H Clinical News

Home visits for decentralized clinical trials (DCTs) in Latin America are different than in the U.S. or Europe. This image was recently taken by a nurse visiting a rural home in Brazil. The road is not paved. The weather conditions are harsh. And yet, when H Clinical is requested to quote home visits for patients with rare diseases, cancer, and other maladies, we are consistently asked to keep travel to a one-hour round trip. Here are some important facts everyone should know about direct-to-patient clinical trials and in-home visits in LATAM. 

Diverse Geographic Locations

According to McKinsey, 70% of trial participants live more than two hours away from research sites. In Latin America, two hours may take three hours considering the safety of conditions. Socio-economic challenges and the lack of transportation infrastructure make travel exponentially more difficult for patients to reach traditional research sites and for nurses to conduct home visits, especially in more rural areas. Even for participants living in urban zones, where 80% of the population lives, traffic across some of the most populated cities in the world can be incredibly challenging.

Harsh Road Conditions

Road conditions, lack of clearly marked streets, and in some cases no visible addresses create increased difficulties as you travel from urban to rural areas. And when inclement weather is coupled with substandard road conditions, particularly in rural zones, the factor of difficulty increases the likelihood of delays. As the image illustrates, finding where you need to go is not as easy as it appears on a spreadsheet.

Limited Transportation Accessibility

In 2021, the number of vehicles per capita in this region was about 0.22, or 220 per 1,000. Europe (0.52) and North America (0.71) were more than double or triple that number, respectively. Reliable transportation is a privilege. Most nurses, urban or rural, do not own cars. And public transportation is limited and not viable when transporting medical equipment. Rideshare or taxis are required, or travel must be arranged.

The H Clinical View

Is patient centricity the common goal of clinical research? If so, in-home visits address the wants and needs of patients, provide an opportunity to deliver diverse patient populations, and optimize patient recruitment, enrollment, and retention. However, estimates for travel times—for nurses to get there, get in, get out, and get on the road—need to be realistic. The context of the regional and local situations needs to drive reasonable travel time estimates.