Microbicide Trials Network

MTN-011 Study Implementation Materials

DescriptionDateSize
Baseline Medical History Questions Sheet2012-Jul-1622.71 KB
Baseline Questionnaire2013-Feb-0438.33 KB
Contraceptive Worksheet2012-Aug-0916.15 KB
Group 1 - Male Practices Questionnaire2012-Jun-0617.49 KB
Group 2 - Male Practices Questionnaire2012-Jun-0617.69 KB
Group 2 Home Dosing Log2012-Sep-0721.74 KB
LDMS Specimen Tracking Sheet - FEMALE2013-Feb-18124.4 KB
LDMS Specimen Tracking Sheet - MALE2012-Sep-1977.34 KB
Men's Acceptability Questionnaire2013-Feb-2836.26 KB
MTN-011 Financial Disclosure Form2014-Aug-0721.74 KB
MTN-011 Financial Disclosure Form - Protocol Chair2014-Aug-0721.97 KB
Pre-existing Conditions Resolution Tracker (for male participants)2012-Jul-1111.69 KB
Product Adherence Counseling Checklist - Enrollment2012-Aug-0916.26 KB
Product Adherence Counseling Checklist - Follow-up2012-Aug-0914.71 KB
Protocol Safety Review Team Query Form2012-Aug-0923.1 KB
QxQ CASI Questionnaires2012-Sep-2448.95 KB
Screening and Enrollment Informed Consent Comprehension Checklist for Men2012-May-1146.5 KB
Screening and Enrollment Informed Consent Comprehension Checklist for Women2012-May-1146.5 KB
Version 2 Eligibility Checklist - Men2013-Jan-31285.03 KB
Version 2 Eligibility Checklist - Women2013-Jan-31312.58 KB
Version 3 Eligibility Checklist - Men2013-Oct-10383.91 KB
Version 3 Eligibility Checklist - Women2013-Oct-10436.83 KB
Visit Calendar Tool2013-Jan-2226.99 KB
Visit Calendar Tool (Protocol Version 2.0)2013-Dec-0428.26 KB
Women's Acceptability Questionnaire2013-Mar-0237.44 KB
I. Sample Visit Checklists, Version 2.0
Female and Male Enrollment Visit Checklist (GROUP 1)2013-Nov-1828.16 KB
Female and Male Screening Visit Checklist (G1 and G2)2013-Nov-1835.19 KB
Female Follow-up Visit Checklist (Group 1)2013-Nov-1829.76 KB
MALE Follow-up Visit Checklist (Group 1)2013-Nov-1827.84 KB
Pelvic Exam Checklist2013-Nov-1825.6 KB
II. Sample Visit Checklists, Version 1.0
Female and Male Screening Visit Checklist (G1 and G2)2012-Aug-1434.13 KB
Female and Male Enrollment Visit Checklist (GROUP 1)2012-Sep-2425.49 KB
Female and Male Enrollment Visit Checklist (GROUP 2)2012-Sep-2424.46 KB
Female Follow-up Visit Checklist (Group 1)2012-Sep-2428.36 KB
Female Follow-up Visit Checklist (Group 2)2012-Sep-2427.99 KB
Male Follow-up Visit Checklist (Group 1)2012-Sep-2426.6 KB
Male Follow-up Visit Checklist (Group 2)2012-Sep-2424.68 KB
Female and Male Final Visit Checklist (Group 2)2012-Aug-1427.82 KB
Pelvic Exam Checklist2013-Feb-2124.72 KB