Community Recruitment into a Cross-sectional
Survey Involving HIV Testing in Beira, Mozambique: Lessons Learned
Rildo Rafael,1 Juliana L. Conjera,2 Selma Mussa,1 Josefo J. Ferro,1 Ivete Meque,1 Karine Dubé,2 Jeannet Bos,3 Janneke van de Wijgert,3 Paul J. Feldblum2
Centro de Investigação de Doenças Infecciosas, Universidade Católica de Moçambique (UCM), Beira, Mozambique 2Family Health International (FHI), Research Triangle Park, Durham, NC and
FHI/Mozambique Country Office, Maputo, Mozambique 3Academic Medical Center, University of Amsterdam, Center for Poverty-related Communicable Diseases, The Netherlands
Recruitment of study candidates for HIV prevention
studies may be challenging when it involves HIV testing
and collection of blood samples. HIV-associated stigma
and myths about how researchers use blood collected
during research pose formidable obstacles both to
recruitment and retention. As part of a project to build
clinical research capacity in Beira, Mozambique, the
newly created Center for Infectious Disease Research,
affiliated with the Catholic University of Mozambique
(UCM), began an HIV prevalence and incidence study
that aims to recruit women at higher risk for HIV
Materials and Methods
Recruitment methods include:
n Community appraisals
n Community meetings that involve local leaders
n Meetings with nongovernmental organizations
n Cooperation with local health post centers
n Mapping of local risk areas and sites where high-risk
partnerships form (i.e., fishing markets)
The sampling frame
takes into account
the size of certain
neighborhoods, the
presence of bars and
markets (considered
‘high-risk’ places),
and the presence of
specific economic
Fishing Village in Beira, Mozambique (Photo by Karine Dubé/FHI)
activities (i.e.,
fishing markets). Trained community volunteers recruit
potential study candidates each day. Recruitment targets
are women with higher-risk sexual behavior who are
between ages 18-35, whose HIV status is unknown, and
who are not currently participating in another HIV study.
Women who are willing to consider enrollment into the
study undergo a detailed informed consent process prior
to enrollment, and are re-informed about important
study features during follow-up visits, as needed.
The most important early lesson learned is that
community recruitment staff must convey very clearly
how and why HIV testing is done. Thus far, messages
related to ‘confidence,’ ‘trust,’ ‘sincerity,’ and ‘motivation’
contributed positively to recruitment into the study. Still,
some women refused to participate because of negative
ideas about HIV testing or misperceptions around blood
draw. To these women, blood means life and strength,
and taking blood means taking a portion of that life and
strength. Community volunteers need to dispel prevailing
views that associate HIV testing with ‘horror,’ ‘fear,’ and
‘death.’ To meet this goal, volunteers received extensive
training that equipped them to deliver consistent and
correct messages.
To dispel myths
about HIV
testing even
further, study
staff have invited
volunteers into
the laboratory to
observe how they
Community Engagement Team (Photo by Karine Dubé/FHI)
process blood
specimens so that
they can convey accurately to potential study participants
how the specimens are used, and that they are intended
for study purposes only. Day-time recruitment of study
candidates seems feasible thus far, even though higherrisk encounters take place mostly at night (i.e., in bars).
Early study results are summarized in an accompanying
The biggest recruitment hurdles that community
volunteers face are fear of HIV testing in the community
and concerns about misuse of blood specimens. Study
staff are taking steps to address these issues. As a result,
enrollment is accelerating.

Mozambique Comm Karine Dube May1210.indd