1
|
Naz-McLean S, Kim A, Zimmer A, Laibinis H, Lapan J, Tyman P, Hung J, Kelly C, Nagireddy H, Narayanan-Pandit S, McCarthy M, Ratnaparkhi S, Rutherford H, Patel R, Dryden-Peterson S, Hung DT, Woolley AE, Cosimi LA. Feasibility and lessons learned on remote trial implementation from TestBoston, a fully remote, longitudinal, large-scale COVID-19 surveillance study. PLoS One 2022; 17:e0269127. [PMID: 35657813 PMCID: PMC9165767 DOI: 10.1371/journal.pone.0269127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 05/14/2022] [Indexed: 11/19/2022] Open
Abstract
Longitudinal clinical studies traditionally require in-person study visits which are well documented to pose barriers to participation and contribute challenges to enrolling representative samples. Remote trial models may reduce barriers to research engagement, improve retention, and reach a more representative cohort. As remote trials become more common following the COVID-19 pandemic, a critical evaluation of this approach is imperative to optimize this paradigm shift in research. The TestBoston study was launched to understand prevalence and risk factors for COVID-19 infection in the greater Boston area through a fully remote home-testing model. Participants (adults, within 45 miles of Boston, MA) were recruited remotely from patient registries at Brigham and Women’s Hospital and the general public. Participants were provided with monthly and “on-demand” at-home SARS-CoV-2 RT-PCR and antibody testing using nasal swab and dried blood spot self-collection kits and electronic surveys to assess symptoms and risk factors for COVID-19 via an online dashboard. Between October 2020 and January 2021, we enrolled 10,289 participants reflective of Massachusetts census data. Mean age was 47 years (range 18–93), 5855 (56.9%) were assigned female sex at birth, 7181(69.8%) reported being White non-Hispanic, 952 (9.3%) Hispanic/Latinx, 925 (9.0%) Black, 889 (8.6%) Asian, and 342 (3.3%) other and/or more than one race. Lower initial enrollment among Black and Hispanic/Latinx individuals required an adaptive approach to recruitment, leveraging connections to the medical system, coupled with community partnerships to ensure a representative cohort. Longitudinal retention was higher among participants who were White non-Hispanic, older, working remotely, and with lower socioeconomic vulnerability. Implementation highlighted key differences in remote trial models as participants independently navigate study milestones, requiring a dedicated participant support team and robust technology platforms, to reduce barriers to enrollment, promote retention, and ensure scientific rigor and data quality. Remote clinical trial models offer tremendous potential to engage representative cohorts, scale biomedical research, and promote accessibility by reducing barriers common in traditional trial design. Barriers and burdens within remote trials may be experienced disproportionately across demographic groups. To maximize engagement and retention, researchers should prioritize intensive participant support, investment in technologic infrastructure and an adaptive approach to maximize engagement and retention.
Collapse
Affiliation(s)
- Sarah Naz-McLean
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA, United States of America
- Division of Epidemiology, University of Toronto Dalla Lana School of Public Health, Toronto, Canada
- Broad Institute of MIT and Harvard, Cambridge, MA, United States of America
| | - Andy Kim
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Andrew Zimmer
- Broad Institute of MIT and Harvard, Cambridge, MA, United States of America
| | - Hannah Laibinis
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA, United States of America
- Broad Institute of MIT and Harvard, Cambridge, MA, United States of America
| | - Jen Lapan
- Broad Institute of MIT and Harvard, Cambridge, MA, United States of America
| | - Paul Tyman
- Broad Institute of MIT and Harvard, Cambridge, MA, United States of America
| | - Jessica Hung
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Christina Kelly
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA, United States of America
- Broad Institute of MIT and Harvard, Cambridge, MA, United States of America
| | - Himaja Nagireddy
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA, United States of America
| | | | - Margaret McCarthy
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Saee Ratnaparkhi
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Henry Rutherford
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Rajesh Patel
- Division of General Internal Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Scott Dryden-Peterson
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- Botswana Harvard AIDS Institute, Gaborone, Botswana
| | - Deborah T. Hung
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA, United States of America
- Broad Institute of MIT and Harvard, Cambridge, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Ann E. Woolley
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA, United States of America
- Broad Institute of MIT and Harvard, Cambridge, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
| | - Lisa A. Cosimi
- Division of Infectious Diseases, Brigham and Women’s Hospital, Boston, MA, United States of America
- Broad Institute of MIT and Harvard, Cambridge, MA, United States of America
- Harvard Medical School, Boston, MA, United States of America
- * E-mail:
| |
Collapse
|