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Osias E, Hung P, Giacani L, Stafylis C, Konda KA, Vargas SK, Reyes-Díaz EM, Comulada WS, Haake DA, Haynes AM, Caceres CF, Klausner JD. Investigation of syphilis immunology and Treponema pallidum subsp. pallidum biology to improve clinical management and design a broadly protective vaccine: study protocol. BMC Infect Dis 2020; 20:444. [PMID: 32576149 PMCID: PMC7309211 DOI: 10.1186/s12879-020-05141-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/08/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The syphilis epidemic continues to cause substantial morbidity and mortality worldwide, particularly in low- and middle-income countries, despite several recent disease control initiatives. Though our understanding of the pathogenesis of this disease and the biology of the syphilis agent, Treponema pallidum subsp. pallidum has improved over the last two decades, further research is necessary to improve clinical diagnosis and disease management protocols. Additionally, such research efforts could contribute to the identification of possible targets for the development of an effective vaccine to stem syphilis spread. METHODS This study will recruit two cohorts of participants with active syphilis infection, one with de novo infection, one with repeat infection. Whole blood specimens will be collected from each study participant at baseline, 4, 12, 24, 36, and 48 weeks, to track specific markers of their immunological response, as well as to compare humoral reactivity to Treponema pallidum antigens between the two groups. Additionally, we will use serum specimens to look for unique cytokine patterns in participants with early syphilis. Oral and blood samples, as well as samples from any syphilitic lesions present, will also be collected to sequence any Treponema pallidum DNA found. DISCUSSION By furthering our understanding of syphilis pathogenesis and human host immune response to Treponema pallidum, we will provide important data that will help in development of new point-of-care tests that could better identify active infection, leading to improved syphilis diagnosis and management. Findings could also contribute to vaccine development efforts.
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Affiliation(s)
- Ethan Osias
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.
| | - Phoebe Hung
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Lorenzo Giacani
- Department of Medicine, Division of Allergy and Infectious Diseases, and Department of Global Health, University of Washington, Seattle, WA, USA
| | - Chrysovalantis Stafylis
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - Kelika A Konda
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.,Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silver K Vargas
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - E Michael Reyes-Díaz
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - W Scott Comulada
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
| | - David A Haake
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA.,Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Austin M Haynes
- Department of Medicine, Division of Allergy and Infectious Diseases, and Department of Global Health, University of Washington, Seattle, WA, USA
| | - Carlos F Caceres
- Unit of Health, Sexuality and Human Development and Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, USA
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Uhlig A. [Strategies to reduce patient loss during the follow-up period of randomized trials]. Urologe A 2019; 57:601-604. [PMID: 29651710 DOI: 10.1007/s00120-018-0639-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- A Uhlig
- Klinik für Urologie, Universitätsmedizin Göttingen, Göttingen, Deutschland.
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Wynne J, Muwawu R, Mubiru MC, Kamira B, Kemigisha D, Nakyanzi T, Kabwigu S, Nakabiito C, Kiweewa Matovu F. Maximizing participant retention in a phase 2B HIV prevention trial in Kampala, Uganda: The MTN-003 (VOICE) Study. HIV CLINICAL TRIALS 2018; 19:165-171. [PMID: 30370830 DOI: 10.1080/15284336.2018.1513711] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND The success of longitudinal trials depends greatly on using effective strategies to retain participants and ensure internal validity, maintain sufficient statistical power, and provide for the generalizability of study results. OBJECTIVE This paper describes the challenges and specific strategies used to retain participants in a Phase 2B safety and effectiveness study of daily oral and vaginal tenofovir formulations for the prevention of HIV-1 infection in the MTN-003 (VOICE) trial in Kampala, Uganda. METHODS Once enrolled, participants were seen every 28 days at the research site and their study product was re-filled. Challenges to retention included a mobile population, non-disclosure of study participation to spouse/family, and economic constraints. Strategies used to maintain high participation rates included the use of detailed locator information, a participant tracking database, regular HIV/STI testing, and the formation of close bonds between staff and subjects. RESULTS We enrolled 322 women out of the 637 screened. The overall retention rate was 95% over a 3 year follow up period. Only 179 (3%) out of the 6124 expected visits were missed throughout study implementation. Reasons for missed visits included: participants thinking that they did not need frequent visits due to their HIV negative status, time constraints due to commercial sex work, and migration for better employment. CONCLUSIONS With the implementation of multi-faceted comprehensive follow-up and retention strategies, we achieved very high retention rates in the MTN-003 study. This paper provides a blueprint for effective participant retention strategies for other longitudinal HIV prevention studies in resource-limited settings in Sub-Saharan Africa.
