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Randomized Controlled Trial
. 2021 Dec 4;22(1):881.
doi: 10.1186/s13063-021-05850-0.

Optimising recruitment to a late-phase tuberculosis clinical trial: a qualitative study exploring patient and practitioner experiences in Uzbekistan

Alexandra Wharton-Smith  1 , Shona Horter  1 , Emma Douch  1 , Nell Gray  1 , Nicola James  1 , Bern-Thomas Nyang'wa  1   2 , Jatinder Singh  3 , Parpieva Nargiza Nusratovna  4 , Zinaida Tigay  5 , Emil Kazounis  1 , Gulayim Allanazarova  3 , Beverley Stringer  6
Affiliations
Randomized Controlled Trial

Optimising recruitment to a late-phase tuberculosis clinical trial: a qualitative study exploring patient and practitioner experiences in Uzbekistan

Alexandra Wharton-Smith et al. Trials. .

Abstract

Background: Addressing the global burden of multidrug-resistant tuberculosis (MDR-TB) requires identification of shorter, less toxic treatment regimens. Médecins Sans Frontières (MSF) is currently conducting a phase II/III randomised controlled clinical trial, to find more effective, shorter and tolerable treatments for people with MDR-TB. Recruitment to the trial in Uzbekistan has been slower than expected; we aimed to study patient and health worker experiences of the trial, examining potential factors perceived to impede and facilitate trial recruitment, as well as general perceptions of clinical research in this context.

Methods: We conducted a qualitative study using maximum variation, purposive sampling of participants. We carried out in-depth interviews (IDIs) and focus group discussions (FGDs) guided by semi-structured topic guides. In December 2019 and January 2020, 26 interviews were conducted with patients, Ministry of Health (MoH) and MSF staff and trial health workers, to explore challenges and barriers to patient recruitment as well as perceptions of the trial and research in general. Preliminary findings from the interviews informed three subsequent focus group discussions held with patients, nurses and counsellors. Focus groups adopted a person-centred design, brainstorming potential solutions to problems and barriers. Interviews and FGDs were audio recorded, translated and transcribed verbatim. Thematic analysis, drawing on constant comparison, was used to analyse the data.

Results: Health system contexts may compete with new approaches especially when legislative health regulations or policy around treatment is ingrained in staff beliefs, perceptions and practice, which can undermine clinical trial recruitment. Trust plays a significant role in how patients engage with the trial. Decision-making processes are dynamic and associated with relationship to diagnosis, assimilation of information, previous knowledge or experience and influence of peers and close relations.

Conclusions: This qualitative analysis highlights ways in which insights developed together with patients and healthcare workers might inform approaches towards improved recruitment into trials, with the overall objective of delivering evidence for better treatments.

Keywords: Clinical trial; Community engagement; MDR-TB; Qualitative; Recruitment.

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Conflict of interest statement

AWS, BS, ED, NG, SH, NJ, BN and JS were employed by MSF. All authors have declared that no competing interests exist.

Figures

Fig. 1
Fig. 1
Map of Karakalpakstan and its 14 rayons
Fig. 2
Fig. 2
Schema illustrating how aspects relating to trust may influence CT recruitment
Fig. 3
Fig. 3
Schema illustrating the dynamic processes in trial recruitment
Fig. 4
Fig. 4
a Drawing that illustrates the decision paths “CC” (Comprehensive Care) or CT (clinical trial) for a TB patient, HCW, FGD. b Sculpture depicting how community engagement activities should be held in all seasons (FGD, HCW). c Drawing that illustrates how patients suffer from TB (on left) and blossom under CT care and treatment (on right) (FGD, HCW)
See this image and copyright information in PMC

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