Research fatigue among injecting drug users in Karachi, Pakistan

Abstract

BackgroundKarachi is the largest metropolis of Pakistan and its economic hub attracting domestic migrants for economic opportunities. It is also the epicenter of HIV epidemic in the country. Since 2004, one pilot study and four behavioral and biological surveillance rounds have been conducted in Karachi. In addition many student research projects have also focused on key risk groups including injection drug users (IDUs). As a result of this extra ordinary exposure of same kind of questions, IDUs know how to respond to high value questions related to sharing of needles or unsafe sexual practices. The purpose of the study was to explore the element of research fatigue among IDUs in Karachi, Pakistan.MethodsThe study was conducted on 32 spots in Karachi, selected on the basis of estimate of IDUs at each spot. A trained field worker (recovered IDU) visited each spot; observed sharing behavior of IDUs and asked questions related to practices in January 2009. Verbal consent was obtained from each respondent before asking questions.ResultsOn average 14 IDUs were present at each spot and out of 32 selected spots, 81% were active while more than two groups were present at 69% spots. In each group three to four IDUs were present and everyone in the group was sharing. One dose of injecting narcotics was observed. Sharing of syringes, needles and distilled water was observed at 63% spots while professional injector/street doctor was present at 60% spots.ConclusionThere is a need to check internal consistency in surveillance research. It is highly likely that IDUs and other risk groups know how to respond to key questions but their responses do not match with the practices.

The Cholera Phone: Diarrheal Disease Surveillance by Mobile Phone in Bangladesh

“…5 To measure changes in incident diarrhea, however, these surveys must be conducted for long periods, which are resource intensive and likely to lead to research fatigue, increasing dropout rates, compliance errors, and demographic challenges. 6,7 As mobile phones become increasingly used globally, they present an opportunity to communicate with households about disease events. 8 Using phones to report diarrheal disease events could provide many advantages over other surveillance methods, including reduced study fatigue compared with in-home visits, real-time reporting that could facilitate laboratory confirmation of etiology, and reporting of mild and moderate symptoms.…”