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Affiliation(s)
- Joshua Wynne
- a Sidney Kimmel Medical College at Thomas Jefferson University , Philadelphia , Pennsylvania , USA
| | - Rosemary Muwawu
- b Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration , Kampala , Uganda
| | - Michael C Mubiru
- b Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration , Kampala , Uganda
| | - Betty Kamira
- b Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration , Kampala , Uganda
| | - Doreen Kemigisha
- b Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration , Kampala , Uganda
| | - Teopista Nakyanzi
- b Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration , Kampala , Uganda
| | - Samuel Kabwigu
- b Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration , Kampala , Uganda
| | - Clemensia Nakabiito
- b Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration , Kampala , Uganda
| | - Flavia Kiweewa Matovu
- b Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration , Kampala , Uganda.,c Department of Epidemiology and Biostatistics , Makerere University School of Public Health, Makerere University College of Health Sciences , Kampala , Uganda
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4
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Forchuk C, O'Regan T, Jeng M, Wright A. Retaining a Sample of Homeless Youth. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2018; 27:167-174. [PMID: 30038654 PMCID: PMC6054288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/12/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Hard to reach populations need to be included in research studies to ensure proper representation of the general population. This paper explores tracking strategies used in the Youth Matters in London project to retain a sample of homeless youth. METHOD A total of 187 youth, aged between 16 and 24 years, homeless or precariously housed, and experiencing a serious mental health issue were recruited at a community drop-in center, by word of mouth and by snowball sampling. After the initial interview, three repeat interviews were conducted six months apart. RESULTS The most successful strategy for contacting participants was through a local agency and e-mail. An analysis of the contact data identified participant retention rates as 88%, 86%, and 82% for each successive interview. This longitudinal retention rate is very high compared with research in other vulnerable populations, suggesting a strong willingness to participate in the Youth Matters in London project. CONCLUSIONS Retaining a sample of homeless youth is difficult, however, with time, patience and effort it has proven possible. This research underscores the importance of relationships with community agencies to retain vulnerable youth samples in longitudinal research designs.
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Affiliation(s)
- Cheryl Forchuk
- Lawson Health Research Institute - Parkwood Institute, London, Ontario
| | - Tony O'Regan
- Lawson Health Research Institute - Parkwood Institute, London, Ontario
| | - Mo Jeng
- Lawson Health Research Institute - Parkwood Institute, London, Ontario
| | - Amanda Wright
- Lawson Health Research Institute - Parkwood Institute, London, Ontario
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Icard LD, Jemmott JB, Carty C, O'Leary A, Sidloyi L, Hsu J, Tyler J, Martinez O. Retention of South African Adolescents in a 54-Month Longitudinal HIV Risk Reduction Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2018; 18:534-540. [PMID: 28508155 DOI: 10.1007/s11121-017-0793-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Retention of participants in clinical trials is a central concern of HIV/STI behavioral researchers and research sponsors. This article describes the strategies used for addressing the challenges in retaining South African adolescents for a 54-month longitudinal study. The objective of the South African adolescent health promotion long-term follow-up trial was to test the sustainability of the effects of an HIV/STI risk reduction intervention, "Let Us Protect Our Future," on young adolescents as they aged into middle and late adolescence. Inaccurate contact information, invalid mobile telephone numbers, lack of transportation, transitory family addresses, and family relocation were among the challenges to retaining participants. Despite a significant gap in time of 36 months between the main trial and the long-term follow-up study, 99.2% of 1057 participants were retained. Solutions used for retaining the adolescents are discussed with suggestions offered for retaining adolescents in longitudinal HIV/STI prevention clinical trials in low resource countries.
