A Phase 3 interventional study of Self Administered Therapy (SAT) and SMS reminders in Latent Tuberculosis Infection, sponsored by Centers for Disease Control and Prevention. Completed at 12 sites in 4 countries. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-03-13.
Sponsored by Centers for Disease Control and Prevention · Phase 3, Interventional, and Prevention
The study is an open label, multicenter, randomized (three arms: DOT (standard control), SAT, SAT with SMS reminders) controlled clinical trial. The trial is conducted in patients diagnosed with latent tuberculosis infection (LTBI) who are recommended for treatment. The primary objective is to evaluate adherence to a three-month (12-dose) regimen of weekly rifapentine and isoniazid (3RPT/INH) given by directly observed therapy (DOT) compared to self-administered therapy (SAT). The secondary objectives:
The World Health Organization (WHO) estimates that approximately 2.3 billion people are infected with Mycobacterium tuberculosis. Approximately 1.7 million people die of TB each year, the second most common infectious cause of death in the world. In order to improve TB control worldwide, an affordable, effective, short course treatment for latent TB infection (LTBI) is a global priority.
Candidates for LTBI treatment are those persons with a positive TST or IGRA, particularly if they also have risk factors for progressing to active TB, including individuals likely to be recently infected. The Prevent TB Study (TBTC Study 26) was an open-label, randomized, phase III controlled clinical trial with over 8,000 high risk TST reactors enrolled. The study compared rifapentine and INH (3RPT/INH) given once-weekly by directly observed treatment (DOT) for 3 months (12 doses) compared with 9 months of daily, self-administered INH. The results demonstrated the safety and efficacy of the shorter regimen. Moreover, the once weekly therapy had significantly higher treatment completion rates than the standard 9 INH regimen.
One of the most effective strategies for assuring adherence with therapy is to have each dose of medication directly administered by a health care worker who observes and records the ingestion of the drugs. DOT for active TB has been successfully used in many settings to improve treatment completion, however cost and logistical constraints of DOT remain. The estimated cost of giving 12 weekly DOT doses to all LTBI patients is likely prohibitive for TB control programs worldwide. This may lead to a decreased uptake of the new regimen or implementation using SAT where adherence has not been studied. Therefore, to apply the Prevent TB study results more broadly, a new study evaluating treatment completion of 3 RPT/INH given as SAT is conducted.
Medication adherence is defined by whether patients take a treatment as prescribed. The effectiveness of any treatment is determined largely by adherence. In clinical practice and research, indirect measures of adherence are commonly used. Indirect measures of adherence include patient self-report, evaluation of pharmacy dispensation records, pill counts, and the use of electronic prescription bottle monitors. Patient self-reported adherence is accurate when non-adherence is reported but tends to overestimate true adherence. Self-report is not discerning enough to be utilized as a sole measure of adherence in research settings where adherence is the primary outcome. Pill counts have been utilized successfully in research and clinical settings for real-time assessment but also tend to overestimate adherence. Electronic drug monitors such as the Medication Event Monitoring System (MEMS) are the best available tools to assess the timing and patterns of adherence. This study uses a combination of indirect measures including MEMS, pill counts, and self-report to provide the most accurate assessment of adherence to once weekly, self-administered RPT/INH.
The number of cellular phone users globally has increased dramatically in the last decade. Cell phones and SMS reminders have been used successfully in randomized controlled clinical trials to improve adherence to vaccines, HIV medications, and asthma treatment. SMS appear to be cost-effective ways to reach patients in remote locations. This study examines effect of SMS on medication adherence.
The goal of this open label clinical trial is to compare the adherence to 3RPT/INH given by DOT versus SAT or SAT with a weekly SMS reminder. The primary assessment of adherence will be treatment completion which is defined as taking at least 90% of the doses (11/12 doses of each drug) within 16 weeks of initiation. Secondary objectives include evaluating the patterns of adherence in participants who fail to complete, determining the feasibility and impact of using SMS reminders on treatment completion with SAT, evaluating the tolerability and any adverse events associated with each treatment arm, monitoring for the development of active TB, determining the drug susceptibility for participants who develop active TB, and measuring important patient-related expenditures associated with each study arm. The trial will be conducted in patients diagnosed with LTBI and recommended for treatment.
