Although at the end BTS yield good results, I think there was problem is stakeholder engagement at different levels (the onion diagram) in the beginning of the trial. It seems there was no common understanding among advocates, organization and different network, the Ministry of Public Health and the sponsors on the details of the trial design and procedures.  On the other hand the reaction of advocates showed the research team that the community is not asleep, thus it was a call for the researchers to do better stakeholder engagement in future.

For better negotiation of HIV prevention package,  the research team was supposed to engage (may be at the stage of trial design) with the Bangkok Metropolitan Administration, the Thailand Ministry of Public Health, Thailand’s narcotics law officials and the sponsors (CDC). These stakeholders would have understood importance of provision of clean needles to study participants for the success of research.