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Affiliation(s)
- Larry D Icard
- College of Public Health, School of Social Work, Temple University, Philadelphia, PA, 19122, USA.
| | - John B Jemmott
- Annenberg School for Communication, Center for Health Behavior and Communication Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Craig Carty
- Annenberg School for Communication, Center for Health Behavior and Communication Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Ann O'Leary
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lulama Sidloyi
- Annenberg School for Communication, Center for Health Behavior and Communication Research, University of Pennsylvania, Philadelphia, PA, USA
| | - Janet Hsu
- Annenberg School for Communication, Center for Health Behavior and Communication Research, University of Pennsylvania, Philadelphia, PA, USA
| | - JoAnn Tyler
- Department of Statistics, University of Fort Hare, Alice, South Africa
| | - Omar Martinez
- College of Public Health, School of Social Work, Temple University, Philadelphia, PA, 19122, USA
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Allan-Blitz LT, Konda KA, Calvo GM, Vargas SK, Leon SR, Segura ER, Caceres CF, Klausner JD. High incidence of extra-genital gonorrheal and chlamydial infections among high-risk men who have sex with men and transgender women in Peru. Int J STD AIDS 2017; 29:568-576. [PMID: 29183269 DOI: 10.1177/0956462417744098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Extra-genital Neisseria gonorrhoeae and Chlamydia trachomatis infections are associated with antimicrobial resistance and HIV acquisition. We analyzed data from a cohort of men who have sex with men (MSM) and transgender women followed quarterly for two years in Peru. Incident cases were defined as positive N. gonorrhoeae or C. trachomatis nucleic acid tests during follow-up. Repeat positive tests were defined as reinfection among those with documented treatment. We used generalized estimating equations to calculate adjusted incidence rate ratios (aIRRs). Of 404 participants, 22% were transgender. Incidence rates of rectal N. gonorrhoeae and C. trachomatis infection were 28.1 and 37.3 cases per 100 person-years, respectively. Incidence rates of pharyngeal N. gonorrhoeae and C. trachomatis infection were 21.3 and 9.6 cases per 100 person-years, respectively. Incident HIV infection was associated with incident rectal (aIRR = 2.43; 95% CI 1.66-3.55) N. gonorrhoeae infection. Identifying as transgender versus cisgender MSM was associated with incident pharyngeal N. gonorrhoeae (aIRR = 1.85; 95% CI 1.12-3.07) infection. The incidence of extra-genital N. gonorrhoeae and C. trachomatis infections was high in our population. The association with incident HIV infection warrants evaluating the impact of rectal N. gonorrhoeae screening and treatment on HIV transmission.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- 1 Division of Infectious Diseases: Department of Medicine, 12222 David Geffen School of Medicine, University of California Los Angeles, USA
| | - Kelika A Konda
- 1 Division of Infectious Diseases: Department of Medicine, 12222 David Geffen School of Medicine, University of California Los Angeles, USA.,2 Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gino M Calvo
- 2 Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru.,3 Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Silver K Vargas
- 2 Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru.,3 Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Segundo R Leon
- 3 Laboratory of Sexual Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eddy R Segura
- 1 Division of Infectious Diseases: Department of Medicine, 12222 David Geffen School of Medicine, University of California Los Angeles, USA
| | - Carlos F Caceres
- 2 Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jeffrey D Klausner
- 1 Division of Infectious Diseases: Department of Medicine, 12222 David Geffen School of Medicine, University of California Los Angeles, USA.,4 Department of Epidemiology, Fielding School of Public Health, 12222 University of California Los Angeles , USA
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Allotey P, Reidpath DD, Devarajan N, Rajagobal K, Yasin S, Arunachalam D, Imelda JD, Soyiri I, Davey T, Jahan N. Cohorts and community: a case study of community engagement in the establishment of a health and demographic surveillance site in Malaysia. Glob Health Action 2014; 7:23176. [PMID: 24804983 PMCID: PMC4013487 DOI: 10.3402/gha.v7.23176] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 02/16/2014] [Accepted: 04/10/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Community engagement is an increasingly important requirement of public health research and plays an important role in the informed consent and recruitment process. However, there is very little guidance about how it should be done, the indicators for assessing effectiveness of the community engagement process and the impact it has on recruitment, retention, and ultimately on the quality of the data collected as part of longitudinal cohort studies. METHODS An instrumental case study approach, with data from field notes, policy documents, unstructured interviews, and focus group discussions with key community stakeholders and informants, was used to explore systematically the implementation and outcomes of the community engagement strategy for recruitment of an entire community into a demographic and health surveillance site in Malaysia. RESULTS For a dynamic cohort, community engagement needs to be an ongoing process. The community engagement process has likely helped to facilitate the current response rate of 85% in the research communities. The case study highlights the importance of systematic documentation of the community engagement process to ensure an understanding of the effects of the research on recruitment and the community. CONCLUSIONS A critical lesson from the case study data is the importance of relationships in the recruitment process for large population-based studies, and the need for ongoing documentation and analysis of the impact of cumulative interactions between research and community engagement.