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Exclusion Criteria:
900mg of isoniazid plus 900mg of rifapentine given weekly for 3 months (12 weeks, 12 doses) under Directly Observed Therapy (DOT)
Drug: isoniazid and rifapentine
900mg of isoniazid plus 900mg of rifapentine given weekly for 3 months (12 weeks, 12 doses) as patient Self Administered Therapy (SAT)
Behavioral: Self Administered Therapy (SAT) · Drug: isoniazid and rifapentine
900mg of isoniazid plus 900mg of rifapentine given weekly for 3 months (12 weeks, 12 doses) as patient Self Administered Therapy (SAT). In addition, patient receives phone Short Message Service (SMS) reminders weekly.
Behavioral: Self Administered Therapy (SAT) · Behavioral: SMS reminders · Drug: isoniazid and rifapentine
Self Administered Therapy (SAT)
Also known as: SAT
Short Message Service (SMS) text reminders
Also known as: SMS, phone text reminder
rifapentine (PRIFTIN, RPT) 900 mg and isoniazid (INH) 900mg, once-weekly, for 12 weeks (12 doses)
Also known as: PRIFTIN, RPT, P, INH, I
Treatment Completion Rate.
To compare the treatment completion rates between participants randomized to DOT vs SAT without reminders and DOT versus SAT with weekly SMS reminders. Treatment completion is defined as taking at least 90% of the doses (11/12 doses of each drug) within 16 weeks of treatment initiation.
Time frame: Up to 16 weeks from start of treatment.
Treatment Completion Rates Between Participants Randomized to SAT Without Reminders Versus SAT With Weekly SMS Reminders
To compare the treatment completion rates between participants randomized to SAT without reminders versus SAT with weekly SMS reminders
Time frame: Up to 16 weeks from start of treatment.
The Percentage of Participants Who Completed Treatment Based on SOC vs SOC Plus MEMS
The number and proportion of participants who adhered (completed treatment) based on pill count and self-report, considered to be standard of care (SOC) vs. the number of participants who completed treatment based on SOC plus MEMS cap.
Time frame: Up to 16 weeks from start of treatment.
Availability and Acceptability
To determine the availability and acceptability of using SMS reminders among all patients consenting to participate in the study.
Time frame: Up to 16 weeks from start of treatment.
Number and Percentage of Participants With Drug-related Grade 3 or 4 Adverse Events or Death
To determine the toxicity and tolerability by comparing the rates of any drug-related grade 3 or 4 adverse events or death between the DOT arm and the SAT arms (both combined and individually)
Time frame: Up to 16 weeks from start of treatment.
Number and Percentage of Participants Reason for Failure to Complete Treatment
To compare the frequency, timing, and causes for failure to complete treatment between the DOT arm and the SAT arms (both combined and individually) including discontinuation due to: * non-adherence * any adverse event (AE) * a diagnosis of active TB * other reasons
Time frame: Up to 16 weeks from start of treatment.
Patient-specific Cost
To collect patient-specific cost data related to the DOT and SAT arms
Time frame: Up to 20 weeks from start of treatment.
Antituberculosis Drug Resistance
To describe the pattern of antituberculosis drug resistance among Mycobacterium tuberculosis strains cultured from participants who develop active TB.
