCT availability, etc). As such, no active outreach or community mobilization will be conducted by the study staff in the SVCT settings (although it is possible that such activities will occur due to local initiative). | Behavioural | 2 |
Primary outcome
Prevalence of recent HIV infection
Time frame: Measured at Year 3
7 secondary outcomes
Less HIV risk behavior
Time frame: Measured at Year 3
Higher rates of HIV testing
Time frame: Measured at Year 3
More favorable social norms regarding HIV testing
Time frame: Measured at Year 3
More frequent discussions about HIV
Time frame: Measured at Year 3
More frequent disclosure of HIV status
Time frame: Measured at Year 3
Less HIV-related stigma
Time frame: Measured at Year 3
Fewer HIV-related life events
Time frame: Measured at Year 3
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 12 Dec 2013.
- Derived from this study: PubMed 25103167Coates TJ, Kulich M, Celentano DD, Zelaya CE, Chariyalertsak S, Chingono A, Gray G, Mbwambo JK, Morin SF, Richter L, Sweat M, van Rooyen H, McGrath N, Fiamma A, Laeyendecker O, Piwowar-Manning E, Szekeres G, Donnell D, Eshleman SH; NIMH Project Accept (HPTN 043) study team. Effect of community-based voluntary counselling and testing on HIV incidence and social and behavioural outcomes (NIMH Project Accept; HPTN 043): a cluster-randomised trial. Lancet Glob Health. 2014 May;2(5):e267-77. doi: 10.1016/S2214-109X(14)70032-4. Epub 2014 Apr 8.
- Derived from this study: PubMed 23874597Laeyendecker O, Piwowar-Manning E, Fiamma A, Kulich M, Donnell D, Bassuk D, Mullis CE, Chin C, Swanson P, Hackett J Jr, Clarke W, Marzinke M, Szekeres G, Gray G, Richter L, Alexandre MW, Chariyalertsak S, Chingono A, Celentano DD, Morin SF, Sweat M, Coates T, Eshleman SH. Estimation of HIV incidence in a large, community-based, randomized clinical trial: NIMH project accept (HIV Prevention Trials Network 043). PLoS One. 2013 Jul 11;8(7):e68349. doi: 10.1371/journal.pone.0068349. Print 2013.
- Derived from this study: PubMed 21943026Piwowar-Manning E, Fiamma A, Laeyendecker O, Kulich M, Donnell D, Szekeres G, Robins-Morris L, Mullis CE, Vallari A, Hackett J Jr, Mastro TD, Gray G, Richter L, Alexandre MW, Chariyalertsak S, Chingono A, Sweat M, Coates T, Eshleman SH. HIV surveillance in a large, community-based study: results from the pilot study of Project Accept (HIV Prevention Trials Network 043). BMC Infect Dis. 2011 Sep 24;11:251. doi: 10.1186/1471-2334-11-251.
- Derived from this study: PubMed 21546309Sweat M, Morin S, Celentano D, Mulawa M, Singh B, Mbwambo J, Kawichai S, Chingono A, Khumalo-Sakutukwa G, Gray G, Richter L, Kulich M, Sadowski A, Coates T; Project Accept study team. Community-based intervention to increase HIV testing and case detection in people aged 16-32 years in Tanzania, Zimbabwe, and Thailand (NIMH Project Accept, HPTN 043): a randomised study. Lancet Infect Dis. 2011 Jul;11(7):525-32. doi: 10.1016/S1473-3099(11)70060-3. Epub 2011 May 3.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
David Celentano, ScD, MHS principal investigator
Johns Hopkins University
Thomas J Coates, PhD principal investigator
University of California, Los Angeles
Stephen F Morin, PhD principal investigator
University of California, San Francisco
5 sites in 4 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A Phase 3 study testing Community-Based HIV VCT and Standard clinic-based VCT in people with HIV Infections, run by University of California, Los Angeles at 5 sites in 4 countries.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 34 inclusion and 31 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 12 Dec 2013. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 5 sites in South Africa, Tanzania, Thailand, Zimbabwe. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
What does this phase mean?
Phase 3 studies compare the treatment with the current standard treatment or a placebo in a large group, to confirm how well it works and watch for side effects.
Not every study follows the same path, and some studies (observational studies, device studies) have no phase.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Prevalence of recent HIV infection (time frame: Measured at Year 3). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT00203749, which also lists 4 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Dec 2013.