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Affiliation(s)
- Pascale Allotey
- South East Asia Community Observatory (SEACO), School of Medicine and Health Sciences, Monash University, Segamat, Malaysia; Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Malaysia;
| | - Daniel D Reidpath
- South East Asia Community Observatory (SEACO), School of Medicine and Health Sciences, Monash University, Segamat, Malaysia; Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Malaysia
| | - Nirmala Devarajan
- South East Asia Community Observatory (SEACO), School of Medicine and Health Sciences, Monash University, Segamat, Malaysia
| | - Kanason Rajagobal
- South East Asia Community Observatory (SEACO), School of Medicine and Health Sciences, Monash University, Segamat, Malaysia
| | - Shajahan Yasin
- South East Asia Community Observatory (SEACO), School of Medicine and Health Sciences, Monash University, Segamat, Malaysia; Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Malaysia
| | - Dharmalingam Arunachalam
- Centre for Population and Urban Research, School of Political and Social Inquiry, Faculty of Arts, Monash University, Clayton, Australia
| | - Johanna Debora Imelda
- South East Asia Community Observatory (SEACO), School of Medicine and Health Sciences, Monash University, Segamat, Malaysia; Post Doc Fellowship, Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands; Department of Social Welfare, Faculty of Social and Political Science, University of Indonesia, Depok, Indonesia
| | - Ireneous Soyiri
- South East Asia Community Observatory (SEACO), School of Medicine and Health Sciences, Monash University, Segamat, Malaysia
| | - Tamzyn Davey
- South East Asia Community Observatory (SEACO), School of Medicine and Health Sciences, Monash University, Segamat, Malaysia; Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University, Malaysia
| | - Nowrozy Jahan
- South East Asia Community Observatory (SEACO), School of Medicine and Health Sciences, Monash University, Segamat, Malaysia
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Perry DC, Griffin XL, Parsons N, Costa ML. Designing clinical trials in trauma surgery: overcoming research barriers. Bone Joint Res 2014; 3:123-9. [PMID: 24764547 PMCID: PMC4036301 DOI: 10.1302/2046-3758.34.2000283] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 01/28/2014] [Indexed: 01/31/2023] Open
Abstract
The surgical community is plagued with a reputation for both failing to engage and to deliver on clinical research. This is in part due to the absence of a strong research culture, however it is also due to a multitude of barriers encountered in clinical research; particularly those involving surgical interventions. 'Trauma' amplifies these barriers, owing to the unplanned nature of care, unpredictable work patterns, the emergent nature of treatment and complexities in the consent process. This review discusses the barriers to clinical research in surgery, with a particular emphasis on trauma. It considers how barriers may be overcome, with the aim to facilitate future successful clinical research. Cite this article: Bone Joint Res 2014;3:123-9.
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Affiliation(s)
- D C Perry
- University of Warwick, Warwick MedicalSchool, Clinical Sciences Research Laboratories, Clifford BridgeRoad, Coventry, CV2 2DX, UK
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Brueton VC, Tierney J, Stenning S, Harding S, Meredith S, Nazareth I, Rait G. Strategies to improve retention in randomised trials. Cochrane Database Syst Rev 2013:MR000032. [PMID: 24297482 PMCID: PMC4470347 DOI: 10.1002/14651858.mr000032.pub2] [Citation(s) in RCA: 114] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Loss to follow-up from randomised trials can introduce bias and reduce study power, affecting the generalisability, validity and reliability of results. Many strategies are used to reduce loss to follow-up and improve retention but few have been formally evaluated. OBJECTIVES To quantify the effect of strategies to improve retention on the proportion of participants retained in randomised trials and to investigate if the effect varied by trial strategy and trial setting. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PreMEDLINE, EMBASE, PsycINFO, DARE, CINAHL, Campbell Collaboration's Social, Psychological, Educational and Criminological Trials Register, and ERIC. We handsearched conference proceedings and publication reference lists for eligible retention trials. We also surveyed all UK Clinical Trials Units to identify further studies. SELECTION CRITERIA We included eligible retention trials of randomised or quasi-randomised evaluations of strategies to increase retention that were embedded in 'host' randomised trials from all disease areas and healthcare settings. We excluded studies aiming to increase treatment compliance. DATA COLLECTION AND ANALYSIS We contacted authors to supplement or confirm data that we had extracted. For retention trials, we recorded data on the method of randomisation, type of strategy evaluated, comparator, primary outcome, planned sample size, numbers randomised and numbers retained. We used risk ratios (RR) to evaluate the effectiveness of the addition of strategies to improve retention. We assessed heterogeneity between trials using the Chi(2) and I(2) statistics. For main trials that hosted retention trials, we extracted data on disease area, intervention, population, healthcare setting, sequence generation and allocation concealment. MAIN RESULTS We identified 38 eligible retention trials. Included trials evaluated six