Time frame: Up to 16 weeks from start of treatment.
| Milestone | 3HP Directly Observed Therapy (DOT) | 3HP Self Administered Therapy (SAT) | 3HP SAT With SMS Reminders |
|---|---|---|---|
| Started | 337 | 337 | 328 |
| Completed | 337 | 337 | 328 |
| Not completed | 0 | 0 | 0 |
To compare the treatment completion rates between participants randomized to DOT vs SAT without reminders and DOT versus SAT with weekly SMS reminders. Treatment completion is defined as taking at least 90% of the doses (11/12 doses of each drug) within 16 weeks of treatment initiation.
| Participants | 3HP Directly Observed Therapy (DOT) | 3HP Self Administered Therapy (SAT) | 3HP SAT With SMS Reminders |
|---|---|---|---|
| Treatment Completion Rate. | 294 | 248 | 250 |
To compare the treatment completion rates between participants randomized to SAT without reminders versus SAT with weekly SMS reminders
| Participants | 3HP Self Administered Therapy (SAT) | 3HP SAT With SMS Reminders |
|---|---|---|
| Treatment Completion Rates Between Participants Randomized to SAT Without Reminders Versus SAT With Weekly SMS Reminders | 248 | 250 |
The number and proportion of participants who adhered (completed treatment) based on pill count and self-report, considered to be standard of care (SOC) vs. the number of participants who completed treatment based on SOC plus MEMS cap.
| Participants | 3HP Directly Observed Therapy (DOT) | 3HP Self Administered Therapy (SAT) | 3HP SAT With SMS Reminders |
|---|---|---|---|
| Treatment completion proportion based on pill count/self-report | 294 | 271 | 266 |
| Treatment completion proportion based on pill count/self-report and MEMS cap | 294 | 248 | 249 |
To determine the availability and acceptability of using SMS reminders among all patients consenting to participate in the study.
| Participants | 3HP Self Administered Therapy (SAT) | 3HP SAT With SMS Reminders | 3HP Directly Observed Therapy (DOT) |
|---|---|---|---|
| Proportion of Participants have cell SMS phone (Availability) | 34 | 29 | 28 |
| Proportion of Participants willing to use SMS (Acceptability) (eSAT arm ONLY) | 0 | 229 | 0 |
To determine the toxicity and tolerability by comparing the rates of any drug-related grade 3 or 4 adverse events or death between the DOT arm and the SAT arms (both combined and individually)
| Participants | 3HP Directly Observed Therapy (DOT) | 3HP Self Administered Therapy (SAT) | 3HP SAT With SMS Reminders |
|---|---|---|---|
| Number and Percentage of Participants With Drug-related Grade 3 or 4 Adverse Events or Death | 23 | 23 | 29 |
To compare the frequency, timing, and causes for failure to complete treatment between the DOT arm and the SAT arms (both combined and individually) including discontinuation due to: * non-adherence * any adverse event (AE) * a diagnosis of active TB * other reasons
| Participants | 3HP Directly Observed Therapy (DOT) | 3HP Self Administered Therapy (SAT) | 3HP SAT With SMS Reminders |
|---|---|---|---|
| Study therapy not started | 3 | 7 | 4 |
| Drug toxicities causing permanent discontinuation | 12 | 18 | 14 |
| Failure to complete minimum number of PP doses | 4 | 7 | 9 |
| Not advisable to continue study drugs | 2 | 5 | 2 |
| Refused further study therapy | 6 | 7 | 11 |
| Patient became pregnant | 2 | 1 | 2 |
| Other | 9 | 12 | 11 |
| Unknown/Missing | 2 | 6 | 6 |
To collect patient-specific cost data related to the DOT and SAT arms
| U.S. Dollar | 3HP Directly Observed Therapy (DOT) | 3HP Self Administered Therapy (Combined SAT and SAT With Reminders) |
|---|---|---|
| Patient-specific Cost | 361.50 (125 to 425) | 257.82 (90 to 340) |
To describe the pattern of antituberculosis drug resistance among Mycobacterium tuberculosis strains cultured from participants who develop active TB.
