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Staunton C, Edgcumbe A, Abdulrauf L, Gooden A, Ogendi P, Thaldar D. Cross-border data sharing for research in Africa: An analysis of the data protection and research ethics requirements in 12 jurisdictions. RESEARCH SQUARE 2024:rs.3.rs-4217849. [PMID: 38699320 PMCID: PMC11065056 DOI: 10.21203/rs.3.rs-4217849/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Background In recent years, there has been a notable uptake in genomic and health-related research activities across the African continent. Similarly, there has been increased introduction of data protection legislation that affects the sharing of personal data such as health data and genomic data, including for research. Many of these statutes have stricter requirements when sharing personal data across borders. Consequently, the cross-border sharing of health data that includes genetic data requires careful navigation of the pertinent data protection legislation, in particular concerning the sharing of such data for research purposes. To help researchers navigate these legal frameworks, 12 African countries were analysed to develop country guides on cross-border data sharing. Results Of the 12 countries that were analysed, ten have data protection laws in place (Botswana, Ghana, Kenya, Malawi, Nigeria, Rwanda, South Africa, Tanzania, Uganda, and Zimbabwe), while two countries (Cameroon and The Gambia) do not. With the exception of Ghana, all countries with data protection statutes or bills had additional requirements to be met when sharing personal data across borders. Consent and adequacy are the most common grounds for justifying the sharing of personal data across borders. Conclusion Given the limitations of the current models of consent, consent is not a suitable basis to transfer large quantities of data for research. Adequacy is a common ground, but there are national differences in the implementation of this ground. Researchers must therefore analyse each national legal framework and make decisions on a case-by-case and country-by-country basis.
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Ibrahim ME, Adarmouch L, Elgamri A, Abd ElHafeez S, Mohammed Z, Abdelgawad F, Elsebaie EH, Abdelhafiz AS, Gamel E, El Rhazi K, Abdelnaby A, Ahram M, Silverman H. Researchers' Perspectives Regarding Ethical Issues of Biobank Research in the Arab Region. Biopreserv Biobank 2024; 22:98-109. [PMID: 36951637 PMCID: PMC11044858 DOI: 10.1089/bio.2022.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
Background: The recent expansion of genomic biobank research in the Arab region in the Middle East North Africa has raised complex ethical and regulatory issues. However, there is a lack of studies regarding the views of Arab researchers involved in such research. We aimed to assess the perceptions and attitudes of Arab researchers regarding these issues in biobank research. Methods: We developed a questionnaire to assess the perceptions and attitudes regarding genetic research of researchers from Egypt, Sudan, Morocco, and Jordan. The questionnaire requested demographic data, perceptions, and attitudes regarding the collection, storage, and use of biospecimens and data, the use of broad consent, data security, data sharing, and community engagement. We used multiple linear regressions to identify predictors of perceptions and attitudes. Results: We recruited 383 researchers. Researchers favored equally the use of broad and tiered consent (44.1% and 39.1%, respectively). Most respondents agreed with the importance of confidentiality protections to ensure data security (91.8%). However, lower percentages were seen regarding the importance of community engagement (64.5%), data sharing with national colleagues and international partners (60.9% and 41.1%, respectively), and biospecimen sharing with national colleagues and international partners (59.9% and 36.2%, respectively). Investigators were evenly split on whether the return of individual research results should depend on the availability or not of a medical intervention that can be offered to address the genetic anomaly (47.5% and 46.4%, respectively). Predictors of attitudes toward biospecimen research included serving on Research Ethics Committees, prior research ethics training, and affiliation with nonacademic institutions. Conclusions: We recommend further exploratory research with researchers regarding the importance of community engagement and to address their concerns about data sharing, with researchers within and outside their countries.
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Affiliation(s)
- Maha E. Ibrahim
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Latifa Adarmouch
- Department of Community Medicine, Public Health and Epidemiology, Faculty of Medicine, Cadi Ayyad University, Marrakesh, Morocco
| | - Alya Elgamri
- Department of Orthodontics, Pediatric Dentistry and Preventive Dentistry, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan
| | - Samar Abd ElHafeez
- Epidemiology Department, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Zeinab Mohammed
- Department of Public Health and Community Medicine, Faculty of Medicine, Beni-Suef University, Beni-Suef, Egypt
| | - Fatma Abdelgawad
- Pediatric Dentistry and Dental Public Health Department, Faculty of Dentistry, Cairo University, Cairo, Egypt
| | - Eman H. Elsebaie
- Department of Public Health, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Samir Abdelhafiz
- Department of Clinical Pathology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ehsan Gamel
- Department of Oral Rehabilitation, Faculty of Dentistry, University of Khartoum, Khartoum, Sudan
| | - Karima El Rhazi
- Department of Epidemiology and Public Health, Faculty of Medicine, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Asmaa Abdelnaby
- Department of Public Health, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mamoun Ahram
- Department of Physiology and Biochemistry, School of Medicine, The University of Jordan, Amman, Jordan
| | - Henry Silverman
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Masamu U, Sangeda RZ, Mgaya J, Nkya S, Octavian B, Mtiiye FR, Nduguru J, Jonathan A, Kandonga D, Minja IK, Rugajo P, Balandya E, Makani J. Improved Biorepository to Support Sickle Cell Disease Genomics and Clinical Research: A Practical Approach to Link Patient Data and Biospecimens from Muhimbili Sickle Cell Program, Tanzania. Biopreserv Biobank 2023. [PMID: 37943607 DOI: 10.1089/bio.2023.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Abstract
In Africa, sickle cell disease phenotypes' genetic contributors remain understudied due to the dearth of databases that pair biospecimens with demographic and clinical details. The absence of biorepositories in these settings can exacerbate this issue. This article documents the physical verification process of biospecimens in the biorepository, connecting them to patient clinical and demographic data and aiding in the planning of future genomic and clinical research studies' experience from the Muhimbili Sickle Cell Program in Dar es Salaam, Tanzania. The biospecimen database was updated with the current biospecimen position following the physical verification and then mapping this information to its demographic and clinical data using demographic identifiers. The biorepository stored 74,079 biospecimens in three -80°C freezers, including 63,345 from 5159 patients enrolled in the cohort between 2004 and 2016. Patients were identified by a control (first visit), entry (when confirmed sickle cell homozygous), admission (when hospitalized), and follow-up numbers (subsequent visits). Of 63,345 biospecimens, follow-ups were 46,915 (74.06%), control 8067 (12.74%), admission 5517 (8.71%), and entry 2846 (4.49%). Of these registered patients, females were 2521 (48.87%) and males were 2638 (51.13%). The age distribution was 1-59 years, with those older than 18 years being 577 (11.18%) and children 4582 (88.82%) of registered patients. The notable findings during the process include a lack of automated biospecimen checks, laboratory information management system, and tubes with volume calibration; this caused the verification process to be tedious and manual. Biospecimens not linked to clinical and demographic data, date format inconsistencies, and lack of regular updating of a database on exhausted biospecimens and updates when biospecimens are moved between positions within freezers were other findings that were found. A well-organized biorepository plays a crucial role in answering future research questions. Enforcing standard operating procedures and quality control will ensure that laboratory users adhere to the best biospecimen management procedures.
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Affiliation(s)
- Upendo Masamu
- Muhimbili Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Raphael Z Sangeda
- Muhimbili Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Josephine Mgaya
- Muhimbili Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Siana Nkya
- Department of Biochemistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Beatrice Octavian
- Muhimbili Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Frank R Mtiiye
- Muhimbili Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Joyce Nduguru
- Muhimbili Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Agnes Jonathan
- Muhimbili Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Daniel Kandonga
- Muhimbili Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Irene K Minja
- Muhimbili Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Restorative Dentistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Paschal Rugajo
- Muhimbili Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Emmanuel Balandya
- Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Julie Makani
- Muhimbili Sickle Cell Program, Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Department of Hematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Kaawa-Mafigiri D, Ekusai Sebatta D, Munabi I, Mwaka ES. Genetic and Genomic Researchers' Perspectives on Biological Sample Sharing in Collaborative Research in Uganda: A Qualitative Study. J Empir Res Hum Res Ethics 2023:15562646231171289. [PMID: 37151037 DOI: 10.1177/15562646231171289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Numerous ethical, legal, and social issues arise with biological sample sharing. The study explored the perspectives of genetic and genomic researchers on the sharing of biological samples in international collaborative research. Qualitative in-depth interviews were conducted with 15 researchers. Participants expressed positive attitudes towards biobanking and appreciated the benefits of cross-border sharing of biological samples but noted that this practice had adversely affected local capacity building efforts. There was limited understanding of the ethical and regulatory frameworks governing sample sharing. Researchers emphasized the importance of respecting cultural values in biobanking research. Issues concerning poor governance and inequitable benefit sharing were also raised. There is a need for fair and equitable international collaborations where all researchers are treated with respect and as equal partners.