broad types of strategies to improve retention. These were incentives, communication strategies, new questionnaire format, participant case management, behavioural and methodological interventions. For 34 of the included trials, retention was response to postal and electronic questionnaires with or without medical test kits. For four trials, retention was the number of participants remaining in the trial. Included trials were conducted across a spectrum of disease areas, countries, healthcare and community settings. Strategies that improved trial retention were addition of monetary incentives compared with no incentive for return of trial-related postal questionnaires (RR 1.18; 95% CI 1.09 to 1.28, P value < 0.0001), addition of an offer of monetary incentive compared with no offer for return of electronic questionnaires (RR 1.25; 95% CI 1.14 to 1.38, P value < 0.00001) and an offer of a GBP20 voucher compared with GBP10 for return of postal questionnaires and biomedical test kits (RR 1.12; 95% CI 1.04 to 1.22, P value < 0.005). The evidence that shorter questionnaires are better than longer questionnaires was unclear (RR 1.04; 95% CI 1.00 to 1.08, P value = 0.07) and the evidence for questionnaires relevant to the disease/condition was also unclear (RR 1.07; 95% CI 1.01 to 1.14). Although each was based on the results of a single trial, recorded delivery of questionnaires seemed to be more effective than telephone reminders (RR 2.08; 95% CI 1.11 to 3.87, P value = 0.02) and a 'package' of postal communication strategies with reminder letters appeared to be better than standard procedures (RR 1.43; 95% CI 1.22 to 1.67, P value < 0.0001). An open trial design also appeared more effective than a blind trial design for return of questionnaires in one fracture prevention trial (RR 1.37; 95% CI 1.16 to 1.63, P value = 0.0003).There was no good evidence that the addition of a non-monetary incentive, an offer of a non-monetary incentive, 'enhanced' letters, letters delivered by priority post, additional reminders, or questionnaire question order either increased or decreased trial questionnaire response/retention. There was also no evidence that a telephone survey was either more or less effective than a monetary incentive and a questionnaire. As our analyses are based on single trials, the effect on questionnaire response of using offers of charity donations, sending reminders to trial sites and when a questionnaire is sent, may need further evaluation. Case management and behavioural strategies used for trial retention may also warrant further evaluation. AUTHORS' CONCLUSIONS Most of the retention trials that we identified evaluated questionnaire response. There were few evaluations of ways to improve participants returning to trial sites for trial follow-up. Monetary incentives and offers of monetary incentives increased postal and electronic questionnaire response. Some other strategies evaluated in single trials looked promising but need further evaluation. Application of the findings of this review would depend on trial setting, population, disease area, data collection and follow-up procedures.
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Affiliation(s)
| | - Jayne Tierney
- Meta-analysis Group, MRC Clinical Trials Unit at UCLLondon, UK
| | | | - Seeromanie Harding
- Social and Public Health Sciences Unit, Medical Research CouncilGlasgow, UK
| | | | - Irwin Nazareth
- Research Department of Primary Care and Population Health, University College LondonLondon, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College LondonLondon, UK
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10
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Deiss RG, Leon SR, Konda KA, Brown B, Segura ER, Galea JT, Caceres CF, Klausner JD. Characterizing the syphilis epidemic among men who have sex with men in Lima, Peru to identify new treatment and control strategies. BMC Infect Dis 2013; 13:426. [PMID: 24016185 PMCID: PMC3846360 DOI: 10.1186/1471-2334-13-426] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 09/02/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Syphilis is an important sexually transmitted infection (STI) with serious public health consequences. Among men who have sex with men (MSM) in Lima, the prevalence and incidence are extraordinarily high. Current syndromic approaches, however, fail to identify asymptomatic cases, and in settings where large proportions of individuals test positive again after treatment, it is frequently difficult to distinguish treatment failure from re-infection. Thus, new approaches are needed to improve treatment strategies and public health control efforts. METHODS/DESIGN Study participants will undergo baseline testing for syphilis infection along with a behavioral survey covering demographics, sexual behavior, drug and alcohol abuse and health-care seeking behavior. The cohort will be followed for 18 months at three-month intervals. Blood and earlobe scrapings will also be collected for T. pallidum DNA testing, to create molecular markers for subtyping. We will also perform cytokine testing on collected samples in order to create host immunologic profiles associated with recurrence, re-infection, treatment failure and success. DISCUSSION Advances in social epidemiology, molecular typing and characterization of host immune responses will offer promise in developing new understandings of syphilis management. We will share our findings with the Peruvian Ministry of Health and other public health organizations, to identify new approaches of case detection and successful treatment.
