title: A novel use of a statewide telecolposcopy network for recruitment of participants in a Phase I clinical trial of a human papillomavirus therapeutic vaccine.
abstract: BACKGROUND
  Historically, recruitment and retention of young women in intervention-based clinical trials have been challenging. In August 2012, enrollment for a clinical trial testing of an investigational human papillomavirus therapeutic vaccine called PepCan was opened at our institution. This study was an open-label, single-arm, single-institution, dose-escalation Phase I clinical trial. Women with recent Papanicolaou smear results showing high-grade squamous intraepithelial lesions or results that could not rule out high-grade squamous intraepithelial lesion were eligible to enroll. Patients with biopsy-confirmed high-grade squamous intraepithelial lesion were also eligible. Colposcopy was performed at the screening visit, and participants became eligible for vaccination when the diagnosis of high-grade squamous intraepithelial lesion was confirmed with biopsy and other inclusion criteria were met. The aim of this study was to identify strategies and factors effective in recruitment and retention of study participants.
  
  
  METHODS
  Potential vaccine candidates were recruited through direct advertisement as well as referrals, including referrals through the Arkansas telecolposcopy network. The network is a federally funded program, administered by physicians and advanced practice nurses. The network telemedically links rural health sites and allows physician-guided colposcopy and biopsies to be conducted by advanced practice nurses. A variety of strategies were employed to assure good retention, including face-to-face contact with the study coordinator at the time of consent and most of study visits; frequent contact using text messaging, phone calls, and e-mails; and creation of a private Facebook page to improve communication among research staff and study participants. A questionnaire, inquiring about motivation for joining the study, occupation, education, household income, number of children, and number of sexual partners, was administered at the screening visit with the intent of identifying factor(s) associated with recruitment and retention.
  
  
  RESULTS
  A total of 37 participants were enrolled between September 2012 and March 2014. The largest proportion of participants (46%) was enrolled from the telecolposcopy network. Others were enrolled through outside institutions (43%), in-house referrals (8%), or direct advertisement (3%). Most participants were motivated to join the study to take care of their health issues. Only two participants joined the Facebook private page. Of the 24 participants who qualified for vaccination, only 1 terminated early due to an unanticipated move.
  
  
  CONCLUSIONS
  The availability of a large number of potential participants from the telecolposcopy network increased recruitment to this clinical trial by 85% over other traditional means of recruitment. The telecolposcopy network is not only a means of providing a gynecological service to women who otherwise would forego care but also a novel and valuable resource in recruiting participants for a clinical trial.
authors.affiliation: Clinical Research Services Core, Translational Research Institute, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA.
authors.forename: Shawna L
authors.initials: SL
authors.lastname: Stratton
authors.affiliation: Department of Biostatistics, College of Medicine, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA.
authors.forename: Horace J
authors.initials: HJ
authors.lastname: Spencer
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA.
authors.forename: William W
authors.initials: WW
authors.lastname: Greenfield
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA.
authors.forename: Gordon
authors.initials: G
authors.lastname: Low
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA.
authors.forename: Wilbur C
authors.initials: WC
authors.lastname: Hitt
authors.affiliation: Department of Pathology, College of Medicine, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Quick
authors.affiliation: Department of Pathology, College of Medicine, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA.
authors.forename: Susanne K
authors.initials: SK
authors.lastname: Jeffus
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA.
authors.forename: Victoria
authors.initials: V
authors.lastname: Blackmon
authors.affiliation: Department of Pathology, College of Medicine, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA mnakagawa@uams.edu.
authors.forename: Mayumi
authors.initials: M
authors.lastname: Nakagawa
mesh_terms: D000328:Adult; D003127:Colposcopy / Q000379:methods*; D003142:Communication; D005260:Female; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D018579:Patient Selection; D012107:Research Design; D019035:Rural Health Services / Q000458:organization & administration; D012959:Socioeconomic Factors; D065310:Squamous Intraepithelial Lesions of the Cervix / Q000175:diagnosis*; D017216:Telemedicine / Q000458:organization & administration*
chemical_list: D053918:Papillomavirus Vaccines
keywords: Facebook; Telecolposcopy network; human papillomavirus; recruitment; therapeutic vaccine