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Affiliation(s)
| | | | - Ian Munabi
- College of Health Sciences, Makerere University, Kampala, Uganda
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Marshall P, Royal CD, Chadwick R. Translational Science, DNA Commercialization, and Informed Consent: The Need for Specific Terminology, Insights from a Review of H3Africa Projects. Public Health Genomics 2022; 25:1-8. [PMID: 35078200 PMCID: PMC9216313 DOI: 10.1159/000521371] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 11/24/2021] [Indexed: 11/19/2022] Open
Abstract
In the past decade, there has been an acceleration in genomic research, its applications, and its translation into healthcare products and services for the benefit of public health. These advances are critical to realizing the potential of genomic research for facilitating improved health and disease prevention, diagnosis, and treatment. Despite its tremendous opportunities, the dynamic and increasingly global landscape of genomic research commercialization has been accompanied by a variety of ethical challenges and concerns. The potential for unauthorized use of DNA samples from African people to develop a DNA chip amplifies discussion on the meanings, implications, and impacts of commercialization, benefit sharing, and appropriate consent in genomic research. Leadership of the Human Heredity and Health in Africa (H3Africa) Consortium convened a panel of experts to review research ethics practices employed in H3Africa Consortium projects and make recommendations regarding commercialization. Eighteen investigators submitted documents for projects involving data sharing and use of genetic information. A total of 39 informed consent documents associated with the 18 projects were reviewed. All 18 projects specified that samples would be used in future research. Less than half of the projects included language noting that samples could be used in drug or product development, that DNA samples would not be sold, and that profits would not be shared with participants. Four projects referred to commercialization. Analysis of information included in consent documents contributed to the development of a Commercialization Typology. The Typology identifies factors to consider regarding acceptability of particular instances of commercialization. DNA samples for translational research in product development require a transparent commercialization framework to inform the consent process.
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Affiliation(s)
- Patricia Marshall
- Department of Bioethics, Case Western Reserve University, Cleveland, Ohio, USA
| | - Charmaine D.M. Royal
- African & African American Studies, Biology, Global Health, and Family Medicine & Community Health, Duke University, Durham, North Carolina, USA
| | - Ruth Chadwick
- School of Social Sciences, Cardiff University, Cardiff, United Kingdom
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Nouvet E, Grandjean Lapierre S, Knoblauch A, Baril L, Andriamiadanarivo A, Raberahona M, Mattern C, Donelle L, Andriantsoa JR. Consent to Research in Madagascar: Challenges, Strategies, and Priorities for Future
Research. CANADIAN JOURNAL OF BIOETHICS 2022. [DOI: 10.7202/1087201ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Data protection, data management, and data sharing: Stakeholder perspectives on the protection of personal health information in South Africa. PLoS One 2021; 16:e0260341. [PMID: 34928950 PMCID: PMC8687565 DOI: 10.1371/journal.pone.0260341] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 11/08/2021] [Indexed: 11/19/2022] Open
Abstract
The Protection of Personal Information Act (POPIA) 2013 came into force in South Africa on 1 July 2020. It seeks to strengthen the processing of personal information, including health information. While POPIA is to be welcomed, there are concerns about the impact it will have on the processing of health information. To ensure that the National Health Laboratory Service [NHLS] is compliant with these new strict processing requirements and that compliance does not negatively impact upon its current screening, treatment, surveillance and research mandate, it was decided to consider the development of a NHLS POPIA Code of Conduct for Personal Health. As part of the process of developing such a Code and better understand the challenges faced in the processing of personal health information in South Africa, 19 semi-structured interviews with stakeholders were conducted between June and September 2020. Overall, respondents welcomed the introduction of POPIA. However, they felt that there are tensions between the strengthening of data protection and the use of personal information for individual patient care, treatment programmes, and research. Respondents reported a need to rethink the management of personal health information in South Africa and identified 5 issues needing to be addressed at a national and an institutional level: an understanding of the importance of personal information; an understanding of POPIA and data protection; improve data quality; improve transparency in data use; and improve accountability in data use. The application of POPIA to the processing of personal health information is challenging, complex, and likely costly. However, personal health information must be appropriately managed to ensure the privacy of the data subject is protected, but equally that it is used as a resource in the individual's and wider public interest.
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Nichol AA, Bendavid E, Mutenherwa F, Patel C, Cho MK. Diverse experts' perspectives on ethical issues of using machine learning to predict HIV/AIDS risk in sub-Saharan Africa: a modified Delphi study. BMJ Open 2021; 11:e052287. [PMID: 34321310 PMCID: PMC8320245 DOI: 10.1136/bmjopen-2021-052287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 07/19/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To better understand diverse experts' views about the ethical implications of ongoing research funded by the National Institutes of Health that uses machine learning to predict HIV/AIDS risk in sub-Saharan Africa (SSA) based on publicly available Demographic and Health Surveys data. DESIGN Three rounds of semi-structured surveys in an online expert panel using a modified Delphi approach. PARTICIPANTS Experts in informatics, African public health and HIV/AIDS and bioethics were invited to participate. MEASURES Perceived importance of or agreement about relevance of ethical issues on 5-point unipolar Likert scales. Qualitative data analysis identified emergent themes related to ethical issues and development of an ethical framework and recommendations for open-ended questions. RESULTS Of the 35 invited experts, 22 participated in the online expert panel (63%). Emergent themes were the inclusion of African researchers in all aspects of study design, analysis and dissemination to identify and address local contextual issues, as well as engagement of communities. Experts focused on engagement with health and science professionals to address risks, benefits and communication of findings. Respondents prioritised the mitigation of stigma to research participants but recognised trade-offs between privacy and the need to disseminate findings to realise public health benefits. Strategies for responsible communication of results were suggested, including careful word choice in presentation of results and limited dissemination to need-to-know stakeholders such as public health planners. CONCLUSION Experts identified ethical issues specific to the African context and to research on sensitive, publicly available data and strategies for addressing these issues. These findings can be used to inform an ethical implementation framework with research stage-specific recommendations on how to use publicly available data for machine learning-based predictive analytics to predict HIV/AIDS risk in SSA.
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Affiliation(s)
- Ariadne A Nichol
- Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, USA
| | - Eran Bendavid
- Department of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, USA
| | - Farirai Mutenherwa
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- School of Applied Human Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Chirag Patel
- Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Mildred K Cho
- Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, California, USA
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Anie KA, Olayemi E, Paintsil V, Owusu-Dabo E, Adeyemo TA, Sani MU, Galadanci NA, Nnodu O, Tluway F, Adjei DN, Mensah P, Sarfo-Antwi J, Nwokobia H, Gambo A, Benjamin A, Salim A, Osae-Larbi JA, Ofori-Acquah SF. Sickle Cell Disease Genomics of Africa (SickleGenAfrica) Network: ethical framework and initial qualitative findings from community engagement in Ghana, Nigeria and Tanzania. BMJ Open 2021; 11:e048208. [PMID: 34301659 PMCID: PMC8311318 DOI: 10.1136/bmjopen-2020-048208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To provide lay information about genetics and sickle cell disease (SCD) and to identify and address ethical issues concerning the Sickle Cell Disease Genomics of Africa Network covering autonomy and research decision-making, risk of SCD complications and organ damage, returning of genomic findings, biorepository, data sharing, and healthcare provision for patients with SCD. DESIGN Focus groups using qualitative methods. SETTING Six cities in Ghana, Nigeria and Tanzania within communities and secondary care. PARTICIPANTS Patients, parents/caregivers, healthcare professionals, community leaders and government healthcare representatives. RESULTS Results from 112 participants revealed similar sensitivities and aspirations around genomic research, an inclination towards autonomous decision-making for research, concerns about biobanking, anonymity in data sharing, and a preference for receiving individual genomic results. Furthermore, inadequate healthcare for patients with SCD was emphasised. CONCLUSIONS Our findings revealed the eagerness of patients and parents/caregivers to participate in genomics research in Africa, with advice from community leaders and reassurance from health professionals and policy-makers, despite their apprehensions regarding healthcare systems.
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Affiliation(s)
- Kofi A Anie
- Faculty of Medicine, Imperial College London, London, UK
- Haematology and Sickle Cell Centre, London North West University Healthcare NHS Trust, London, UK
| | - Edeghonghon Olayemi
- Department of Haematology, University of Ghana Medical School, University of Ghana, Accra, Ghana
- Ghana Institute of Clinical Genetics, Accra, Ghana
| | - Vivian Paintsil
- School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Directorate of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Ellis Owusu-Dabo
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Titilope Adenike Adeyemo
- Department of Haematology and Blood Transfusion, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Mahmoud U Sani
- Department of Medicine, Bayero University and Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Najibah Aliyu Galadanci
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Obiageli Nnodu
- Department of Haematology and Centre of Excellence for Sickle Cell Disease Research and Training, University of Abuja, Abuja, Nigeria
| | - Furahini Tluway
- Sydney Brenner Institute for Molecular Bioscience, University of the Witwatersrand, Johannesburg, South Africa
| | - David Nana Adjei
- School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Legon, Ghana
| | | | | | | | | | | | - Arafa Salim
- Community Liaison, Dar es Salaam, Tanzania, United Republic of
| | - Judith A Osae-Larbi
- West African Genetic Medicine Centre (WAGMC), College of Health Sciences, University of Ghana, Legon, Ghana
| | - Solomon Fiifi Ofori-Acquah
- School of Biomedical and Allied Health Sciences, College of Health Sciences, University of Ghana, Legon, Ghana
- West African Genetic Medicine Centre (WAGMC), College of Health Sciences, University of Ghana, Legon, Ghana
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Nichol AA, Mwaka ES, Luyckx VA. Ethics in Research: Relevance for Nephrology. Semin Nephrol 2021; 41:272-281. [PMID: 34330367 DOI: 10.1016/j.semnephrol.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Research is crucial to progress in nephrology. It is important that studies are conducted rigorously from the scientific perspective, as well as in adherence to ethical standards. Traditional clinical research places a high value on individual research subject autonomy. Research questions often include the clinical effectiveness of new interventions studied under highly controlled conditions. Such research has brought the promise of new game-changers in nephrology, such as the sodium-glucose cotransporter 2 inhibitors. Implementation research takes such knowledge further and investigates how to translate it into broader-scale policy and practice, to achieve swift and global uptake, with a focus on justice and equity. Newer challenges arising globally in research ethics include those relating to oversight of innovation, biobanking and big data, human-challenge studies, and research during emergencies. This article details the history of clinical research ethics and the role of research ethics committees, describes the evolving spectrum of biomedical research in human medicine, and presents emerging clinical research ethics issues using illustrative examples and a hypothetical case study. It is imperative that researchers and research ethics committees are well versed in the ethical principles of all forms of human research such that research is conducted to the highest standards and that effective interventions can be implemented at scale as rapidly as possible.
