Table 4.

Stakeholder engagement during the results dissemination phase for STREAM clinical trial

Stakeholder	Engagement activities/approach	Communication activities	Barriers addressed by engagement	Impact of engagement
Project coordinating unit, Country coordinating mechanism of GFATM and WHO country office	Activities: Attended CSO-led national forum “Civil Society leadership to end TB in Mongolia,” where study team presented results Strategic Insights: Engagement was important to ensure key donor organizations aware of excellent experience with shorter MDR-TB regimen assessed in the trial and operational achievements of trial team/NTP	Timing: Two months after results available Mode: In-person meeting Frequency: Once Written materials used (if any): PowerPoint deck prepared by Sponsor and adapted/translated for the local audience by the study team	Financial and human capacity constraints Lack of favorable research environment	Strengthened donor support for NTP, in particular, during later transition to shorter treatment regimen in response to STREAM results
MoH	Activities: Attended a meeting with study team to gain deeper understanding of the findings and discuss key outcomes and their potential implications for national policies and programs. Attended trial closing event for implementing partners (where study team presented results and CAB member shared her lived experience with TB and the trial) to acknowledge contributions of participants to the trial and achievements of trial team. Attended national CSO-led forum where study team presented results. Strategic insights: Participation of MoH in these events was important to reinforce MoH’s institutional commitment to the trial/research and “ownership” of trial’s results, while publicly acknowledging the contributions of participants and the site team to strengthening TB research in the country	Timing: Beginning shortly after results available Mode: In-person meetings Frequency: Twice Written materials used (if any): PowerPoint deck prepared by Sponsor and adapted/translated for the local audience by the study team	Lack of favorable research environment	Demonstrated buy-in of MoH for results Highlighted MoH’s support for research in the country and the achievements of the NCCD/NTP in implementing the trial Strengthened partnerships between MoH and implementing partners Helped reduce stigma of TB
NTP, NTRL of the NCCD	Activities: Attended trial closing event (see above) Strategic insights: Attendance at event was important to ensure NTP’s contributions to the trial were publicly acknowledged and they learned about the results their work helped to produce	Timing: One month after results available Mode: In-person meeting Frequency: Once Written materials used (if any): PowerPoint deck prepared by Sponsor and adapted/translated for the local audience by the study team	Lack of favorable research environment	Public recognition of trial’s positive impact on research capacity in the country and contribution of NTP to producing important evidence for improving TB care Strengthened partnerships between implementing partners Strengthened environment of trust surrounding the trial
Frontline health workers at district TB dispensaries	Activities: Attended trial closing event (see above) Strategic insights: Attendance at event was important to ensure contributions of frontline health workers to the trial were publicly acknowledged and they learned about the results their work helped to produce	Timing: One month after results available Mode: In-person meeting Frequency: Once Written materials used (if any): PowerPoint deck prepared by Sponsor and adapted/translated for the local audience by the study team	Lack of favorable research environment	Public recognition of trial’s positive impact on research capacity in the country and contribution of frontline health workers to producing important evidence for improving TB care Strengthened partnerships between implementing partners Strengthened environment of trust surrounding the trial
NCCD directors/management	Activities: Attended meeting with the study team where results presented before public dissemination events occurred	Timing: Shortly after results available (before public events) Mode: In-person meeting Frequency: Once Written materials used (if any): PowerPoint deck prepared by Sponsor and adapted/translated for the local audience by the study team	Lack of favorable research environment	Strengthened environment of trust surrounding the trial
Wider NCCD staff (Other Infectious Diseases staff)	Trial results dissemination meeting at the NCCD Dissemination of the printed trial results booklets	Timing: Eight months after the last participant enrollment at the site Mode: In-person Frequency: One time Strategic insights: - Widespread dissemination of trial findings and institutional knowledge sharing ensuring that key stakeholders were informed about the study’s findings and implications for policy planning and TB control efforts	Financial and human capacity constraints Lack of favorable research environment	Strengthened trial site transparency Strengthened partnership and trust
