By Martha Henry
The Botswana equivalent of knock knock is ko ko. For the Botswana
Combination Prevention Project field team, trying to contact family members of the 20% of randomly selected households in each village is their biggest challenge.
Adults of selected households are invited to participate in the Baseline Household Survey (BHS). Those who are HIV-negative are then invited to become part of the HIV Incidence Cohort that will establish the number of new infections that occur over the course of the study.
By randomly selecting which households will be visited, researchers control for the bias that easily finding people at home would have. It’s possible that people who are often absent from home are different in some ways relevant to the study from people who are usually present, making it even more important to reach and enroll people who are initially absent.
A number of factors influence when people are at home. The typical workweek in Botswana runs from 7:30 to 4:30, Monday through Friday. The team quickly realized that their hours would look nothing like that. Their task was to enroll 16- to 64-year-olds. Many of the people they found at home during working hours were young children or the elderly. The optimal time to reach adults was early evening or weekends. The team adapted accordingly, working mostly in the early evening and on weekends.
By protocol, a Research Assistant (RA) will make three attempts to reach each adult in a household. Depending on the size of the household, that could mean returning a dozen times, interviewing and testing one or more people, then returning again to reach other family members. RAs use cell phones, notes, and word of mouth to reach those who are missing.
In Botswana, people move with the seasons. To reach villagers in this highly mobile society, the team must time their campaigns for when most of a community will be in residence. If they arrive during certain seasons, they’ll miss important segments of the population.
“Each part of Botswana has different cultures, different ways of doing things for economic survival,” said Kutlwano Mukokomani, Operations and Project Manager for the BCPP. “Normally, we have three settlements, maybe four.” For example, he said, “I have where I stay, my home village. Then I have the lands where I plow; I’ll relocate and stay there through the plowing season. And then I have where I raise cattle—my cattle post. I also can go there sometimes.”
The village of Shakawe, located on the Okavango River, has a fishing season, a season for harvesting grass for thatch roofs, and the tourist season, during which many villagers leave to work at tourist lodges.
Knowledge of and respect for local cultures are essential to the study’s success. The team’s schedule relies heavily on guidance from in-country leadership. Despite the challenges of enrolling adults for the study, in late 2015 the team met their targets for the Baseline Household Survey (BHS).
Title photo by Dominic Chavez