Microbicide Trials Network

MTN-013/IPM 026 Study Implementation Materials

Behavioral Measures
CASI Questionnaire Question by Question (QxQ) Instructions2011-Sep-02156.05 KB
Semi-Structured File Log2012-Mar-2626 KB
Semi-Structured Interview2012-Mar-2656.5 KB
Site Implementation Tools
Baseline Medical History Questions2011-Jul-1168 KB
Baseline Pregnancy/Contraceptive History2011-Jul-1155.5 KB
Baseline/Follow-up Medical History Overview2011-Jul-1136.01 KB
Calculated Creatinine Clearance Worksheet - mg/dL convert2011-Jul-2039.5 KB
Calculated Creatinine Clearance Worksheet - umoI/L Convert2011-Jul-2050.5 KB
Counseling Checklists2011-Sep-0156 KB
Eligibility Checklist, LoA#12011-Dec-1997.57 KB
Eligibility Checklist, Version 1.02011-Jun-1196.03 KB
Frequently Asked Questions2012-May-24326.84 KB
Informed Consent Checklist2011-Jul-2068.5 KB
Informed Consent Coversheet2011-Jul-2040 KB
Medical History Log2011-Jul-1153.5 KB
Menstrual History2011-Aug-1047 KB
PK Timepoint Calculator2012-Jan-2429 KB
Protocol Safety Review Team Query Form2011-Sep-0136 KB
Ring Use Log2011-Sep-0146 KB
Screening & Enrollment Log2011-Nov-0169 KB
Visit Calendar Tool - Calculation of Last Possible Day to Enroll2011-Aug-1846.5 KB
Visit Checklists
01: Screening Visit Checklist2011-Dec-1981 KB
02: Enrollment Visit Checklist2011-Nov-14109.5 KB
03: Follow-up Visit Checklist, Days 1, 2, 3, 5, 7, 14, 212011-Nov-1468.5 KB
04: Follow-up Visit Checklist, Day 28, Ring Removal2011-Nov-1473 KB
05: Follow-up Visit Checklist, Days 29 & 302011-Sep-0259 KB
06: Follow-up Visit Checklist, Days 31, 35 & 422011-Nov-1466 KB
07: Follow-up Visit Checklist, Day 52, Final Visit/Early Termination2011-Nov-1466 KB
08: Pelvic Exam Checklists2012-Apr-1332.76 KB
09: Interim Visit Checklist2011-Jul-2757.5 KB