Microbicide Trials Network

MTN-029/IPM 039 Study Implementation Materials

DescriptionDateSize
Baseline Medical History Questions Sheet2015-Oct-2940.31 KB
Breast Milk Production Maintenance Counseling Worksheet2015-Oct-1324.18 KB
Eligibility Checklist2015-Nov-02119 KB
Enrollment Behavioral Eligibility Worksheet2015-Oct-2927.96 KB
Follow- up Medical History Log2015-Oct-1942.75 KB
HIV Pre/Post Test Counseling Worksheet2015-Sep-1423.77 KB
Informed Consent Comprehension Assessment (Open Ended)2015-Sep-1528.32 KB
Informed Consent Comprehension Assessment (True/False)2015-Sep-0427.31 KB
Informed Consent Cover Sheet2015-Jul-3125.65 KB
Participant Breast Milk Collection Log2016-Feb-1666.03 KB
Participant Ring Use Log2016-Apr-28170 KB
Protocol Adherence Counseling Worksheet2015-Nov-1927.4 KB
Protocol Safety Review Team Query Form2015-Sep-0879 KB
Screening and Enrollment Log2015-Sep-1531.1 KB
Screening Behavioral Eligibility Worksheet2015-Oct-2972.75 KB
Site-Specific Clinic Study Product Accountability Log2015-Nov-1019.01 KB
Study Staff Delegation of Duties (DoD) and Signature Key/Staff Roster2015-Sep-1598 KB
Suggested Filing Structure for MTN-029/IPM 039 Essential Documents2015-Oct-2827.95 KB
Template Source Document SOP2015-Nov-02197.5 KB
Vaginal Ring Insertion Instructions2015-Jul-311.13 MB
Visit Calendar Tool2015-Nov-0919.48 KB
Financial Disclosure
Financial Disclosure Form2016-May-0325.72 KB
Financial Disclosure Form for Protocol Chair2016-May-0324.07 KB
Financial Disclosure Form Training Slides2016-Apr-29495.58 KB
LDMS Specimen Tracking Sheets
At-home Breast Milk2016-Mar-24272.15 KB
Enrollment Baseline2016-Mar-24294.11 KB
Enrollment PK/PD2016-Mar-24302.7 KB
Follow-Up Specimens2016-Mar-24346.29 KB
Visit Checklists
01. Screening Visit Checklist2015-Oct-16116.5 KB
02. Enrollment Visit Checklist2015-Oct-16109.5 KB
03. Day 1 Visit Checklist2015-Oct-16108 KB
04. Day 7 Visit Checklist2015-Oct-16110.5 KB
05. Day 14 Visit Checklist2015-Oct-16111.5 KB
06. Day 16 Visit Checklist/Termination Visit2015-Oct-19113.5 KB
07. Pelvic Exam Checklist2016-Jan-19104 KB