| Participants | 3HP Directly Observed Therapy (DOT) | 3HP Self Administered Therapy (SAT) | 3HP SAT With SMS Reminders |
|---|---|---|---|
| Developed TB but not drug resistant | 0 | 0 | 1 |
| Antituberculosis Drug Resistant | 0 | 0 | 0 |
Collected over Adverse event data were collected for the duration of study treatment (up to 16 weeks) + 14 days (for late toxicity). Non-serious events are listed at a 0% frequency threshold.
| Group | Deaths | Serious | Other |
|---|---|---|---|
| 3HP Directly Observed Therapy (DOT) | 0/337 (0%) | 11/337 (3.3%) | 42/337 (12.5%) |
| 3HP Self Administered Therapy (SAT) | 0/337 (0%) | 5/337 (1.5%) | 54/337 (16%) |
| 3HP SAT With SMS Reminders | 1/328 (0.3%) | 6/328 (1.8%) | 56/328 (17.1%) |
| Event | 3HP Directly Observed Therapy (DOT) | 3HP Self Administered Therapy (SAT) | 3HP SAT With SMS Reminders |
|---|---|---|---|
| unrelated to study drugGeneral disorders | 8/337 | 5/337 | 4/328 |
| Acute gastroenteritisGastrointestinal disorders | 1/337 | 0/337 | 1/328 |
| fatigueGeneral disorders | 0/337 | 0/337 | 1/328 |
| Systemic Drug ReactionGeneral disorders | 1/337 | 0/337 | 0/328 |
| rheumatoid arthritis flareGeneral disorders | 1/337 | 0/337 | 0/328 |
| Event | 3HP Directly Observed Therapy (DOT) | 3HP Self Administered Therapy (SAT) | 3HP SAT With SMS Reminders |
|---|---|---|---|
| OtherGeneral disorders | 27/337 | 36/337 | 50/328 |
| Systemic Drug ReactionGeneral disorders | 13/337 | 15/337 | 14/328 |
| HepatitisGeneral disorders | 1/337 | 3/337 | 5/328 |
| ThrombocytopeniaGeneral disorders | 0/337 | 0/337 | 1/328 |
| NeutropeniaGeneral disorders | 1/337 | 0/337 | 0/328 |
| Age, Continuous(years) | 3HP Directly Observed Therapy (DOT) | 3HP Self Administered Therapy (SAT) | 3HP SAT With SMS Reminders | Total |
|---|---|---|---|---|
| Median | 36 (27 to 48) | 36 (27 to 48) | 38 (27 to 49) | 36 (27 to 49) |
| Sex: Female, Male(Participants) | 3HP Directly Observed Therapy (DOT) | 3HP Self Administered Therapy (SAT) | 3HP SAT With SMS Reminders | Total |
|---|---|---|---|---|
| Female | 153 | 161 | 168 | 482 |
| Male | 184 | 176 | 160 | 520 |
| Race (NIH/OMB)(Participants) | 3HP Directly Observed Therapy (DOT) | 3HP Self Administered Therapy (SAT) | 3HP SAT With SMS Reminders | Total |
|---|---|---|---|---|
| American Indian or Alaska Native | 0 | 0 | 0 | 0 |
| Asian | 68 | 62 | 70 | 200 |
| Native Hawaiian or Other Pacific Islander | 0 | 0 | 0 | 0 |
| Black or African American | 84 | 91 | 75 | 250 |
| White | 171 | 175 | 172 | 518 |
| More than one race | 14 | 9 | 11 | 34 |
| Unknown or Not Reported | 0 | 0 | 0 | 0 |
| Region of Enrollment(participants) | 3HP Directly Observed Therapy (DOT) | 3HP Self Administered Therapy (SAT) | 3HP SAT With SMS Reminders | Total |
|---|---|---|---|---|
| United States | 261 | 262 | 251 | 774 |
| China | 15 | 14 | 16 | 45 |
| South Africa | 26 | 29 | 28 | 83 |
| Spain | 35 | 32 | 33 | 100 |
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