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Affiliation(s)
- Robert G Deiss
- Division of Infectious Diseases, Harbor-UCLA Medical Center, 1000 W. Carson Street, Box 466, Torrance, CA 90502, USA
| | - Segundo R Leon
- Unit of Health, Sexuality and Human Development, Cayetano Heredia University School of Public Health, Lima, Peru. Av. Armendariz 445 Lima 18, Peru
- Department of Global Health, University of Washington, Harborview Medical Center, 325 9th Avenue Box 359931, Seattle, WA 98104, USA
| | - Kelika A Konda
- Program in Global Health, Division of Infectious Diseases, David Geffen School of Medicine, University of California, 10833 Le Conte Ave. CHS 12-105, Los Angeles, CA 90095-1688, USA
| | - Brandon Brown
- Program in Public Health, Department of Population Health & Disease Prevention, University of California, Irvine, 653 E. Peltason Road Suite 2010, Irvine, CA 92697-3957, USA
| | - Eddy R Segura
- Program in Global Health, Division of Infectious Diseases, David Geffen School of Medicine, University of California, 10833 Le Conte Ave. CHS 12-105, Los Angeles, CA 90095-1688, USA
| | - Jerome T Galea
- Unit of Health, Sexuality and Human Development, Cayetano Heredia University School of Public Health, Lima, Peru. Av. Armendariz 445 Lima 18, Peru
- Centre for Sexual Health and HIV Research, Faculty of Population Health, University College London, Gower St, London, Greater London WC1E 6BT, UK
| | - Carlos F Caceres
- Unit of Health, Sexuality and Human Development, Cayetano Heredia University School of Public Health, Lima, Peru. Av. Armendariz 445 Lima 18, Peru
| | - Jeffrey D Klausner
- Program in Global Health, Division of Infectious Diseases, David Geffen School of Medicine, University of California, 10833 Le Conte Ave. CHS 12-105, Los Angeles, CA 90095-1688, USA
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Conn DL, Pan Y, Easley KA, Comeau DL, Carlone JP, Culler SD, Tiliakos A. The effect of the Arthritis Self-Management Program on outcome in African Americans with rheumatoid arthritis served by a public hospital. Clin Rheumatol 2012; 32:49-59. [DOI: 10.1007/s10067-012-2090-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 08/30/2012] [Accepted: 09/10/2012] [Indexed: 01/18/2023]
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Hughes S, Harris J, Flack N, Cuffe RL. The statistician's role in the prevention of missing data. Pharm Stat 2012; 11:410-6. [PMID: 22807372 DOI: 10.1002/pst.1528] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 05/02/2012] [Accepted: 06/18/2012] [Indexed: 11/11/2022]
Affiliation(s)
- Sara Hughes
- Clinical Statistics; GSK Research & Development; Stockley Park West Uxbridge UB11 1BT UK
| | - Julia Harris
- Infectious Diseases Statistics; GSK Research & Development; Stockley Park West Uxbridge UB11 1BT UK
| | - Nancy Flack
- Center for Project and Study Excellence; GSK Research and Development; Research Triangle Park NC 27709 USA
| | - Robert L. Cuffe
- Statistics; ViiV Healthcare; 980 Great West Road Brentford TW8 9GS UK
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Severi E, Free C, Knight R, Robertson S, Edwards P, Hoile E. Two controlled trials to increase participant retention in a randomized controlled trial of mobile phone-based smoking cessation support in the United Kingdom. Clin Trials 2011; 8:654-60. [PMID: 21933834 PMCID: PMC3573670 DOI: 10.1177/1740774511416524] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Loss to follow-up of trial participants represents a threat to research validity. To date, interventions designed to increase participants' awareness of benefits to society of completing follow-up, and the impact of a telephone call from a senior female clinician and researcher requesting follow-up have not been evaluated