Wits RHI, an institute of the University of the Witwatersrand, is a leading African research institute focusing on sexual and reproductive health, HIV and vaccine-preventable diseases. The head office is strategically located in the Hugh Solomon Building, a heritage site within the Hillbrow Health Precinct (HHP). This places Wits RHI at the centre of the communities we serve, which are mostly marginalised or hard-to-reach and include women; pregnant women and mother and infant pairs; adolescents (both male and female); adults and children living with TB/HIV; people at high risk of HIV; and key populations (particularly sex workers, men who have sex with men and transgender people).
The Wits RHI site began enrolling participants in December 2015. Study Coordinator Krishnaveni Reddy tells us more about her team’s experience to date.
How many participants have you enrolled so far?
As of Friday 14 July 2017, we had enrolled 620 participants.
What has contributed to the success of your recruitment efforts?
Firstly, I would say diligence. Our team diligently goes out to recruit every day, and they maintain a positive attitude. Secondly, pre-screening tools help us ensure that only eligible women proceed to the site for full screening and enrolment. We have also refined our messaging and counselling techniques. Our community education sessions on family planning have also contributed to our recruitment efforts.
Where do you primarily recruit from?
We primarily recruit from local clinics within Region F in Johannesburg. We have noticed that word of mouth has contributed to our high recruitment numbers. We give our participants flyers that they give to their friends, neighbours and family members who might be interested in joining the study.
I know you run several other studies at this site. What has been the most surprising thing about ECHO?
There have been a lot of women who report that their partner or mother does not want them to use contraceptives. In cases like this, we gently ask questions, such as do they already have a baby or are they ready to have a baby? Ultimately, this kind of discussion helps women realise that they need to do what is right for them. Sometimes we ask them to bring their partners for a chat — in most cases this has worked and the participant has decided to join the study.
What has been the response from the community?
The response from the community has been positive. Participants are happy with the services provided at the Wits RHI Research Centre. In particular, participants are happy to receive free full health screening. I can think of a participant who moved back to KwaZulu Natal, but she chooses to come to our site in Johannesburg for her follow-up visits.
On the other hand, some community members are discouraged by the IUD and Jadelle side effects. For example, some women experience prolonged bleed, which has at times affected their employment. Before enrolment, we openly discuss potential side effects and possible options for managing these side effects. We are planning to hold a meeting with the participants in each arm to discuss their side effects and any other concerns they have about their assigned method.
Do you think ECHO has contributed to raising awareness on contraceptives?
Yes. Our community outreach includes comprehensive education programmes on contraceptives, which raise awareness on contraceptives and debunk the myths and stereotypes that exist in communities on various contraceptives, especially Jadelle and the IUD.
Can you say ECHO has contributed to the promotion of method mix?
Absolutely. The use of condoms along with all the other contraceptives is highly promoted whenever we speak to our participants and engage with community members.
Have you received any questions from participants about the new MEC guidance?
We are disseminating the new MEC guidance to participants, and to date we have not received any questions. This isn’t surprising because our messages have consistently addressed the potential for increased risk of HIV infection with DMPA use and the need for more evidence.
What have been the lessons learnt?
What participants say during the screening process is not conclusive. Many women during the screening process agree that they will accept any method they might be randomised on; however, in some cases when the method is assigned, participants have shown uncertainty. In these cases we have provided additional counselling to clarify uncertainties and any other concerns that the participant may have. With the uncertainties clarified many of the participants are happy to proceed with their assigned method. For those participants that not happy with their assigned method, we refer them to the nearest local clinic where they can receive their preferred method.
What are the main questions that participants have been asking?
How are our methods different from the methods they receive from the public clinic? We answer this by saying the methods we use on the ECHO Study are the same as those in the public clinics. We do however, offer a slightly different implant that is not available outside of the ECHO Study right now. These methods have been used by women for many years, and they are highly effective and reversible.
We would like to thank Krishnaveni Reddy (Study Coordinator) and the entire Wits RHI team for their dedication to this important study and their contributions to this article.