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Performing clinical trials in resource-constrained settings requires an affordable and easy to use data management system that is compliant with applicable standards. It is a bold step to adopt a web-based system in a large multi-site clinical trial in an area with challenging communication infrastructure. The process has been successful but not without its challenges. In this presentation, we look at the experience in setting up and use of OpenClinica in Africa with a case study on a large multi-site clinical trial in East Africa that has adopted OpenClinica. The presentation describes the difficulties faced, approaches taken to counter the challenges and best practices adopted. We also propose additional functionality that we believe would make the system more useful in such settings.