How did they do it? A qualitative study of the successful recruitment and retention of female sex workers in a HIV vaccine trials network preparedness trial in Santo Domingo, Dominican Republic
C. Barrington1, B. Clio1, L. Moreno2, Y. Donastorg3, M. Perez3, A. Giroux4, D. Kerrigan5
1University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, United States, 2Unidad de Vacunas IDCP-COIN-DIGECITSS, Santo Domingo, Trinidad and Tobago, 3Unidad de Vacunas IDCP-COIN-DIGECITSS, Santo Domingo, Dominican Republic, 4National Human Genome Research Institute, National Institutes of Health, Bethesda, United States, 5Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
Background: Protocol 903 HIV vaccine preparedness study was implemented in Santo Domingo to assess feasibility of recruiting and retaining female sex workers (FSW) for future HIV vaccine trials. Nearly all participants (96%) completed the trial despite high mobility and social vulnerability. The purpose of this study is to identify participants' explanations for the high level of retention.
Methods: Qualitative in-depth interviews using a semi-structured guide were conducted in 2006 with 24 FSW after their final follow-up visit. Data analysis included multiple readings of transcripts to identify themes, coding with Atlas.ti qualitative software, and development of matrices to compare findings within and across participants.
Results: The most salient theme regarding retention process was that the trial was conducted in a culturally sensitive and supportive way that made women feel respected and motivated to stay enrolled. Participants appreciated that recruiters were trusted individuals who worked with the NGO that provides HIV prevention services to FSW, although there was concern that being seen with the recruiters, or at the vaccine unit in general, could cause them to be labeled HIV positive. Participants appreciated the welcoming environment and high quality clinical care they received at the unit as much as the material compensation (i.e. food, transportation). Beyond the vaccine unit, ongoing communication with the trial staff, including home visits, and celebrating meaningful events (i.e. Mother's day) created a sense of community.
Conclusions: The welcoming environment of the vaccine unit, respectful treatment, and outreach beyond the trial created a sense of community that facilitated retention and overcame the potential stigma associated with participation. Future HIV-related biomedical studies with vulnerable populations should consider their local context to develop contextually appropriate recruitment and retention strategies, in particular opportunities for social integration and cohesion beyond the trial setting and ongoing support and counseling between trial visits.
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