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Affiliation(s)
- Ariadne A Nichol
- Stanford Center for Biomedical Ethics, Stanford University School of Medicine, Stanford, CA
| | - Erisa S Mwaka
- Department of Anatomy, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Valerie A Luyckx
- Renal Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa.
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Ali J, Cohn B, Mwaka E, Bollinger JM, Kwagala B, Barugahare J, Sewankambo NK, Ochieng J. A scoping review of genetics and genomics research ethics policies and guidelines for Africa. BMC Med Ethics 2021; 22:39. [PMID: 33810790 PMCID: PMC8017870 DOI: 10.1186/s12910-021-00611-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/30/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Genetics and genomics research (GGR) is increasingly being conducted around the world; yet, researchers and research oversight entities in many countries have struggled with ethical challenges. A range of ethics and regulatory issues need to be addressed through comprehensive policy frameworks that integrate with local environments. While important efforts have been made to enhance understanding and awareness of ethical dimensions of GGR in Africa, including through the H3Africa initiative, there remains a need for in-depth policy review, at a country-level, to inform and stimulate local policy development and revision on the continent. METHODS To identify and characterize existing ethics-related guidelines and laws applicable to GGR across much of Africa, we conducted a scoping review of English language policy documents identified through databases, repositories, and web searches. Thirty-six documents were included and coded using a framework that contained a range of themes across five analytical categories: (1) respect, (2) beneficence, (3) justice, (4) independent oversight, and (5) bans and prohibitions. Data analysis software (NVivo 12) was used to organize, code, and tabulate information according to document characteristics and topics. Illustrative examples of policy requirements were selected for inclusion. RESULTS Documents that met inclusion criteria spanned 20 years; published between 1996 and 2018, with the majority (58%) published after 2009. About two-thirds were denoted as "guidelines," and slightly more than half were non-exclusive to GGR. Very few (six) country-level documents identified were specific to GGR. Requirements related to the principle of "respect" appeared most often across all documents, relative to other principles and processes. The most commonly stated ban was on reproductive cloning. Other prohibitions applied to germline editing, undue inducements in research, sample use for commercial purposes, employee mandatory DNA testing, fetal sex selection, stem cell use, eugenics, and research without public health benefits. CONCLUSIONS Enforceable policies that are indispensable to the ethical conduct and review of GGR are either deficient or missing in many African countries. Existing international, GGR-specific ethics guidelines can be used to inform GGR policy development at a country-level, in conjunction with insight from country specific ethics committees and other local stakeholders.
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Affiliation(s)
- Joseph Ali
- Johns Hopkins Berman Institute of Bioethics, 1809 Ashland Ave, Rm 208, Baltimore, MD, 21205, USA. .,Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Betty Cohn
- Johns Hopkins Berman Institute of Bioethics, 1809 Ashland Ave, Rm 208, Baltimore, MD, 21205, USA
| | - Erisa Mwaka
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Juli M Bollinger
- Johns Hopkins Berman Institute of Bioethics, 1809 Ashland Ave, Rm 208, Baltimore, MD, 21205, USA
| | - Betty Kwagala
- College of Business and Management, Makerere University, Kampala, Uganda
| | - John Barugahare
- Department of Philosophy, Makerere University, Kampala, Uganda
| | | | - Joseph Ochieng
- College of Health Sciences, Makerere University, Kampala, Uganda
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Warrier P, Ho CWL, Bull S, Vaz M, Vaz M. Engaging publics in biobanking and genetic research governance - a literature review towards informing practice in India. Wellcome Open Res 2021; 6:5. [PMID: 38645686 PMCID: PMC11026954 DOI: 10.12688/wellcomeopenres.16558.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 04/23/2024] Open
Abstract
Background: There is growing interest in advancing biobanking and genetic research in many countries, including India. Concurrently, more importance is being placed on participatory approaches involving the public and other stakeholders in addressing ethical issues and policymaking as part of a broader governance approach. We analyse the tools, purposes, outcomes and limitations of engaging people towards biobanking and genetic research governance that have been undertaken worldwide, and explore their relevance to India. Methods: Papers to be reviewed were identified through a targeted literature search carried out using ProQuest and PubMed. Retrieved papers were analysed with the Rpackage for Qualitative Data Analysis using inductive coding and thematic analysis, guided by the Framework Method. Results: Empirical studies on public and community engagement in the context of biobanking and or genetic research show a predominance towards the end of the last decade, spanning 2007 to 2019. Numerous strategies-including public meetings, community durbars, focus group discussions, interviews, deliberations, citizen-expert panels and community advisory boards-have been used to facilitate communication, consultation and collaboration with people, at the level of general and specific publics. Engagement allowed researchers to understand how people's values, opinions and experiences related to the research process; and enabled participants to become partners within the conduct of research. Conclusions: Constructs such as 'co-production', 'engagement of knowledges', 'rules of engagement' and 'stewardship' emerge as significant mechanisms that can address the ethical challenges and the governance of biobanking and genetic research in India. Given the inherent diversity of the Indian population and its varying cultural values and beliefs, there is a need to invest time and research funds for engagement as a continuum of participatory activity, involving communication, consultation and collaboration in relation to biobanking and genetic research. Further research into these findings is required to explore their effective employment within India.
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Affiliation(s)
- Prasanna Warrier
- Health and Humanities, St John's Research Institute, Bengaluru, Karnataka, 560034, India
| | - Calvin Wai-Loon Ho
- Faculty of Law and Centre for Medical Ethics and Law, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Susan Bull
- Ethox Centre and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, OX3 7LF, UK
| | - Mario Vaz
- Health and Humanities, St John's Research Institute, Bengaluru, Karnataka, 560034, India
| | - Manjulika Vaz
- Health and Humanities, St John's Research Institute, Bengaluru, Karnataka, 560034, India
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13
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Conradie EH, Malherbe H, Hendriksz CJ, Dercksen M, Vorster BC. An Overview of Benefits and Challenges of Rare Disease Biobanking in Africa, Focusing on South Africa. Biopreserv Biobank 2021; 19:143-150. [PMID: 33567219 DOI: 10.1089/bio.2020.0108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The North-West University's Centre for Human Metabolomics (CHM) is in the process of establishing the first rare disease (RD) biobank in South Africa and Africa. The CHM Biobank's main focus is on the collection of samples and information for rare congenital disorders. Approximately 72% of all RDs have a genetic origin, of which 70% have an exclusive pediatric onset. The need for such a biobank was identified by the CHM diagnostic laboratory. Feedback toward this initiative was overwhelmingly positive at the first stakeholder meeting in August 2019. However, gaining support from the public sector and recruiting of participants have proven to be challenging. Problems experienced to date include lack of support from government and clinicians; lack of knowledge on RDs (patients and clinicians); public health care focus not directed toward RDs; patients not returning for follow-up visits; and unwillingness to participate due to fear of exploitation. The CHM Biobank's vision and goals are aligned to address a national and international research need: it will provide a valuable resource for scientists to improve what is known about these diseases; to better understand the natural history and pathophysiology; to optimize diagnostic methods; and to potentially develop treatments. The genetic variability of the South African population provides added value to the RD biobank. This review provides a brief overview of the literature on the challenges and benefits of an RD biobank and how this relates to low- and middle-income countries (LMIC) like South Africa. The aim of the review is to draw attention to the potential benefits of such an undertaking and to create awareness, at both local and global level, toward some of the unique collective considerations that an RD biobank in LMIC (also unique South African challenges) faces on an operational, collaborate, and sustainability level.
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Affiliation(s)
- Engela H Conradie
- North-West University, Human Metabolomics, Potchefstroom, South Africa
| | - Helen Malherbe
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Rare Diseases South Africa NPC, Sunninghill, South Africa
| | | | - Marli Dercksen
- North-West University, Human Metabolomics, Potchefstroom, South Africa
| | - Barend C Vorster
- North-West University, Human Metabolomics, Potchefstroom, South Africa
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14
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Warrier P, Ho CWL, Bull S, Vaz M, Vaz M. Engaging publics in biobanking and genetic research governance - a literature review towards informing practice in India. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16558.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: There is growing interest in advancing biobanking and genetic research in many countries, including India. Concurrently, more importance is being placed on participatory approaches involving the public and other stakeholders in addressing ethical issues and policymaking as part of a broader governance approach. We analyse the tools, purposes, outcomes and limitations of engaging people towards biobanking and genetic research governance that have been undertaken worldwide, and explore their relevance to India. Methods: Papers to be reviewed were identified through a targeted literature search carried out using ProQuest and PubMed. Retrieved papers were analysed with the R package for Qualitative Data Analysis using inductive coding and thematic analysis, guided by the Framework Method. Results: Empirical studies on public and community engagement in the context of biobanking and or genetic research show a predominance towards the end of the last decade, spanning 2007 to 2019. Numerous strategies—including public meetings, community durbars, focus group discussions, interviews, deliberations, citizen-expert panels and community advisory boards—have been used to facilitate communication, consultation and collaboration with people, at the level of general and specific publics. Engagement allowed researchers to understand how people’s values, opinions and experiences related to the research process; and enabled participants to become partners within the conduct of research. Conclusions: Constructs such as ‘co-production’, ‘engagement of knowledges’, ‘rules of engagement’ and ‘stewardship’ emerge as significant mechanisms that can address the ethical challenges and the governance of biobanking and genetic research in India. Given the inherent diversity of the Indian population and its varying cultural values and beliefs, there is a need to invest time and research funds for engagement as a continuum of participatory activity, involving communication, consultation and collaboration in relation to biobanking and genetic research. Further research into these findings is required to explore their effective employment within India
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15
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Stein CM. Challenges of Genetic Data Sharing in African Studies. Trends Genet 2020; 36:895-896. [PMID: 32807514 DOI: 10.1016/j.tig.2020.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/21/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
Data sharing is a valuable aspect of science and required by most funding bodies and journals. However, the national regulatory guidelines of many African nations do not explicitly allow for broad genetic data sharing. Given these restrictions, there is a need to reconsider these policies and propose creative solutions.
