The "seeded" focus group: a strategy to recruit HIV plus community members into treatment research

Objective(s): We piloted an innovative community-based recruitment approach to contact known HIV+ individuals for referral to treatment without endangering their confidentiality. Methods: Nested within an HIV cohort study, operations research to monitor and improve rural uptake of antiretroviral therapy (ART) was conducted alongside the introduction of Tanzania's national treatment programme. We confronted the challenge of recruiting participants without inadvertently disclosing their HIV status to family or other community members. During post-test counselling, nurses compiled a list of HIV+ persons who expressed interest in being contacted when ART became available. Study numbers, but not names, of 12 "seeds'' were added to a randomly generated list of residents, matched by age group and sex, and all were invited to participate in focus-group discussions on community perceptions of treatment. After the discussion, the original counsellors met each participant in private, inviting the "seed'' for ART referral and offering VCT to others. Results: Ten "seeds'' were successfully located and attended the local focus-group discussion; all subsequently volunteered to undergo clinical tests in advance of receiving antiretroviral therapy. They also agreed to participate in a study of barriers to ART access. The other focus-group members contributed useful information on levels of understanding and support for treatment, and several came forward for HIV testing. Conclusions: The "seeded'' focus group is a very straightforward and easily arranged method of recruiting HIV+ people for research or service delivery within a wider context of engaging with local community perceptions.