robustly. PURPOSE Trial 1 aimed to evaluate the effect on trial follow-up of written information regarding the benefits of participation to society. Trial 2 aimed to evaluate the effect on trial follow-up of a telephone call from a senior female clinician and researcher. METHODS Two single-blind randomized controlled trials were nested within a larger trial, Txt2stop. In Trial 1, participants were allocated using minimization to receive a refrigerator magnet and a text message emphasizing the benefits to society of completing follow-up, or to a control group receiving a simple reminder regarding follow-up. In Trial 2, participants were randomly allocated to receive a telephone call from a senior female clinician and researcher, or to a control group receiving standard Txt2stop follow-up procedures. RESULTS Trial 1: 33.5% (327 of 976) of the intervention group and 33.8% (329 of 974) of the control group returned the questionnaire within 26 weeks of randomization, risk ratio (RR) 0.99; 95% confidence interval (CI) 0.88-1.12. In all, 83.3% (813 of 976) of the intervention group and 82.2% (801 of/974) of the control group sent back the questionnaire within 30 weeks of randomization, RR 1.01; 95% CI 0.97, 1.05. Trial 2: 31% (20 of 65) of the intervention group and 32% (20 of 62) of the control group completed trial follow-up, RR 0.93; 95%CI 0.44, 1.98. CONCLUSIONS In presence of other methods to increase follow-up neither experimental method (refrigerator magnet and text message emphasizing participation's benefits to society nor a telephone call from study's principal investigator) increased participant follow-up in the Txt2stop trial.
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Manson SM, Jiang L, Zhang L, Beals J, Acton KJ, Roubideaux Y. Special diabetes program for Indians: retention in cardiovascular risk reduction. THE GERONTOLOGIST 2011; 51 Suppl 1:S21-32. [PMID: 21565816 DOI: 10.1093/geront/gnq083] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This study examined the associations between participant and site characteristics and retention in a multisite cardiovascular disease risk reduction project. DESIGN AND METHODS Data were derived from the Special Diabetes Program for Indians Healthy Heart Demonstration Project, an intervention to reduce cardiovascular risk among American Indians and Alaska Natives with diabetes. In 2006, a total of 1,072 participants from 30 participating sites completed baseline questionnaires measuring demographics and sociobehavioral factors. They also underwent a medical examination at baseline and were reassessed annually after baseline. A Provider Annual Questionnaire was administered to staff members of each grantee site at the end of each year to assess site characteristics. Generalized estimating equation models were used to evaluate the relationships between participant and site characteristics and retention 1 year after baseline. RESULTS Among enrolled participants, 792 (74%) completed their first annual assessment. Participants who completed the first annual assessment tended to be older and had, at baseline, higher body mass index and higher level of physical activity. Site characteristics associated with retention included average age of staff, proportion of female staff members, and percentage of staff members having completed graduate or professional school. IMPLICATIONS Understanding successful retention must reach beyond individual characteristics of participants to include features of the settings that house the interventions.
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Affiliation(s)
- Spero M Manson
- Centers for American Indian and Alaska Native Health, University of Colorado Denver, 13055 East 17th Avenue, Mail Stop F800, Aurora, CO 80045.