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Affiliation(s)
- Catherine M Stein
- Department of Population and Quantitative Health Sciences, and Division of Infectious Disease and HIV Medicine, Case Western Reserve University, Cleveland, OH 44106, USA.
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16
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Mweemba O, Musuku J, Matenga TFL, Parker M, Rutakumwa R, Seeley J, Simanga T, Tindana P, de Vries J. Policy makers, regulators and researchers’ perspectives on genomics research and the capacity of the National Health Research Act of 2013 to regulate genomics research in Zambia. AAS Open Res 2020. [DOI: 10.12688/aasopenres.13092.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Health research in sub-Saharan Africa takes place against a lengthy history of exploitation and unfair collaboration. This has involved the export of samples and data from the continent for the benefit of institutions and researchers elsewhere. In this paper, we report the perspectives of people involved in conducting genomics research in Zambia and the capacity of the Health Research Act (HRA) of 2013 in regulating genomics research. Methods: We approached 14 purposively selected stakeholders involved in the development or implementation of the HRA in Zambia for in-depth interviews. These were members of research ethics committees, genomics researchers, Ministry of Health policy makers and institutional lawyers. Results: Participants reported that there are benefits in genomics research for Zambia such as diagnosing and treatment of diseases. Participants also expressed concerns, most of which were ethical in nature. Prominent concerns were on consent. Participants’ main concern was the possible misuse of samples in the future. These concerns resonated with the HRA, which prohibits the use of broad consent for the collection of samples and data for future unspecified research. The implications of this is that Zambians may not participate in any kind of health research for which the storage, sharing and re-use of data or samples is envisaged. The restrictive nature of HRA means that genomics research may be excluded from future health research collaborations, thus isolating the country from potentially beneficial health research. Some policy makers also worried the samples and data that comes from such research may be difficult to access by local scientists. Conclusion: In this article, we describe the views of Zambian policymakers on genomics research and the capacity of HRA in regulating genomics research. Our findings are relevant for the Zambian audience, and other African countries that are aiming to regulate health research, especially genomics research.
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Matandika L, Ngóngóla RT, Mita K, Manda-Taylor L, Gooding K, Mwale D, Masiye F, Mfutso-Bengo J. A qualitative study exploring stakeholder perspectives on the use of biological samples for future unspecified research in Malawi. BMC Med Ethics 2020; 21:61. [PMID: 32689995 PMCID: PMC7372640 DOI: 10.1186/s12910-020-00503-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 07/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is growing interest in the collection, storage and reuse of biological samples for future research. Storage and future use of biological samples raise ethical concerns and questions about approaches that safeguard the interests of participants. The situation is further complicated in Africa where there is a general lack of governing ethical frameworks that could guide the research community on appropriate approaches for sample storage and use. Furthermore, there is limited empirical data to guide development of such frameworks. A qualitative study to address this gap was conducted with key stakeholders in Malawi to understand their experiences and perspectives regarding storage and usage of samples for future research. METHODS This study conducted 13 in-depth interviews with ethics committee members, regulators and researchers, and five focus group discussions with community representatives and clinical trial participants in Malawi. Interviews and focus group discussions were audio-recorded, transcribed verbatim, and thematically analysed. RESULTS On the current regulatory guidelines that governs the collection, storage and reuse of samples in Malawi, participants highlighted their different understanding of it, with some indicating that it prohibited the reuse and sharing of samples, while others believed it permitted. Views on the informed consent model used in Malawi, some stakeholders expressed that the current model limited options for sample contributors regarding future use. Researchers supported storing samples for future use in order to maximize their value and reduce research costs. However, they expressed concern over the exportation of samples highlighting that it could lead to misuse and would not support the development of research capacity within Malawi. They recommended use of broad consent or tiered consent and establishment of biobanks to address these concerns. CONCLUSIONS Study findings highlighted the need for a review of the current regulatory guideline and the development of infrastructure to support the use of stored biological samples for future use among the research community in Malawi. At the moment, there are ethical and practical concerns arising from the collection, storage and secondary use of biological samples make it hard to reconcile scientific progress and the protection of participants.
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Affiliation(s)
- Limbanazo Matandika
- Centre for Bioethics in Eastern and Southern Africa, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi.
| | - Ruby Tionenji Ngóngóla
- Centre for Bioethics in Eastern and Southern Africa, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Khama Mita
- Centre for Bioethics in Eastern and Southern Africa, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi.,College of Medicine Research Ethics Committee, University of Malawi, Blantyre, Malawi
| | - Lucinda Manda-Taylor
- Centre for Bioethics in Eastern and Southern Africa, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | | | - Daniel Mwale
- John Hopkins- One Community Project, Blantyre, Malawi
| | - Francis Masiye
- Centre for Bioethics in Eastern and Southern Africa, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi.,The Centre for Medical Ethics and Law (Department of Medicine), Stellenbosch University, Tygerberg Campus, Cape Town, South Africa.,Directorate of Postgraduate Studies, Research and Outreach, Malawi University of Science and Technology, P.O Box 5196, Limbe, Malawi
| | - Joseph Mfutso-Bengo
- Centre for Bioethics in Eastern and Southern Africa, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
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Moodley K, Beyer C. Tygerberg Research Ubuntu-Inspired Community Engagement Model: Integrating Community Engagement into Genomic Biobanking. Biopreserv Biobank 2019; 17:613-624. [PMID: 31603696 PMCID: PMC6921246 DOI: 10.1089/bio.2018.0136] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Introduction: Community engagement (CE) is an ethical imperative in research, but the knowledge base for what constitutes effective and ethically sound CE is limited. Ubuntu, as a component of responsive communitarianism where communal welfare is valued together with individual autonomy, is useful in furthering our understanding of effective CE and how it could best be achieved. Similarly, a relative solidarity model serves as a compromise between extreme individualism and extreme communalism and is more appropriate in a heterogenous African context. Approaching CE from an Ubuntu philosophical perspective in southern Africa is particularly important in genomic biobanking, given the implications for individuals, families, and communities. Discussion: CE is often implemented in a tokenistic manner as an ancillary component of research. Understanding consent information is challenging where genomic biobanking is concerned due to scientific complexity. We started a process of CE around genomic biobanking and conducted empirical research in an attempt to develop a model to promote effective and ethically sound CE, using relative solidarity to create a nuanced application of Ubuntu. The TRUCE model is an eight-step model that uses social mapping to identify potential communities, establishes the scope of CE, and requires that communities are approached early. Co-creation strategies for CE are encouraged and co-ownership of knowledge production is emphasized. Recruiting and engaging communities at each stage of research is necessary. Evaluation and adaptation of CE strategies are included. Discussion and dissemination of results after the research is completed are encouraged. Conclusions: There is a significant gap between the theory of CE and its authentic application to research in Africa. This Ubuntu-inspired model facilitates bridging that gap and is particularly suited to genomic biobanking. The CE model enhances and complements the consent process and should be integrated into research as a funding and regulatory requirement where applicable.
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Affiliation(s)
- Keymanthri Moodley
- Department of Medicine, Faculty of Medicine and Health Sciences, Centre for Medical Ethics & Law, Stellenbosch University, Cape Town, South Africa
- Address correspondence to: Keymanthri Moodley, MBChB, MFamMed, MPhil, FCFP (SA), Executive MBA, DPhil, Department of Medicine, Faculty of Medicine and Health Sciences, Centre for Medical Ethics & Law, Stellenbosch University, P.O. Box 241, Cape Town 7505, South Africa
| | - Chad Beyer
- Department of Medicine, Faculty of Medicine and Health Sciences, Centre for Medical Ethics & Law, Stellenbosch University, Cape Town, South Africa
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19
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Mutenherwa F, Wassenaar DR, de Oliveira T. Ethical issues associated with HIV molecular epidemiology: a qualitative exploratory study using inductive analytic approaches. BMC Med Ethics 2019; 20:67. [PMID: 31590695 PMCID: PMC6781327 DOI: 10.1186/s12910-019-0403-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/30/2019] [Indexed: 11/30/2022] Open
Abstract
Background HIV molecular epidemiology is increasingly recognized as a vital source of information for understanding HIV transmission dynamics. Despite extensive use of these data-intensive techniques in both research and public health settings, the ethical issues associated with this science have received minimal attention. As the discipline evolves, there is reasonable concern that existing ethical and legal frameworks and standards might lag behind the rapid methodological developments in this field. This is a follow-up on our earlier work that applied a predetermined analytical framework to examine the perspectives of a sample of scientists from the fields of epidemiology, public health, virology and bioethics on key ethical issues associated with HIV molecular epidemiology in HIV network research. Methods Fourteen in-depth interviews were conducted with scientists from the fields of molecular epidemiology, public health, virology and bioethics. Inductive analytical approaches were applied to identify key themes that emerged from the data. Results Our interviewees acknowledged the potential positive impact of molecular epidemiology in the fight against HIV. However, they were concerned that HIV phylogenetics research messages may be incorrectly interpreted if not presented at the appropriate level. There was consensus that HIV phylogenetics research presents a potential risk to privacy, but the probability and magnitude of this risk was less obvious. Although participants acknowledged the social value that could be realized from the analysis of HIV genetic sequences, there was a perceived fear that the boundaries for use of HIV sequence data were not clearly defined. Conclusions Our findings highlight distinct ethical issues arising from HIV molecular epidemiology. As the discipline evolves and HIV sequence data become increasingly available, it is critical to ensure that ethical standards keep pace with biomedical advancements. We argue that the ethical issues raised in this study, whether real or perceived, require further conceptual and empirical examination.
