HPTN 035 Zimbabwe 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 Harare 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 Kuwadzana 18km Dzivarasekwa Mabvuku 23km Budiriro 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 .