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InfluenzaPhase 4NCT04141917

Test-and-treat for Influenza in Homeless Shelters

A Phase 4 study testing Point-of-care molecular testing and treatment of influenza in people with Influenza and Respiratory Viral Infection, run by University of Washington at 9 sites in United States.

Terminated

Stopped early. The study ended before it was planned to and will not resume.

Official record
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Trial summary

This study is a stepped-wedge cluster-randomized trial of on-site rapid testing and treatment for influenza in homeless shelters within the Seattle area to determine whether this strategy reduced the incidence of influenza in the shelter environment. Read more about this study

Who is it for?
Ages 3 months and older
Conditions the study is for
Influenza, Respiratory Viral Infection
What is being tested?
Point-of-care molecular testing and treatment of influenza
Could I receive a placebo?
No, everyone receives an active treatment
How many people
1,618 participants
Where
9 sitesUnited States
Study dates
15 Nov 2019to 31 Mar 2021
Phase
Phase 4
Are there results?
Yes, posted in the registrySummary in the doctors' view

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 3 months and older
  • All sexes
  • No healthy volunteers
  • Child, Adult, Older adult

Who may be able to join

  • Resident for 1 or more days at a participating shelter
  • ≥2 ARI symptoms or acute cough alone
  • Willing to take study medication
  • Willing to comply with all study procedures, including weekly surveillance and repeat nasal swab at day 2/3 and day 5/6/7 post-treatment
  • Able to provide written, informed consent and/or assent

Who cannot join

  • Any serious or uncontrolled medical disorder or active infection that, in the opinion of the investigator, may increase the risk associated with study participation or study drug administration
  • Inability to consent and/or comply with study protocol
  • Individuals who have received oseltamivir or baloxavir within past 7 days for treatment of influenza
  • Individuals with known hypersensitivity to baloxavir marboxil or oseltamivir
  • Individuals with chronic kidney disease

Trial locations and contacts

9 sites in 1 country.

9 sites in 1 country

United States9 sites
  • Mary's Place Burien

    Burien, Washington, 98146

  • Compass Housing Alliance at First Presbyterian

    Seattle, Washington, 98104

  • Downtown Emergency Service Center Shelter

    Seattle, Washington, 98104

  • ROOTS Young Adult Shelter

    Seattle, Washington, 98105

  • Compass Housing Alliance Blaine Center Men's Shelter

    Seattle, Washington, 98109

  • Mary's Place North Seattle

    Seattle, Washington, 98133

  • St Martin De Porres Shelter

    Seattle, Washington, 98134

  • Compass Housing Alliance Jan & Peter's Place Women's Shelter

    Seattle, Washington, 98144

  • Mary's Place White Center

    Seattle, Washington, 98146

Other trials in United States

About this study

Official title: Stepped-wedge Design Study of Point-of-care Molecular Testing for Influenza and Treatment With Baloxavir for Prevention of Secondary Transmission of Influenza in Homeless Shelters in Seattle, WA

This study is a stepped-wedge cluster-randomized trial of on-site rapid testing and treatment for influenza in homeless shelters within the Seattle area to determine whether this strategy reduced the incidence of influenza in the shelter environment.

Read the detailed description

The study will be conducted over the course of two flu seasons, and all shelters will start with routine surveillance of influenza using mid-turbinate nasal swabs for sample collection and RT-PCR testing. Shelters will be randomized to implement a test-and-treat strategy at different months throughout flu season, treating individuals who present ARI symptoms or new or worsening cough within 2 days (48 hours). Shelters will continue routine surveillance until all offer the test-and-treat strategy. Eligible individuals will be tested on site with a point-of-care molecular influenza test and, if positive, offered antiviral treatment. Individuals with 3-7 days of symptoms, or who choose not to participate in the intervention strategy, will still be eligible for participation in the routine surveillance.

Our primary hypothesis is that implementation of a point-of-care diagnostic and antiviral treatment intervention among sheltered individuals experiencing homelessness will reduce the incidence of influenza within this population over the course of a flu season. A process evaluation will also be conducted to explore the feasibility of point-of-care testing implementation in this population.

Being tested
Point-of-care molecular testing and treatment of influenza
Keywords
Tamiflu, Oseltamivir, Baloxavir, Influenza, Flu, Rapid Test, Xofluza
Medical subject headings
Influenza, Human

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Point-of-care molecular testing and treatment of influenzaCombination product

    Eligible individuals will be tested on site with a point-of-care molecular influenza test and, if positive, offered antiviral treatment with baloxavir for those aged ≥12 years, or oseltamivir for those aged <12 years; pregnant; breastfeeding; liver disease; or are immunosuppressed. Follow-up nasal swabs and symptom diaries will be collected from participants 2 or 3 days after receiving the antiviral, and again 5, 6, or 7 days after receiving.