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Affiliation(s)
- Farirai Mutenherwa
- School of Applied Human Sciences, University of KwaZulu-Natal, Private Bag X01, Scottsville, Pietermaritzburg, 3209, South Africa. .,KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.
| | - Douglas R Wassenaar
- School of Applied Human Sciences, University of KwaZulu-Natal, Private Bag X01, Scottsville, Pietermaritzburg, 3209, South Africa
| | - Tulio de Oliveira
- KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.,Department of Global Health, University of Washington, Seattle, USA.,Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
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20
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Abimiku AG, Croxton T, Ozumba PJ, Agala N, Balogun O, Jonathan E, Onyemata E, Ndifon K, Nadoma S, Anazodo T, Peters S, Beiswanger CM. Blueprint for building a biorepository in a resource-limited setting that follows international best practices. Afr J Lab Med 2019; 8:722. [PMID: 31534913 PMCID: PMC6739520 DOI: 10.4102/ajlm.v8i1.722] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/22/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Genetic diversity is abundant on the African continent. However, genomic research has been hampered by a lack of high quality and extensively annotated biospecimens and the necessary infrastructure to support such a technology-intensive effort. OBJECTIVE The Institute of Human Virology Nigeria (IHVN) partnered with the H3Africa Consortium and the Coriell Institute for Medical Research to build an internationally recognised biorepository for the receipt, processing, storage and distribution of biospecimens for biomedical research. Here, the authors describe the procedures, challenges and results encountered. RESULTS Key requirements for a high-quality biorepository were identified: (1) institutional support of infrastructure and services, (2) on-site trained staff with primary commitment to the biorepository, (3) reliance on best practices from globally recognised biorepository groups, (4) early implementation of a quality management system, (5) adoption of a laboratory information management system with demonstrated versatility in functions, (6) collaboration with external experts and sharing of experience through abstracts, newsletters, published manuscripts, and attendance at meetings and workshops, (7) strict adherence to local and national ethical standards and (8) a sustainability plan that is reviewed and updated annually. CONCLUSION Utilising published best practices of globally recognised experts in the biorepository field as a benchmark, IHVN expanded and reorganised its existing laboratory facility and staff to take on this new purpose.
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Affiliation(s)
- Alash'le G Abimiku
- Institute of Human Virology Nigeria, Abuja, Nigeria
- Institute of Human Virology, University of Maryland, Baltimore, Maryland, United States
| | - Talishea Croxton
- Institute of Human Virology Nigeria, Abuja, Nigeria
- Institute of Human Virology, University of Maryland, Baltimore, Maryland, United States
| | | | - Ndidi Agala
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | | | | | | | | | - Sunji Nadoma
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | | | - Sam Peters
- Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Christine M Beiswanger
- Coriell Institute for Medical Research, Camden, New Jersey, United States
- Independent contractor, Philadelphia, Pennsylvania, United States
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21
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Mwaka E, Horn L. Researchers' Perspectives on Informed Consent and Ethical Review of Biobank Research in South Africa: A Cross-Sectional Study. J Empir Res Hum Res Ethics 2019; 14:307-317. [PMID: 31378129 DOI: 10.1177/1556264619866991] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
There is limited literature on the opinions and perspectives of researchers on the ethical issues in biobank research in South Africa. This study aimed to explore researchers' perspectives on informed consent and ethical review of biobank research in South Africa. An online survey was conducted among researchers and scientists at Stellenbosch University and the University of Kwazulu-Natal. The majority of researchers opined that broad consent is appropriate for biobank research. However, there was no consensus on the necessity for re-consent. Researchers were also in agreement that issues concerning informed consent and future use of samples require thorough discussions during the ethical review process. Overall, the attitude of researchers on informed consent and ethical review of biobank research was positive and ethically informed.
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Affiliation(s)
- Erisa Mwaka
- 1 Makerere University College of Health Sciences, Kampala, Uganda.,2 University of Kwazulu-Natal, Durban, South Africa
| | - Lyn Horn
- 3 University of Cape Town, South Africa
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22
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Roberts CC. Emerging infectious disease laboratory and diagnostic preparedness to accelerate vaccine development. Hum Vaccin Immunother 2019; 15:2258-2263. [PMID: 31268394 PMCID: PMC6816404 DOI: 10.1080/21645515.2019.1634992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Rapid vaccine development in response to an outbreak of a new emerging infectious disease (EID) is a goal targeted by public health agencies worldwide. This goal becomes more complicated when there are no standardized sets of viral and immunological assays, no accepted and well-characterized samples, standards or reagents, and no approved diagnostic tests for the EID pathogen. The diagnosis of infections is of critical importance to public health, but also in vaccine development in order to track incident infections during clinical trials, to differentiate natural infection responses from those that are vaccine-related and, if called for by study design, to exclude subjects with prior exposure from vaccine efficacy trials. Here we review emerging infectious disease biological standards development, vaccine clinical assay development and trial execution with the recent experiences of MERS-CoV and Zika virus as examples. There is great need to establish, in advance, the standardized reagents, sample panels, controls, and assays to support the rapid advancement of vaccine development efforts in response to EID outbreaks.
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Affiliation(s)
- Christine C. Roberts
- Clinical Laboratory Development, GeneOne Life Science, Inc., Blue Bell, PA, USA,Contact Christine C. Roberts Clinical Laboratory Development, GeneOne Life Science, Inc., 1040 DeKalb Pike, Suite 200, Blue Bell, PA 19422, USA
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23
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Staunton C, Adams R, Dove ES, Harriman N, Horn L, Labuschaigne M, Mulder N, Olckers A, Pope A, Ramsay M, Swanepoel C, Ni Loideain N, De Vries J. Ethical and practical issues to consider in the governance of genomic and human research data and data sharing in South Africa: a meeting report. AAS Open Res 2019; 2:15. [PMID: 32259025 PMCID: PMC7118803 DOI: 10.12688/aasopenres.12968.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Genomic research and biobanking has undergone exponential growth in Africa and at the heart of this research is the sharing of biospecimens and associated clinical data amongst researchers in Africa and across the world. While this move towards open science is progressing, there has been a strengthening internationally of data protection regulations that seek to safeguard the rights of data subjects while promoting the movement of data for the benefit of research. In line with this global shift, many jurisdictions in Africa are introducing data protection regulations, but there has been limited consideration of the regulation of data sharing for genomic research and biobanking in Africa. South Africa (SA) is one country that has sought to regulate the international sharing of data and has enacted the Protection of Personal Information Act (POPIA) 2013 that will change the governance and regulation of data in SA, including health research data, once it is in force. To identify and discuss challenges and opportunities in the governance of data sharing for genomic and health research data in SA, a two-day meeting was convened in February 2019 in Cape Town, SA with over 30 participants with expertise in law, ethics, genomics and biobanking science, drawn from academia, industry, and government. This report sets out some of the key challenges identified during the workshop and the opportunities and limitations of the current regulatory framework in SA.
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Affiliation(s)
| | - Rachel Adams
- Information Law and Policy Centre, Institute of Advanced Legal Studies, University of London, London, UK.,Human Sciences Research Council, Cape Town, South Africa
| | - Edward S Dove
- School of Law, University of Edinburgh, Edinburgh, UK
| | | | - Lyn Horn
- Office of Research Integrity, University of Cape Town, Cape Town, South Africa
| | | | - Nicola Mulder
- Computational Biology Division, University of Cape Town, Cape Town, South Africa
| | | | - Anne Pope
- Department of Private Law, University of Cape Town, Cape Town, South Africa
| | - Michèle Ramsay
- Sydney Brenner Institute for Molecular Bioscience, University of the Witwatersrand, Johannesburg, South Africa
| | - Carmen Swanepoel
- Division of Haematological Pathology, Stellenbosch University, Cape Town, South Africa.,Department of Pathology, Stellenbosch University, Cape Town, South Africa.,National Health Laboratory Services, Tygerberg Hospital, Cape Town, South Africa.,Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nora Ni Loideain
- Information Law and Policy Centre, Institute of Advanced Legal Studies, University of London, London, UK
| | - Jantina De Vries
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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24
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Yakubu A, Tindana P, Matimba A, Littler K, Munung NS, Madden E, Staunton C, De Vries J. Model framework for governance of genomic research and biobanking in Africa - a content description. AAS Open Res 2018; 1:13. [PMID: 30714023 PMCID: PMC6354903 DOI: 10.12688/aasopenres.12844.2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2018] [Indexed: 12/17/2022] Open
Abstract
Genomic research and biobanking are expanding globally, with a promise to fast-track the research needed to improve approaches to disease treatment and prevention through scientific collaborations such as the Human Heredity and Health in Africa (H3Africa) initiative. Integral to this type of research is the availability of samples and data for research. The need for broad access brings along a host of ethical concerns, including those related to privacy and confidentiality, as well as fairness and equity in access and capacity to utilise these samples between scientists from the high income and low income countries. Addressing these concerns while promoting genomic research, especially in Africa, requires the implementation of a sound governance framework. In this paper, we describe the contents of a Framework for Best Practice for Genomics Research and biobanking in Africa that was developed, under the auspices of the H3Africa initiative. This framework is broad enough to be used and adapted by African countries to facilitate the development of country-specific guidelines and to help improve the conduct and governance of genomics research.
