Table 4.

Lesson learned and recommendations

Implementation area	Lessons learned and recommendations
Conducting research in communities	Lessons learned: Conducting research in communities offers many benefits but introduces challenges requiring rapid responses and pivoting. Research activities may conflict with the direct service provision site mandates or business operations of partner organizations. Not all sites are suitable for data collection, even if partner organizations agree to data collection on site. On-site research may create safety risks for research staff. Recommendations: Teams are guests of partner organizations and must work with the schedules, workflow, and spacing needs of direct service provision sites. Initiate regular communication with partner organizations to maintain trust and share information. Provide weekly team updates and scheduling changes, actively solicit their concerns, and resolve conflicts together. Be willing to pause data collection while seeking solutions. Consider situating recruitment and data collection activities in nearby accessible community spaces (e.g., public health departments, parking lots of clinics and hospitals or the sites) or leasing a mobile study van or tent that can be stationed adjacent to sites, to offer privacy to participants. Assess ongoing suitability of each site throughout data collection. Consider providing additional incentives to PWUD participants who complete the study to improve retention. Create a central SmartSheet or discussion forum for teams to identify real-time challenges and resolutions.
Making timely payments	Lessons learned: Late payments to PWUD participants and difficulty accessing those payments can distress participants and cause high workloads for the team. Multiple compensation models for organizational participants may be appropriate. Payment to partner organizations may need to be formalized in memorandums of understanding. These may take months to generate and delay payment. Recommendations: Prioritize equitable and timely compensation that values the expertise of PWUD participants, organizational participants, and partner organizations. Select participant incentive payment systems supported by the institution, communicate activation instructions to participants with handouts, and allows for delays with the payment system (e.g., system upgrades or institutional delays making contracted payments). Set realistic timelines to load payments to cards that accommodate surges in participant volume (e.g., before the weekend). Communicate payment timelines to participants at every contact to set expectations and reduce distress. Reassure partner organizations that compensation payments are being approved and provide updates on when they will receive them.
Ov ersight of research staff	Lessons learned: Collecting data with vulnerable participants can be physically and emotionally demanding for research staff, even with experience. Long driving times to reach data collection sites increases fatigue and accident risk, particularly during inclement weather. Staff may be both energized and exhausted from meeting with participants and challenged by setting limits on interactions. Staff who manage participant communications and incentive payments may work beyond effort allocation at peak periods, including weekends and holidays. Employees of direct service provision sites who are contracted to recruit and collect data may be inconsistent in their research practices. Recommendations: The well-being of research staff contributes to team cohesion and commitment to study completion. Monitor staff well-being and hours. When staff develop fatigue, reduce the number of data collection sites, contract part-time study personnel, ask other staff to assist with data collection, or pause activities to provide rest. Allow staff to cancel data collection if inclement weather poses a driving or outdoors hazard. Encourage staff to respect their limits (e.g., leave sites when their hours are completed) and prioritize their safety. Provide additional on-site training to employees of data collection sites and check on the consistency of their practices.
Returning oral fluid results to participants	Lesson learned: Returning oral fluid results to PWUD participants can provide actionable information but increases operational complexity by adding non-data collection contact events. Return of oral fluid results can be burdensome to research staff, partner organizations, and/or participants. Staff may need to schedule appointments with participants and add additional driving once data collection has ended. Recommendations: Acknowledge the validity of different implementation approaches, along with potential burdens to all parties. Solicit preferences of partner organizations for approaches to return results that are minimally disruptive. Balance pragmatic considerations for most effective return approaches with ethical concerns about protecting participant privacy and integrity of results. There may be no single best practice, and several approaches can achieve the same objectives. Communicate the intention and purpose of returning oral fluid results to partner organizations so that they understand this is a non-data collection event and can communicate this to PWUD participants.