The lack of provision for clean needles affected the data in that key stakeholders did not have any confidence in the validity of the results. This is not good in that the stakeholders are unlikely to share these results with their communities. Stakeholder engagement was not implemented properly and it is evident. Stakeholders were not consulted during the conception and write up of the protocol.

Attempts to engage stakeholders before trial implementation is crucial. This will help the site staff and sponsors see any potential problems that may arise in the various communities and get a chance to iron out those issues before trial implementation. Stakeholders are valuable to the trial if they are on board and have knowledge of the trial prior to trial implementation so all efforts to consult and engage with them should be tried. Find out when the local community has any meetings and inform the community about the trial at those meetings or at community events. Putting out an ad on the local newspaper and the local radio station could also prove to be fruitful and could get the community and stakeholders talking.