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Affiliation(s)
- Aminu Yakubu
- Department of Health Planning, Research & Statistics, Federal Ministry of Health, Abuja, Nigeria
| | - Paulina Tindana
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Alice Matimba
- Wellcome Genome Campus Advanced Courses and Scientific Conferences, Cambridge, UK
| | | | | | - Ebony Madden
- Division of Genomic Medicine, National Human Genome Research Institute, National Institutes of Health, Rockville, MD, USA
| | | | - Jantina De Vries
- Department of Medicine, University of Cape Town, Cape Town, South Africa
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Yakubu A, Tindana P, Matimba A, Littler K, Munung NS, Madden E, Staunton C, De Vries J. Model framework for governance of genomic research and biobanking in Africa - a content description. AAS Open Res 2018; 1:13. [PMID: 30714023 DOI: 10.12688/aasopenres.12844.1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Genomic research and biobanking are expanding globally, with a promise to fast-track the research needed to improve approaches to disease treatment and prevention through scientific collaborations such as the Human Heredity and Health in Africa (H3Africa) initiative. Integral to this type of research is the availability of samples and data for research. The need for broad access brings along a host of ethical concerns, including those related to privacy and confidentiality, as well as fairness and equity in access and capacity to utilise these samples between scientists from the high income and low income countries. Addressing these concerns while promoting genomic research, especially in Africa, requires the implementation of a sound governance framework. In this paper, we describe the contents of a Framework for Best Practice for Genomics Research and biobanking in Africa that was developed, under the auspices of the H3Africa initiative. This framework is broad enough to be used and adapted by African countries to facilitate the development of country-specific guidelines and to help improve the conduct and governance of genomics research.
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Affiliation(s)
- Aminu Yakubu
- Department of Health Planning, Research & Statistics, Federal Ministry of Health, Abuja, Nigeria
| | - Paulina Tindana
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Alice Matimba
- Wellcome Genome Campus Advanced Courses and Scientific Conferences, Cambridge, UK
| | | | | | - Ebony Madden
- Division of Genomic Medicine, National Human Genome Research Institute, National Institutes of Health, Rockville, MD, USA
| | | | - Jantina De Vries
- Department of Medicine, University of Cape Town, Cape Town, South Africa
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Zawati MH, Tassé AM, Mendy M, Caboux E, Lang M. Barriers and Opportunities in Consent and Access Procedures in Low- and Middle-Income Country Biobanks: Meeting Notes from the BCNet Training and General Assembly. Biopreserv Biobank 2018; 16:171-178. [PMID: 29668303 DOI: 10.1089/bio.2017.0081] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
As biobanking research in low- and middle-income countries (LMICs) continues to grow, novel legal and policy considerations have arisen. Also, while an expansive literature has developed around these issues, the views and concerns of individual researchers in these contexts have been less actively studied. These meeting notes aim to contribute to the growing literature on biobanking in LMICs by communicating a number of challenges and opportunities identified by biobank researchers themselves. Specifically, we describe concerns that emerge in consent and access policy domains. First, we present a review of the literature on distinct policy and legal concerns faced in LMICs, giving special attention to the general absence of practitioner perspectives. From there, we outline and discuss considerations that were raised by meeting participants at a Biobank and Cohort Building Network (BCNet) Ethical, Legal, and Social Issues training program. We conclude by proposing that the unique perspectives of biobank researchers in LMICs should be given serious attention and further research on these perspectives should be conducted.
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Affiliation(s)
- Ma'n H Zawati
- Department of Human Genetics, Centre of Genomics and Policy, McGill University, Montreal, Canada
| | - Anne Marie Tassé
- Department of Human Genetics, Centre of Genomics and Policy, McGill University, Montreal, Canada
- Public Population Project in Genomics and Society, Montreal, Canada
| | - Maimuna Mendy
- Laboratory Services and Bio Bank Group (LSB), Office of the Director (DIR), International Agency for Research on Cancer (IARC), Lyon, France
| | - Elodie Caboux
- Biobank Process Management, International Agency for Research on Cancer (IARC), Lyon, France
| | - Michael Lang
- Department of Human Genetics, Centre of Genomics and Policy, McGill University, Montreal, Canada
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Emerging proteomics biomarkers and prostate cancer burden in Africa. Oncotarget 2018; 8:37991-38007. [PMID: 28388542 PMCID: PMC5514967 DOI: 10.18632/oncotarget.16568] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/27/2017] [Indexed: 12/25/2022] Open
Abstract
Various biomarkers have emerged via high throughput omics-based approaches for use in diagnosis, treatment, and monitoring of prostate cancer. Many of these have yet to be demonstrated as having value in routine clinical practice. Moreover, there is a dearth of information on validation of these emerging prostate biomarkers within African cohorts, despite the huge burden and aggressiveness of prostate cancer in men of African descent. This review focusses of the global landmark achievements in prostate cancer proteomics biomarker discovery and the potential for clinical implementation of these biomarkers in Africa. Biomarker validation processes at the preclinical, translational and clinical research level are discussed here, as are the challenges and prospects for the evaluation and use of novel proteomic prostate cancer biomarkers.
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Baqui AH, Khanam R, Rahman MS, Ahmed A, Rahman HH, Moin MI, Ahmed S, Jehan F, Nisar I, Hussain A, Ilyas M, Hotwani A, Sajid M, Qureshi S, Zaidi A, Sazawal S, Ali SM, Deb S, Juma MH, Dhingra U, Dutta A, Ame SM, Hayward C, Rudan I, Zangenberg M, Russell D, Yoshida S, Polašek O, Manu A, Bahl R. Understanding biological mechanisms underlying adverse birth outcomes in developing countries: protocol for a prospective cohort (AMANHI bio-banking) study. J Glob Health 2018; 7:021202. [PMID: 29163938 PMCID: PMC5665675 DOI: 10.7189/jogh.07.021202] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives The AMANHI study aims to seek for biomarkers as predictors of important pregnancy–related outcomes, and establish a biobank in developing countries for future research as new methods and technologies become available. Methods AMANHI is using harmonised protocols to enrol 3000 women in early pregnancies (8–19 weeks of gestation) for population–based follow–up in pregnancy up to 42 days postpartum in Bangladesh, Pakistan and Tanzania, with collection taking place between August 2014 and June 2016. Urine pregnancy tests will be used to confirm reported or suspected pregnancies for screening ultrasound by trained sonographers to accurately date the pregnancy. Trained study field workers will collect very detailed phenotypic and epidemiological data from the pregnant woman and her family at scheduled home visits during pregnancy (enrolment, 24–28 weeks, 32–36 weeks & 38+ weeks) and postpartum (days 0–6 or 42–60). Trained phlebotomists will collect maternal and umbilical blood samples, centrifuge and obtain aliquots of serum, plasma and the buffy coat for storage. They will also measure HbA1C and collect a dried spot sample of whole blood. Maternal urine samples will also be collected and stored, alongside placenta, umbilical cord tissue and membrane samples, which will both be frozen and prepared for histology examination. Maternal and newborn stool (for microbiota) as well as paternal and newborn saliva samples (for DNA extraction) will also be collected. All samples will be stored at –80°C in the biobank in each of the three sites. These samples will be linked to numerous epidemiological and phenotypic data with unique study identification numbers. Importance of the study AMANHI biobank proves that biobanking is feasible to implement in LMICs, but recognises that biobank creation is only the first step in addressing current global challenges.