Study groups in NCT04141917
Study groupRoleWhat they receive
Standard influenza surveillanceNo interventionSubjects exhibiting ≥ 2 ARI symptoms or new or worsening cough in the last 7 days at a participating shelter complete a survey collecting demographic and clinical data, and provide a mid-turbinate nasal swab for RT-PCR testing.
Point-of-care molecular testing and treatment of influenzaActive comparatorSubjects exhibiting ≥ 2 ARI symptoms, or new or worsening cough, in the last 48 hrs at a participating shelter complete a survey collecting demographic and clinical data, and provide a mid-turbinate nasal swab to be tested on-site with a molecular assay (Abbott ID NOW™ Influenza A \& B (Chicago, IL)) and receive an antiviral if tested positive (XOFLUZA™ or Tamiflu®) .
Receives: Combination Product: Point-of-care molecular testing and treatment of influenza

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Number of Participants With Cases of Influenza in Shelters During the Intervention Period Compared to the Control Period

    The intervention period is when test and treatment on-site was available and the control period is when just standard surveillance was available at a shelter.

    Measured: Year 1 of the intervention (4.5 months)

Secondary outcomes (7)
  1. Feasibility of Implementation of Point-of-care Molecular Testing and Treatment of Influenza in Shelters

    Number of participants/participant encounters with les than 48 hours between symptom onset until diagnosis with RT-PCR.

    Measured: Up to 24 months

  2. Feasibility of Implementation of Influenza Treatment in Shelters

    Number of influenza-positive participants identified through on-site molecular testing in the intervention period that were treated with an antiviral

    Measured: Up to 24 months

  3. Number of Participants That Drop Out of Study

    Measured as becoming lost to follow-up (did not complete both follow-up study visits on day 2/3 and day 5/6/7) after testing positive for influenza at baseline enrollment with an on-site molecular test and receiving an antiviral

    Measured: Up to 24 months

  4. Number of Participants That Show Non-compliance With Study Drug

    Only applicable to those that receive oseltamivir rather than baloxavir which is a single-dose antiviral. Measured based on self-report during follow-up visits with study research assistants. Non-compliance is measured as the participant self-reporting fewer doses taken than to be expected at time of of follow-up (e.g. a participant that took there first dose of oseltamivir in the AM on March 8 would be expected to have taken 6 doses if their follow-up visit was in the PM on March 10).

    Measured: Up to 24 months

  5. Number of Laboratory-confirmed Influenza Cases That Report Fever

    Based on self-report of new or worsening fever in the past 7 days; not gold standard measurement

    Measured: Up to 24 months

  6. Influenza Viral RNA Levels

    Measured mean cycle threshold (Ct) value for each laboratory-confirmed influenza-positive specimen collected at baseline enrollment, by subtype. Ct values have an inverse relationship with viral load.

    Measured: Up to 24 months

  7. Number of Samples With Detectable Influenza RNA Virus at Days 2/3 and Days 5/6/7

    Measured at subject follow-up visits with nasal swabs provided to study staff; provided subject has not become lost to follow up.

    Measured: Up to 24 months

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted28 Oct 2019
  2. Study start15 Nov 2019
  3. Primary completion31 Mar 2021
  4. Study completion31 Mar 2021

Why it stopped: Operational futility (i.e. near zero circulation of influenza in the community during year 2)

Resources

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 4
Primary purpose
Prevention
Allocation
Randomised
Intervention model
Crossover
Masking
None (open label)
Enrolment
1,618 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04141917
Sponsor's protocol ID
STUDY00007800
Status last verified
May 2022
First submitted
23 Oct 2019
Last updated
22 Jun 2022
Data monitoring committee
Yes
FDA-regulated drug
Yes
FDA-regulated device
No
Individual data sharing
No: We do not currently expect to share specimens with outside investigators, but if compelling opportunities arise that will advance the overall objectives of this research, the Executive Committee of the study will consider such requests. They alone have the authority to make such decisions. All biospecimens (nasal swabs) will be coded and identifiable through the study's main database. Any specimens shared with external investigators (if deemed appropriate by the Executive Committee) will have identifiers removed prior to sharing.

Publications

  • Hayden FG, Sugaya N, Hirotsu N, Lee N, de Jong MD, Hurt AC, Ishida T, Sekino H, Yamada K, Portsmouth S, Kawaguchi K, Shishido T, Arai M, Tsuchiya K, Uehara T, Watanabe A; Baloxavir Marboxil Investigators Group. Baloxavir Marboxil for Uncomplicated Influenza in Adults and Adolescents. N Engl J Med. 2018 Sep 6;379(10):913-923. doi: 10.1056/NEJMoa1716197.