SC and EC	Activities: Attended online and in-person results sharing meetings with the site	Timing: Following the release of results Mode: Online and in-person meetings Frequency: Once for each stakeholder Written materials used (if any): PowerPoint deck prepared by Sponsor and adapted/translated for the local audience by the study team; key successes and challenges faced by the site	Lack of favorable research environment	Strengthened the transparency and ethical oversight Support the translation of evidence into policy or programmatic decisions Reinforced collaboration among researchers and regulatory bodies, improving coordination for future studies
CSOs	Activities: MTC organized and led a national forum in partnership with the site called “Civil Society leadership to end TB in Mongolia,” where study team presented results Strategic Insights: Decision to disseminate results through a CSO-led event for multiple stakeholders emphasized the important role of CSOs in research, as well as promoting knowledge exchange and encouraging participation in TB research Dissemination at CSO-led event was an opportunity for CSOs and site to work together, strengthening partnership	Timing: Two months after the last participant’s follow up at the site Mode: In-person meeting Frequency: Once Written materials used (if any): PowerPoint deck prepared by Sponsor and adapted/translated for the local audience by the CAB and study team	Lack of favorable research environment	Underscored positive role CSOs can play in the research cycle and programmatic TB care Strengthened partnerships between CSOs and health sector stakeholders
CAB	Activities: Shortly after results available, attended small meeting with study team where results were presented to CAB in advance of public events. Attended national CSO-led forum where study team presented results. Participated in evaluation of Stage 1 dissemination, providing feedback to improve Stage 2 dissemination. Some CAB members participated in small working group formed to develop the Stage 2 dissemination strategy/materials with the sponsor. Hosted dissemination event for patients and families, featuring celebrations, poetry reading and singing performances. Worked with study team to develop dissemination materials for communication to wider community. Strategic insights: CAB participation improved the dissemination process and materials, built capacity of CAB members and strengthened relationship of CAB with health sector.	Timing: Beginning three months before availability of results and ending four months after Mode: Virtual and In-person meetings Frequency: Each dissemination event occurred once for each Stage of STREAM. There were app. 5 meetings to develop the Stage 2 dissemination plan and materials. Written materials used (if any): Study team used PowerPoint deck to share results with CAB. CAB reviewed/revised draft dissemination materials aimed at patients and community members provided by sponsor. CAB developed social media and broadcast television materials with support of study team.	Lack of favorable research environment	Deepened CAB’s understanding of research concepts and communications. Built trust between CAB and study team, who worked together to implement the dissemination plan. Improved reach and impact of results of the trial by ensuring they were communicated using appropriate materials
Participantss and families	Activities: Attended celebratory meeting hosted by the CAB, where study team communicated results of the trial Some participants attended one-on-one meetings with the PI to discuss the trial/results Strategic insights: Succes of event improved through active outreach to participants, encouraging attendance at the event. Significant input of CAB members into dissemination materials helped ensure they were appropriate and relevant for participants and their families One-on-one sessions with PI provide an opportunity for participants to ask questions and strengthened participant trust in the trial process	Timing: One month after results available Mode: In-person Frequency: One time Written materials used (if any): PowerPoint deck for patients and community members developed by sponsor and CAB. “One-pager” summarizing results developed by sponsor and CAB.	Lack of favorable research environment	Improved patient experience and involvement Strengthened perception of trial transparency and built trust in research Improved family support for people with TB and helped reduce stigma Strengthened ownership of results of trial
Wider Community	Trial results were shared via CAB social media page Trial experience documentary was broadcasted by the National TV channels	Timing: Eight months after the last participant follow-up visit at the site Mode: In-person/online Frequency: One time Strategic insights: - Community-led information sharing and national media advocacy: Leveraging social media and TV broadcasts to enhance public awareness of TB research, trial implementation and its impact on TB care and policy	Lack of favorable research environment	Addressing TB stigma and discrimination Improved community engagement in research and acceptance of trial