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Affiliation(s)
| | - Abdullah H Baqui
- Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rasheda Khanam
- Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mohammad Sayedur Rahman
- Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aziz Ahmed
- Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hasna Hena Rahman
- Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mamun Ibne Moin
- Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Salahuddin Ahmed
- Center for Maternal and Newborn Health, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Fyezah Jehan
- Department of Pediatrics and Child Health, Aga Khan University, Pakistan
| | - Imran Nisar
- Department of Pediatrics and Child Health, Aga Khan University, Pakistan
| | - Atiya Hussain
- Department of Pediatrics and Child Health, Aga Khan University, Pakistan
| | - Muhammad Ilyas
- Department of Pediatrics and Child Health, Aga Khan University, Pakistan
| | - Aneeta Hotwani
- Department of Pediatrics and Child Health, Aga Khan University, Pakistan
| | - Muhammad Sajid
- Department of Pediatrics and Child Health, Aga Khan University, Pakistan
| | - Shahida Qureshi
- Department of Pediatrics and Child Health, Aga Khan University, Pakistan
| | - Anita Zaidi
- Department of Pediatrics and Child Health, Aga Khan University, Pakistan
| | - Sunil Sazawal
- Centre for Public Health Kinetics, India and Public Health Laboratory-IdC, Pemba, Tanzania
| | - Said M Ali
- Centre for Public Health Kinetics, India and Public Health Laboratory-IdC, Pemba, Tanzania
| | - Saikat Deb
- Centre for Public Health Kinetics, India and Public Health Laboratory-IdC, Pemba, Tanzania
| | - Mohammed Hamad Juma
- Centre for Public Health Kinetics, India and Public Health Laboratory-IdC, Pemba, Tanzania
| | - Usha Dhingra
- Centre for Public Health Kinetics, India and Public Health Laboratory-IdC, Pemba, Tanzania
| | - Arup Dutta
- Centre for Public Health Kinetics, India and Public Health Laboratory-IdC, Pemba, Tanzania
| | - Shaali Makame Ame
- Centre for Public Health Kinetics, India and Public Health Laboratory-IdC, Pemba, Tanzania
| | - Caroline Hayward
- University of Edinburgh: Centre for Global Health Research, Old Medical School, Edinburgh, Scotland, UK
| | - Igor Rudan
- University of Edinburgh: Centre for Global Health Research, Old Medical School, Edinburgh, Scotland, UK
| | | | - Donna Russell
- World Health Organization (MCA/MRD), Geneva, Switzerland
| | | | - Ozren Polašek
- University of Split School of Medicine, Split, Croatia.,Gen-info Ltd, Zagreb, Croatia
| | - Alexander Manu
- World Health Organization (MCA/MRD), Geneva, Switzerland
| | - Rajiv Bahl
- World Health Organization (MCA/MRD), Geneva, Switzerland
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Moodley K. Legitimacy, Trust and Stakeholder Engagement: Biobanking in South Africa. Asian Bioeth Rev 2017. [DOI: 10.1007/s41649-017-0035-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Genomic Research Data Generation, Analysis and Sharing – Challenges in the African Setting. DATA SCIENCE JOURNAL 2017. [DOI: 10.5334/dsj-2017-049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Berghs M. Practices and discourses of ubuntu: Implications for an African model of disability? Afr J Disabil 2017; 6:292. [PMID: 28730067 PMCID: PMC5502472 DOI: 10.4102/ajod.v6.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 10/28/2016] [Indexed: 11/10/2022] Open
Abstract
Background Southern African scholars and activists working in disability studies have argued that ubuntu or unhu is a part of their world view. Objectives Thinking seriously about ubuntu, as a shared collective humanness or social ethics, means to examine how Africans have framed a struggle for this shared humanity in terms of decolonisation and activism. Method Three examples of applications of ubuntu are given, with two mainly linked to making explicit umaka. Firstly, ubuntu is linked to making visible the invisible inequalities for a common humanity in South Africa. Secondly, it becomes correlated to the expression of environmental justice in West and East African countries. Results An African model of disability that encapsulates ubuntu is correlated to how Africans have illustrated a social ethics of a common humanity in their grassroots struggles against oppression and disablement in the 20th century. Ubuntu also locates disability politically within the wider environment and practices of sustainability which are now important to the post-2105 agenda, Convention on the Rights of Persons with Disabilities (CRPD) and the (UN) Sustainable Development Goals linked to climate change. Conclusion A different kind of political action linked to social justice seems to be evolving in line with ubuntu. This has implications for the future of disability studies.
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Mayne ES, Croxton T, Abimiku A, Joloba M, Kyobe S, Beiswanger CM, Wideroff L, Guyer M, Troyer J, Kader M, H3Africa Biorepository Working Grou. Genes for Life: Biobanking for Genetic Research in Africa. Biopreserv Biobank 2017. [PMCID: PMC5397245 DOI: 10.1089/bio.2017.0007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Elizabeth Sarah Mayne
- Department of Molecular Medicine and Haemotology, University of the Witwatersrand, National Health Laboratory Service, Johannesburg, South Africa
| | - Talishiea Croxton
- Institute of Human Virology-Nigeria, Abuja, Nigeria
- University of Maryland, College Park, Maryland
| | - Alash'le Abimiku
- Institute of Human Virology-Nigeria, Abuja, Nigeria
- University of Maryland, College Park, Maryland
| | | | | | | | | | - Mark Guyer
- National Institutes of Health, Bethesda, Maryland
| | | | - Mukthar Kader
- Clinical Laboratory Services, University of the Witwatersrand, Johannesburg, South Africa
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Croxton T, Swanepoel C, Musinguzi H, Kader M, Ozumba P, Pillay AD, Syed R, Swartz G, Kyobe S, Lwanga N, Katabazi FA, Edgar K, Ndidi A, Jonathan E, Onyemata E, Isaacs S, Mayne ES, Joloba M, Jentsch U, Abayomi A, Abimiku A, Troyer J, Penno S, H3Africa Biorepository PI Committee. Lessons Learned from Biospecimen Shipping Among the Human Heredity and Health in Africa Biorepositories. Biopreserv Biobank 2017. [DOI: 10.1089/bio.2017.0009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Talishiea Croxton
- Clinical Laboratory Department, Institute of Human Virology-Nigeria, Abuja, Nigeria
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Carmen Swanepoel
- Division of Haematology, National Health Laboratory Services (NHLS), Tygerberg Hospital, Cape Town, South Africa
- Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Henry Musinguzi
- Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mukthar Kader
- Clinical Laboratory Services-Wits Health Consortium, Johannesburg, South Africa
| | - Petronilla Ozumba
- Clinical Laboratory Department, Institute of Human Virology-Nigeria, Abuja, Nigeria
| | - Azure-Dee Pillay
- Clinical Laboratory Services-Wits Health Consortium, Johannesburg, South Africa
| | - Raeesa Syed
- Clinical Laboratory Services-Wits Health Consortium, Johannesburg, South Africa
| | - Garth Swartz
- Clinical Laboratory Services-Wits Health Consortium, Johannesburg, South Africa
| | - Samuel Kyobe
- Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Newton Lwanga
- Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Fred Ashaba Katabazi
- Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Kigozi Edgar
- Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Agala Ndidi
- Clinical Laboratory Department, Institute of Human Virology-Nigeria, Abuja, Nigeria
| | - Emmanuel Jonathan
- Clinical Laboratory Department, Institute of Human Virology-Nigeria, Abuja, Nigeria
| | - Enzenwa Onyemata
- Clinical Laboratory Department, Institute of Human Virology-Nigeria, Abuja, Nigeria
| | - Shafieka Isaacs
- Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | | | - Moses Joloba
- Department of Medical Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ute Jentsch
- Clinical Laboratory Services-Wits Health Consortium, Johannesburg, South Africa
| | - Akin Abayomi
- Division of Haematology, National Health Laboratory Services (NHLS), Tygerberg Hospital, Cape Town, South Africa
- Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Alash'le Abimiku
- Clinical Laboratory Department, Institute of Human Virology-Nigeria, Abuja, Nigeria
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jennifer Troyer
- National Human Genome Research Institute, National Institutes of Health and Human Services, Bethesda, Maryland
| | - Sue Penno
- National Human Genome Research Institute, National Institutes of Health and Human Services, Bethesda, Maryland
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de Vries J, Munung SN, Matimba A, McCurdy S, Ouwe Missi Oukem-Boyer O, Staunton C, Yakubu A, Tindana P. Regulation of genomic and biobanking research in Africa: a content analysis of ethics guidelines, policies and procedures from 22 African countries. BMC Med Ethics 2017; 18:8. [PMID: 28153006 PMCID: PMC5289015 DOI: 10.1186/s12910-016-0165-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 12/29/2016] [Indexed: 11/17/2022] Open
Abstract
Background The introduction of genomics and biobanking methodologies to the African research context has also introduced novel ways of doing science, based on values of sharing and reuse of data and samples. This shift raises ethical challenges that need to be considered when research is reviewed by ethics committees, relating for instance to broad consent, the feedback of individual genetic findings, and regulation of secondary sample access and use. Yet existing ethics guidelines and regulations in Africa do not successfully regulate research based on sharing, causing confusion about what is allowed, where and when. Methods In order to understand better the ethics regulatory landscape around genomic research and biobanking, we conducted a comprehensive analysis of existing ethics guidelines, policies and other similar sources. We sourced 30 ethics regulatory documents from 22 African countries. We used software that assists with qualitative data analysis to conduct a thematic analysis of these documents. Results Surprisingly considering how contentious broad consent is in Africa, we found that most countries allow the use of this consent model, with its use banned in only three of the countries we investigated. In a likely response to fears about exploitation, the export of samples outside of the continent is strictly regulated, sometimes in conjunction with regulations around international collaboration. We also found that whilst an essential and critical component of ensuring ethical best practice in genomics research relates to the governance framework that accompanies sample and data sharing, this was most sparingly covered in the guidelines. Conclusions There is a need for ethics guidelines in African countries to be adapted to the changing science policy landscape, which increasingly supports principles of openness, storage, sharing and secondary use. Current guidelines are not pertinent to the ethical challenges that such a new orientation raises, and therefore fail to provide accurate guidance to ethics committees and researchers.
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Affiliation(s)
- Jantina de Vries
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Syntia Nchangwi Munung
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Alice Matimba
- Department of Clinical Pharmacology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Sheryl McCurdy
- Center for Health Promotion and Prevention Research, School of Public Health, University of Texas Health Science Center at Houston, Houston, USA
| | | | | | - Aminu Yakubu
- National Health Research Ethics Committee, Federal Ministry of Health, Abuja, Nigeria
| | - Paulina Tindana
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
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Barchi F, Little MT. National ethics guidance in Sub-Saharan Africa on the collection and use of human biological specimens: a systematic review. BMC Med Ethics 2016; 17:64. [PMID: 27770794 PMCID: PMC5075204 DOI: 10.1186/s12910-016-0146-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 10/11/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Ethical and regulatory guidance on the collection and use of human biospecimens (HBS) for research forms an essential component of national health systems in Sub-Saharan Africa (SSA), where rapid advances in genetic- and genomic-based technologies are fueling clinical trials involving HBS and the establishment of large-scale biobanks. METHODS An extensive multi-level search for publicly available ethics regulatory guidance was conducted for each SSA country. A second review documented active trials listed in the WHO International Clinical Trials Registry Platform as of January 2015 in which HBS collection was specified in the protocol. Findings were combined to determine the extent to which countries that are study sites for HBS-related research are supported by regulatory guidance language on the collection, use, ownership and storage of biospecimens. RESULTS Of the 49 SSA countries, 29 had some form of national ethics guidance, yet only 17 provided language relating to HBS-related research, with specific guidance on consent (14), ownership (6), reuse (10), storage (9), and export/import/transfer (13). Ten countries accounted for 84 % of the active clinical trials involving the collection of HBS in SSA. All except one of these countries were found to have some national guidance in the form of regulations, codes of ethics, and/or standard operating procedures; however, only seven of the ten offered any language specific to HBS. CONCLUSIONS Despite the fact that the bulk of registered clinical trials in SSA involving HBS, as well as existing and proposed sites for biorepositories under the H3Africa Initiative, are currently situated in countries with the most complete ethics and regulatory guidance, variability in the regulations themselves may create challenges for planned and future pan-African collaborations and may require legislative action at the national level to revise. Countries in SSA that still lack regulatory guidance on HBS will require extensive health system strengthening in ethics governance before they can be full participants in the modern research enterprise.
