Achieving equitable recruitment through inclusive protocol design: lessons learned from the ILANA study

The importance of conducting inclusive research is well-established, yet recruiting a sample which reflects the distribution of a disease or condition within a target population has proven elusive for many triallists. We draw on our experiences of achieving inclusive recruitment through the intentional protocol design and delivery in the ILANA (Implementing Long-Acting Novel Antiretrovirals) study to highlight some tangible steps that could be extrapolated to trials to aid inclusive recruitment to research and produce findings which can contribute to tackling health inequities. These include the importance of meaningful public involvement from start to finish, drawing on existing data to determine appropriate targets, factoring targets into analysis plans through pre-specified analyses and triangulation with qualitative data, and making targets mandatory (rather than aspirational) through a range of strategies. We believe ILANA offers a proof of concept for triallists seeking to radically improve representation and conduct more equitable RCTs that engage all those who could benefit.