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CT site successfully recruited minorities for HIV vaccine study
Community recruiters, bus ads helped
When a phase IIb clinical trial site needed to ensure minority enrollment in an HIV vaccine trial, CT staff and investigators tried a variety of successful methods to engage and educate the targeted community.
"We enrolled for two years between March, 2005 and March, 2007, and were one of the top-enrolling sites," says Paula Frew, PhD, MPH, assistant professor of medicine in infectious disease and in behavioral sciences and health education at the School of Medicine and Rollins School of Public Health of Emory University in Atlanta, GA.
It's a priority in many HIV clinical trials to enroll minority participants, especially African Americans, because the African Americans are disproportionately impacted by the HIV/AIDS epidemic in the United States.
So investigators first formed a community advisory board (CAB) that included representatives from all of the targeted communities, and then devised strategies for community outreach. Here are their strategies:
• Recruiting black women: CT staff and investigators learned that a good way to reach African American women was to provide face-to-face activities, Frew says.
"We hired a woman from the community who had done clinical trial recruitment with high-risk populations in the past," she explains. "We went into parts of town where they had higher HIV prevalence and had this woman out on the street, meeting people."
The site also hired another woman to help have discussions with women who might be interested in being part of an HIV prevention study," Frew adds.
Dázon Dixon Diallo, MPH, of SisterLove Inc. of Atlanta, a group focused on HIV/AIDS education for women, was an expert consultant to the vaccine study, Frew says.
"She's an expert on African American women issues related to HIV risk and on communication with the group we were trying to meet," Frew adds.
The site invited African American women to various activities and events an also bought advertising in newspapers and magazines popular in that community, she says.
"It's helpful to extend our reach," Frew explains. "We ran ads on Marta buses, and people thought that was very novel."
The key was having trusted members of the target community help the CT site with designing and doing outreach events that resonated with the target group, she adds.
"We knew where to find women, and that's where we went," Frew says.
• Reaching men who have sex with men (MSM): The CT site used the Internet to reach MSM.
When the study began several years ago, Facebook and some of the other most popular social networking sites didn't exist, but there were other online venues that were frequented by MSM, Frew notes.
"We identified various online sites that we could advertise on, and we placed banner ads on those Web sites," she says. "We also had one of our recruiters go into chat rooms and host discussions with members who were in those chat rooms."
The recruiters were part of the MSM community, who they hired because of their expertise on where the site could find its target population.
"We put about a 40% weight on the recruiters and a 30 to 40% weight on Internet recruiting," Frew says. "We also had a heavy volume of mass media advertising and advertising in local Southern gay newspapers."
A significant proportion of the recruitment budget went toward print and online advertising, and a smaller percentage went toward participation in community events, such as PRIDE, the annual gay festival in Atlanta, Frew adds.
"We had recruiters at the events and often CAB members with us," she says. "Many of the CAB members who are from the community are recognized and trusted in the community, so when people see them, it conveys a certain amount of trust in what we're doing."
• Targeting black MSM: The same strategies employed to reach MSM in general were also aimed at reaching African American men who have sex with men, Frew says.
There were some specific outreach attempts aimed at African American MSM, including having CT recruiters at Atlanta's annual black gay pride event called In The Life Atlanta (ITLA), and ads placed in black gay publications, she notes.
"We made sure we were working with our partners very closely and online, and we reached out through appropriate mechanisms," Frew says.
The efforts resulted in successful minority recruitment and enrollment in the vaccine trial, she says.
"We were very pleased our strategies and behavioral research done in advance of the study paid off for us," Frew says. "All of that investment did yield some reasonable percent of minority participation, and hopefully that will carry over into other studies."
In fact, there already has been a carry-over effect seen in Atlanta, she notes.
"We just finished a phase I microbicide study in Atlanta and 44% of participants were African American women," Frew says.
"It's all about building trust and a relationship with the community and having an informed recruitment approach," she adds. "We did a lot to help us understand the women we were going to try to focus on to enroll in the study, and understanding a lot of factors in advance helped us get to that point."