    PubMed 30184455
  • Boonyaratanakornkit J, Ekici S, Magaret A, Gustafson K, Scott E, Haglund M, Kuypers J, Pergamit R, Lynch J, Chu HY. Respiratory Syncytial Virus Infection in Homeless Populations, Washington, USA. Emerg Infect Dis. 2019 Jul;25(7):1408-1411. doi: 10.3201/eid2507.181261.

    PubMed 31211675
  • Hwang SW, Orav EJ, O'Connell JJ, Lebow JM, Brennan TA. Causes of death in homeless adults in Boston. Ann Intern Med. 1997 Apr 15;126(8):625-8. doi: 10.7326/0003-4819-126-8-199704150-00007.

    PubMed 9103130
  • Thiberville SD, Salez N, Benkouiten S, Badiaga S, Charrel R, Brouqui P. Respiratory viruses within homeless shelters in Marseille, France. BMC Res Notes. 2014 Feb 5;7:81. doi: 10.1186/1756-0500-7-81.

    PubMed 24499605
  • Cox SN, Rogers JH, Thuo NB, Meehan A, Link AC, Lo NK, Manns BJ, Chow EJ, Al Achkar M, Hughes JP, Rolfes MA, Mosites E, Chu HY. Trends and factors associated with change in COVID-19 vaccination intent among residents and staff in six Seattle homeless shelters, March 2020 to August 2021. Vaccine X. 2022 Dec;12:100232. doi: 10.1016/j.jvacx.2022.100232. Epub 2022 Oct 19.

    PubMed 36276877
  • Chow EJ, Casto AM, Roychoudhury P, Han PD, Xie H, Pfau B, Nguyen TV, Sereewit J, Rogers JH, Cox SN, Wolf CR, Rolfes MA, Mosites E, Uyeki TM, Greninger AL, Hughes JP, Shim MM, Sugg N, Duchin JS, Starita LM, Englund JA, Chu HY. The Clinical and Genomic Epidemiology of Rhinovirus in Homeless Shelters-King County, Washington. J Infect Dis. 2022 Oct 7;226(Suppl 3):S304-S314. doi: 10.1093/infdis/jiac239.

    PubMed 35749582
  • Rogers JH, Cox SN, Hughes JP, Link AC, Chow EJ, Fosse I, Lukoff M, Shim MM, Uyeki TM, Ogokeh C, Jackson ML, Boeckh M, Englund JA, Mosites E, Rolfes MA, Chu HY. Trends in COVID-19 vaccination intent and factors associated with deliberation and reluctance among adult homeless shelter residents and staff, 1 November 2020 to 28 February 2021 - King County, Washington. Vaccine. 2022 Jan 3;40(1):122-132. doi: 10.1016/j.vaccine.2021.11.026. Epub 2021 Nov 15.

    PubMed 34863618
  • Newman KL, Rogers JH, McCulloch D, Wilcox N, Englund JA, Boeckh M, Uyeki TM, Jackson ML, Starita L, Hughes JP, Chu HY; Seattle Flu Study Investigators. Point-of-care molecular testing and antiviral treatment of influenza in residents of homeless shelters in Seattle, WA: study protocol for a stepped-wedge cluster-randomized controlled trial. Trials. 2020 Nov 23;21(1):956. doi: 10.1186/s13063-020-04871-5.

    PubMed 33228787
  • Rogers JH, Link AC, McCulloch D, Brandstetter E, Newman KL, Jackson ML, Hughes JP, Englund JA, Boeckh M, Sugg N, Ilcisin M, Sibley TR, Fay K, Lee J, Han P, Truong M, Richardson M, Nickerson DA, Starita LM, Bedford T, Chu HY; Seattle Flu Study Investigators. Characteristics of COVID-19 in Homeless Shelters : A Community-Based Surveillance Study. Ann Intern Med. 2021 Jan;174(1):42-49. doi: 10.7326/M20-3799. Epub 2020 Sep 15.

    PubMed 32931328

Questions about this trial

What is this clinical trial studying?

A Phase 4 study testing Point-of-care molecular testing and treatment of influenza in people with Influenza and Respiratory Viral Infection, run by University of Washington at 9 sites in United States.

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 5 inclusion and 5 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: stopped early, as of the sponsor's last update on 22 Jun 2022. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 9 sites in United States. 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 4 studies take place after a treatment is approved, to learn more about its long-term benefits and risks in everyday use.

Not every study follows the same path, and some studies (observational studies, device studies) have no phase.

Are results available for this study?

Yes. Results are posted in the registry (first posted 22 Jun 2022). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

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?

Number of Participants With Cases of Influenza in Shelters During the Intervention Period Compared to the Control Period (time frame: Year 1 of the intervention (4.5 months)). 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 NCT04141917, which also lists 9 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 22 Jun 2022.

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