HPTN 035

Presented by Dr K. V Chikwanda UZ-UCSF Research Programme MTN Regional meeting 21-24 May 2007

SPILHAUS CLINIC Seke South location

• Located within Seke South Polyclinic (offers primary health care) • Within low income urban community • Population of Chitungwiza – 189 133 women of child bearing age. • Has 3 other polyclinics within 5km radius Location of Seke South Clinic

Seke South

St Mary's Zengeza 5 km 3 km Seke North 4 km SPILHAUS LOCATION

• Southern part of urban and serves the city’s low income suburbs. • On the grounds of Zimbabwe’s 2nd largest hospital – a referral and teaching hospital. • Within ZNFPC complex which offers a wide range of reproductive health services • Well established referral linkages for health care and support. • Recruits from surrounding 13 low income suburbs – a pool of 132 692 women (15-45yr) Location of Spilhaus Clinic Mbare 5km Mufakose Glen Norah 12km 8km

Glen View Kambuzuma 10km 10km

Tafara 34km 18km Mabvuku 23km 30km 13km Recruitment of high risk women • Site has done relatively well in targeting high risk women • MAJOR CHALLENGES ¾ Risk is assessed more at individual level rather than in groups. ¾Site specific criteria used for recruiting high Risk participants to be used Community Involvement • CAB plays key role in our interaction with communities • CAB knowledgeable about research issues • Ability to disseminate information to community through CAB and other stakeholders. • COMMUNITY ADVOCACY GROUPS ¾WASN- Women's Action Support Network ¾WAG- Women's Action Group ¾PADARE – Male Involvement • Beaurocracy is prohibitive when dealing with urgent issues like rumors or negative information Retention • CHALLENGES ¾ Seasonal migration to rural areas ¾ Cross boarder traders ¾ Women who do not disclose to partners about being in the study. • KEY LESSONS ¾ Retention is a process that starts at recruitment. ¾ Use of the data base ¾ Participant Retention meetings. ¾Male partner involvement also key Product Adherence CHALLENGES

¾Relying on self reports by participants , no way to verify information.

KEY LESSONS ¾ Standardisation of adherence counseling messages. ¾ Group meetings with participants to discuss adherence issues. ¾ Regular review of adherence data with study staff useful. Picture of Site Team