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Govinden Roshini*
Ramjee G*
Medical Research Council, HIV Prevention Research Unit, Durban, South Africa
HPTN GRANT NO: 1 UO1 A148008
Background:
Developing countries with high HIV prevalence rates are obvious sites for HIV prevention studies. Funding for these trials largely comes from developed countries committed to curbing the spread of the virus. Implementing protocols developed in the sponsor countries poses a great challenge for researchers in developing countries, primarily because these countries lack the basic health care and research infrastructure and clinics. Further, there is a strong divide between urban and rural communities based on socio-economic status, health care provision and health seeking behavior.
We describe the challenges faced in:
Obtaining ethical and regulatory approval
Community education and awareness and site development
Implementing the protocol specific activities
Challenges of high HIV prevalence rates
Recruitment and retentions strategies
Challenges of conducting laboratory tests
Results:
The unit had to seek approval from Provincial Health Department and the Ethics Committee. The ethics committee requested that a paragraph on the results of N9 be included in the informed consent form. Community education and awareness was a long process with several meetings between traditional leaders, service providers, womens groups and the community at large. The high prevalence rates detected at both urban (Durban) and rural (Hlabisa) sites of 29.6% and 35.8% respectively, resulted in the need for extra study staff such as nurses, counselors and community educators. HIV positive women requested the need to be counseled by clinical staff and were reluctant to be referred elsewhere. The recruitment and retention to date has been successful at both Durban and Hlabisa sites having no participants lost to follow-up in the first 3 months of operations.
Multi-site study protocols can be implemented in developing countries provided there is adequate research infrastructure, trained and skilled staff, and community health care support.
Dr Roshini Govinden
P O Box 70380, Overport, 4067, Durban, Kwazulu-Natal, South Africa
(Telephone) +27-31-2034700 (Fax) +27-31-2034702 (E-mail) roshini.govinden@mrc.ac.za
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