Brazil - Clinical Exchange Programme

Sally Newell, Clinical Research Coordinator visiting Praca Onze Clinical Research Unit, Rio de Janiero

In August 2011 I was given the opportunity to visit the Praca Onze clinical research unit in Rio, Brazil. The arrangement was to spend a week with various members of the research team to gain some understanding of the organisation, conduct and implementation of clinical trials within HIV research in Rio.
 
The Praca Onze unit is part of the Hospital Escola Sao Francisco de Assis located just outside the heart of downtown Rio. It is part of the network of academic institutions that make up the Universidade Federal do Rio de Janeiro.

I spent the early part of the week getting to know the various members of the research team headed by Dr Mauro Schechter. The unit has many similarities to the clinical research unit at SSAT with physicians, nurses, study coordinators and pharmacists on site working on several projects. At the time of my visit the unit was involved in two trials, START and IPREX. Although the volume of active studies is some what less than SSAT the number of participants recruited is considerably greater with approximately 90 subjects alone enrolled in the START trial. As a result of this there are several individuals devoted exclusively to the task of data management and quality control, essentially completing trial paperwork and answering queries enabling an exceptional standard of data collection.

Another striking difference is how the unit manages both recruitment and retention of trial participants with the employment of staff to actively recruit off site within the community. The services provided by this highly capable team also include on site social work, psychologists and even individuals who would actively follow up those subjects who failed to attend study visits by visiting them at home. These methods all seems to be effective and although there are clear reasons for differences in the way we conduct research practices at SSAT I felt there were some areas we could learn from.

The second part of the week I spent visiting the University Hospital which treats many of the trial participants who require inpatient admissions. Part of this building had undergone some controlled demolition some years ago and much of the building work was ongoing. This was all explained to me by the driver from Praca Onze who gave me a lift to the hospital. Not only did we not speak the same language but he was driving at high speed across Rio with the siren blaring as we had ambient blood samples to deliver. It was quite a ride.

I also had time to explore some of the many fantastic sites that Rio has to offer including Christ the Redeemer and the Sugar Loaf Mountain. It was a fantastic experience!

Carina Beppu Yoshida visiting St Stephen's Centre in August 2011

The agenda (the subjects and the time) made for the Programme was very useful for me. To follow the HIV outpatients with Dr. Gazzard and Dr. Nelson was a good experience, including the Virtual Clinic and the Ward Round although these activities are not part of my routine. However, it was very interesting to participate in patients’ discussions. To meet the HIV research center was really useful for me since I could see relevant differences between my site and yours. I was really impressed with the facilities, including the laboratory and the pharmacy.  I liked to spend some time at pharmacy and at regulatory department. I could meet the pharmacy and bring some new ideas I can implement at site. In regard to the regulatory procedures, I could learn about the UK regulatory process and see the differences between UK and Brazil. Unfortunately I could not meet more the Inpatients area. Maybe, to increase the time there would be a good idea. My conversation with Breda Ward, Advanced HIV Practitioner, was very profitable since I could find out what responsibilities a nurse can have in UK. To meet more about my profession in another country was amazing as well as to have the possibility to change experiences concerning the research field. The conversation I had with the research physicians (Dr. Akil Jackson and Dr. Tristan Barber) was useful as well since their knowledge in research field is big. I suggest including one more day of activities in the Exchange Program, that is, from Monday through Friday. To spend more time assisting the HIV Outpatients or assisting the HIV Inpatients would be very interesting.
Now I have the possibility to talk about this great experience to the nurses who are under my coordination. I hope next year one of them might have the same opportunity I had. Definitely, the experience I had will contribute to my professional development.