Conclusions
malaria
MALARIA
Building trust and working relationships were crucial for the implementation of a complex trial design that assigned participants responsibility for correct adherence to drug regimens, communication with the trial team, as well as in maintaining long-term collaboration with communities and marginalized groups in this malaria endemic area. In order to build trust, a carefully developed, continually adapted and long-term community engagement strategy was essential. Being flexible and responsive to the needs and concerns of the community members (e.g. ancillary health care) were critical aspects of the community engagement strategy. Each village was unique in terms of social and cultural context, for instance, ethnic backgrounds, authority structures and dynamics with the population, literacy and health conditions such that the engagement needed tailored approaches. The participatory engagement strategy required extensive planning and multiple adaptations that ultimately contributed to the successful implementation of a clinical trial in a hard-to-reach and remote population.