Malawi Outdoor community health education performance in Malawi

Global Health Liaisons Associates have extensive experience preparing healthcare facility staff, community volunteers, and administrators to conduct federally funded HIV/AIDS prevention and therapeutic studies. Team members supported project sites in Africa, Asia, and the Caribbean, evaluating and training implementing partners for several NIH Division of AIDS Networks, and PEPFAR, and CDC sponsored studies. GHL team members who functioned as liaisons between international sites, community and the National Institutes of Health and the Division of AIDS leadership are core team members.  Read more

Site Development and Capacity Building for Therapeutic Clinical Trials Targeting HIV-
Positive Pregnant Women in Resource-Limited Settings: Challenges and Solutions

International AIDS Society Abstract (2010) C. Blanchard-Horan 1* , J. Hitti 2 , E.Ferguson 3 , K. L. Klingman 4 and D. McMahon 5

Access to HIV clinical trials is a vital component of HIV care globally. We explored challenges related to implementation of a complex multicenter perinatal research protocol in resource-limited settings. Targeted development areas included community involvement, site staff training safety and HIV laboratory monitoring, pharmaceutical matters, labor and delivery care, and regulatory affairs.

Methods 

We surveyed NIAID-sponsored clinical research sites under development in India, Haiti, Uganda, Malawi, South Africa, and Tanzania that had been selected to participate in an HIV-related perinatal research protocol. All communications were documented and stored in a tracking database. We conducted site assessments through telecommunication link-ups and in-person site visits. Reports were generated for use in tracking and evaluation of site progress.

Results

Although diverse with respect to geography, infrastructure, previous research experience and HIV standard of care, research sites experienced similar challenges implementing the study. Engagement of community and site staff demonstrated logistical issues, language differences, and a limited knowledge about research methods and medical terminology; At the laboratory level, there were issues around the irregular power supply, difficulty obtaining reagents, lack of qualified technicians, and inexperience with study-mandated tests and validation procedures.

Pharmacies had problems with supply chain and study drug custody, obtaining and maintaining inventory, and storage conditions. As for labor and delivery care, the sites had difficulty retaining qualified staff, confidentiality, and large patient caseloads.

Regulatory and other site matters, such as IRB review timelines. That is, the length of time it takes the sites to get clearance from their institutional review board and the national government review. There were concerns related to maternal and fetal exposure to antiretrovirals, indemnity insurance, post-treatment antiretroviral access, and limited administrative infrastructure.

Recommendations
Researchers conducting clinical trials in resource-limited settings should:
  • Educate community members about the purpose of research, medical terms, and
    research methods;
  • Allow sufficient time for laboratory implementation and validation procedures
  • Assess drug supply chain and importation, storage, and records;
  • Budget for indemnity insurance, which may be substantial for perinatal studies.
1 Global Health Liaisons (formerly with Social & Scientific Systems Inc.), Silver Spring, MD, USA; 2 University of Washington
Medical Center, Seattle, WA, USA; 3 National Institute of Allergy and Infectious Diseases
(NIAID), Bethesda, MD, USA; 4 NIAID, Bethesda, MD, USA; and 5 University of
Pittsburgh, Pittsburgh, PA, USA.

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