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Sahay S, Gupte N, Brahme RG, Nirmalkar A, Bembalkar S, Bollinger RC, Mehendale S. Predictors of retention among men attending STI clinics in HIV prevention programs and research: a case control study in Pune, India. PLoS One 2011; 6:e17448. [PMID: 21412414 PMCID: PMC3055872 DOI: 10.1371/journal.pone.0017448] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 02/04/2011] [Indexed: 11/18/2022] Open
Abstract
Background Retention is critical in HIV prevention programs and clinical research. We studied retention in the three modeled scenarios of primary prevention programs, cohort studies and clinical trials to identify predictors of retention. Methodology/Principal Findings Men attending Sexually Transmitted Infection (STI) clinics (n = 10, 801) were followed in a cohort study spanning over a ten year period (1993–2002) in Pune, India. Using pre-set definitions, cases with optimal retention in prevention program (n = 1286), cohort study (n = 940) and clinical trial (n = 896) were identified from this cohort. Equal number of controls matched for age and period of enrollment were selected. A case control analysis using conditional logistic regression was performed. Being employed was a predictor of lower retention in all the three modeled scenarios. Presence of genital ulcer disease (GUD), history of commercial sex work and living away from the family were predictors of lower retention in primary prevention, cohort study and clinical trial models respectively. Alcohol consumption predicted lower retention in cohort study and clinical trial models. Married monogamous men were less likely to be retained in the primary prevention and cohort study models. Conclusions/Significance Predicting potential drop-outs among the beneficiaries or research participants at entry point in the prevention programs and research respectively is possible. Suitable interventions might help in optimizing retention. Customized counseling to prepare the clients properly may help in their retention.
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Affiliation(s)
- Seema Sahay
- Division of Social and Behavioral Research, National AIDS Research Institute, Pune, India.
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Brueton VC, Rait G, Tierney J, Meredith S, Darbyshire J, Harding S, Stenning S, Nazareth I. Strategies to reduce attrition in randomised trials. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2011. [DOI: 10.1002/14651858.mr000032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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17
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Zook PM, Jordan C, Adams B, Visness CM, Walter M, Pollenz K, Logan J, Tesson E, Smartt E, Chen A, D'Agostino J, Gern JE. Retention strategies and predictors of attrition in an urban pediatric asthma study. Clin Trials 2010; 7:400-10. [PMID: 20571137 DOI: 10.1177/1740774510373798] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The Urban Environment and Childhood Asthma (URECA) study is a multicenter prospective birth cohort study designed to examine factors related to the development of childhood asthma and allergies in an inner-city population. The retention of these participants has been challenging due to high mobility, inconsistent phone service, custody issues, and stressful life situations. PURPOSE In this article, we describe the specific retention challenges we encountered during the first 2 years of follow-up in URECA and the strategies we utilized to address them. We also examine how selected maternal characteristics and other factors are related to retention and missed study visits. METHODS Strategies implemented to engage participants included: collecting updated and alternative contact information, after-hours phone calls to participants, culturally competent staff, flexible study event scheduling, clinic visit transportation, quarterly newsletters, retention events, drop-in home visits, and cell phone reimbursements. An internally developed web-based data management system enabled close monitoring by site teams and the coordinating center. The rate of deactivations was calculated using survival analysis. Characteristics of active and deactivated participants were compared using the chi-squared test with a Cochran-Mantel - Haenszel adjustment for study site. The proportion of missed visits of the total expected in the first 2 years was calculated and compared by family characteristics using an ANOVA model or a trend test controlling for study site. All analyses were performed using SAS version 9.1 (Cary, NC). RESULTS The 2-year retention rate was 89%. Participation in the first study event predicted subsequent engagement in study activities. Mothers who did not complete the first visit were more likely to miss future events (46.1% vs. 8.9%, p<0.0001) and to be deactivated (38.5% vs. 4.5%, p<0.0001). Mothers under 18 years of age were more likely to leave the study compared to older mothers (22.7% vs. 10.1%, p = 0.02). Also, mothers who were married missed fewer events than those not married (8.8% vs. 15.6%, p = 0.01). In addition, deactivations were more common when the child had entered daycare by 3 months of age (10.9% vs. 3.6%, p = 0.05). LIMITATIONS The URECA population is predominantly minority, thus our findings might not be generalizable to other populations. Furthermore, we may not be able to observe the effects that might exist in a more diverse population. For example, 86% of the mothers are unmarried, making it difficult to reliably examine the effect of marital status. CONCLUSION In research, successfully engaging and retaining participants is essential for achieving the study objectives. Identifying factors related to missed visits and deactivations are the initial step in recognizing the potential at-risk participants and can enable the design of targeted strategies to retain participants.
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Affiliation(s)
- Patricia M Zook
- Statistical and Clinical Coordinating Center - Rho Federal Systems Division, Inc., Chapel Hill, NC, USA.
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Furin J, Behforouz H, Shin S, Mukherjee J, Bayona J, Farmer P, Kim J, Keshavjee S. Expanding Global HIV Treatment. Ann N Y Acad Sci 2008; 1136:12-20. [DOI: 10.1196/annals.1425.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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