CHWs as clinical trial staff: Strategies used and lessons learned from a study in rural Uganda

In rural Uganda there is a growing trend of CHW participation in health services. Since 2005 CHWs have been administering the injectable contraception depot medroxyprogesterone acetate (DMPA) to clients. As the responsibilities of CHWs expands, their exposure to and role in clinical trials will increase. However, CHWs with previous research experience is rare. Clinical trials traditionally take place in clinic settings and adhere to stringent guidelines called Good Clinical Practice (GCP) to protect human subjects involved in trials. Thirty-eight CHWs from Mubende and Nakasongola districts were trained to be staff family planning (FP) providers in a clinical trial studying the acceptability of depo-subQ in Uniject. The study assessed FP provider and DMPA client acceptability of this new injectable contraceptive method. To assess acceptability, the study was designed to maintain CHW current working practices as close as possible. CHWs routinely collect FP supplies from local clinics, transport and store the supplies in their home, and provide FP counseling and services to clients in a variety of community settings including their home. In this presentation, we will discuss the challenges faced and strategies used to meet GCP guidelines in this non-clinic setting, with a focus on CHW training and oversight, and CHWs' role in meeting documentation requirements, client participant recruitment and consent, and study product storage and accountability. As CHW participation in health services continues to grow, the challenges and lessons learned from this example will help inform future research strategies considering engaging CHWs as researchers.