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Affiliation(s)
- Francis Barchi
- Edward J. Bloustein School of Planning and Public Policy, Rutgers University-New Brunswick, 33 Livingston Street, New Brunswick, NJ 08901 USA
| | - Madison T. Little
- Department of Social Policy & Intervention, University of Oxford, Oxford, UK
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Moodley K, Singh S. "It's all about trust": reflections of researchers on the complexity and controversy surrounding biobanking in South Africa. BMC Med Ethics 2016; 17:57. [PMID: 27724893 PMCID: PMC5057490 DOI: 10.1186/s12910-016-0140-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 09/27/2016] [Indexed: 01/05/2023] Open
Abstract
Background Biobanks are precariously situated at the intersection of science, genetics, genomics, society, ethics, the law and politics. This multi-disciplinarity has given rise to a new discourse in health research involving diverse stakeholders. Each stakeholder is embedded in a unique context and articulates his/her biobanking activities differently. To researchers, biobanks carry enormous transformative potential in terms of advancing scientific discovery and knowledge. However, in the context of power asymmetries in Africa and a distrust in science born out of historical exploitation, researchers must balance the scientific imperative of collecting, storing and sharing high quality biological samples with obligations to donors/participants, communities, international collaborators, regulatory and ethics authorities. To date, researcher perspectives on biobanking in South Africa have not been explored and documented. Methods In-depth qualitative interviews were conducted with a purposive sample of 21 researchers – 8 in the Western Cape, 3 in Gauteng and 10 in Kwa-Zulu Natal. Interviews lasted approximately 40–60 min and were audiotaped with consent. Thematic analysis of the transcribed interviews was conducted by the co-authors. Results Researchers articulated serious concerns over standardised regulatory approaches that failed to consider the heterogeneity of biobanks. Given that biobanks differ considerably, guidelines and RECs need to stratify risk accordingly and governance processes and structures must be flexible. While RECs were regarded as an important component of the governance structure researchers expressed concern about their expertise in biobanking. Operational management of biobanks was regarded as an ethical imperative and a pre-requisite to building trust during consent processes. While broad general consent was preferred, tiered consent was thought to be more consistent with respect for autonomy and building trust. Material Transfer Agreements (MTAs) were often lacking when biosamples were exported and this was perceived to impact negatively on trust. On the other hand, researchers believed that authentic community engagement would help to build trust. Conclusion Building trust will best be achieved via a system of governance structures and processes that precede the establishment of a biobank and monitor progress from the point of sample collection through to future use, including export. Such governance structures must be robust and must include comprehensive national legislation, policy and contextualised guidelines. Currently such governance infrastructure appears to be lacking in many African countries including South Africa. Capacity development of all stakeholders including REC members will enhance expeditious and efficient review of biobanking protocols which in turn will reinforce trust in the researcher-donor relationship. Science translation and community engagement in biobanking is integral to the success of biobanking in South Africa. Electronic supplementary material The online version of this article (doi:10.1186/s12910-016-0140-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Keymanthri Moodley
- Centre for Medical Ethics and Law, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa.
| | - Shenuka Singh
- Centre for Medical Ethics and Law, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, Tygerberg, South Africa
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Matimba A, Tybring G, Chitereka J, Zinyama-Gutsire R, Dandara C, Bürén E, Dhoro M, Masimirembwa C. Practical Approach to Biobanking in Zimbabwe: Establishment of an Inclusive Stakeholder Framework. Biopreserv Biobank 2016; 14:440-446. [DOI: 10.1089/bio.2015.0043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Alice Matimba
- Department of Clinical Pharmacology, University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
| | - Gunnel Tybring
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Collet Dandara
- Division of Human Genetics, Faculty of Health Sciences, Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Eva Bürén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Milcah Dhoro
- African Institute of Biomedical Science and Technology, Wilkins Hospital, Harare, Zimbabwe
| | - Collen Masimirembwa
- African Institute of Biomedical Science and Technology, Wilkins Hospital, Harare, Zimbabwe
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Ravinetto R, Becker SL, Sacko M, El-Safi S, Mahendradhata Y, Lutumba P, Rijal S, Lim K, Sundar S, N'Goran EK, Verdonck K, Utzinger J, Chappuis F, Boelaert M. Governance and Standards in International Clinical Research: The Role of Transnational Consortia. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2016; 16:59-61. [PMID: 27653405 DOI: 10.1080/15265161.2016.1214317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
| | - Sören L Becker
- b Swiss Tropical and Public Health Institute, University of Basel, and Saarland University
| | - Moussa Sacko
- c Institut National de Recherche en Santé Publique
| | | | | | - Pascal Lutumba
- f Institut National de Recherche Biomédicale and University of Kinshasa
| | | | - Kruy Lim
- h Sihanouk Hospital Center of HOPE
| | - Shyam Sundar
- i Kala-Azar Medical Research Centre and Banaras Hindu University
| | - Eliézer K N'Goran
- j Université Félix Houphouët-Boigny and Centre Suisse de Recherches Scientifiques en Côte d'Ivoire
| | | | - Jürg Utzinger
- l Swiss Tropical and Public Health Institute and University of Basel
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Roach AN, Braithwaite T, Carrington C, Marcellin E, Sharma S, Hingorani A, Casas JP, Hauser MA, Allingham RR, Ramsewak SS, Bourne R. Addressing ethical challenges in the Genetics Substudy of the National Eye Survey of Trinidad and Tobago (GSNESTT). Appl Transl Genom 2016; 9:6-14. [PMID: 27556007 PMCID: PMC4986520 DOI: 10.1016/j.atg.2016.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The conduct of international collaborative genomics research raises distinct ethical challenges that require special consideration, especially if conducted in settings that are research-naïve or resource-limited. Although there is considerable literature on these issues, there is a dearth of literature chronicling approaches taken to address these issues in the field. Additionally no previous ethical guidelines have been developed to support similar research in Trinidad and Tobago. METHODS A literature review was undertaken to identify strategies used to address common ethical issues relevant to human genetics and genomics research in research-naïve or resource-limited settings. Strategies identified were combined with novel approaches to develop a culturally appropriate, multifaceted strategy to address potential challenges in the Genetics Substudy of the National Eye Survey of Trinidad and Tobago (GSNESTT). RESULTS Regarding the protection of study participants, we report a decision to exclude children as participants; the use of a Community Engagement and Sensitization Strategy to increase the genetic literacy of the target population; the involvement of local expertise to ensure cultural sensitivity and to address potential comprehension barriers in informed consent; and an audit of the informed consent process to ensure valid consent. Concerning the regulation of the research, we report on ethics approvals from relevant authorities; a Materials Transfer Agreement to guide sample ownership and export; and a Sample Governance Committee to oversee data use and data access. Finally regarding the protection of the interests of scientists from the host country, we report on capacity building efforts to ensure that local scientists have access to data collected through the project and appropriate recognition of their contributions in future publications. CONCLUSION This paper outlines an ethical framework for the conduct of population-based genetics and genomics research in Trinidad and Tobago; highlights common issues arising in the field and strategies to address these.
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Affiliation(s)
- Allana N. Roach
- Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies (UWI), St. Augustine, Trinidad and Tobago
- Corresponding author at: University of Trinidad and Tobago, O'Meara Road, Arima, Trinidad and Tobago.University of Trinidad and TobagoO'Meara RoadArimaTrinidad and Tobago
| | | | - Christine Carrington
- Department of Preclinical Sciences, Faculty of Medical Sciences, The University of the West Indies (UWI), St. Augustine, Trinidad and Tobago
| | - Elysse Marcellin
- Research Assistant, Faculty of Medical Sciences, The University of the West Indies (UWI), St. Augustine, Trinidad and Tobago
| | - Subash Sharma
- Optometry Programme, Faculty of Medical Sciences, The University of the West Indies (UWI), St. Augustine, Trinidad and Tobago
| | - Aroon Hingorani
- Institute of Cardiovascular Sciences, University College London (UCL), UK
| | - Juan P. Casas
- Institute of Health Informatics, University College London, UK
| | - Michael A. Hauser
- Department of Medicine, Duke Institute of Molecular Physiology, Duke University, Durham, NC, USA
- Department of Ophthalmology, Duke University, Durham, NC, USA
| | - R. Rand Allingham
- Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies (UWI), St. Augustine, Trinidad and Tobago
| | - Samuel S. Ramsewak
- Department of Preclinical Sciences, Faculty of Medical Sciences, The University of the West Indies (UWI), St. Augustine, Trinidad and Tobago
| | - Rupert Bourne
- Vision and Eye Research Unit, Anglia Ruskin University (ARU), Cambridge, UK
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A biobank to support HIV malignancy research for sub-Saharan Africa. S Afr Med J 2016; 106:867-9. [PMID: 27601106 DOI: 10.7196/samj.2016.v106i9.10891] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 05/03/2016] [Indexed: 12/31/2022] Open
Abstract
Sub-Saharan Africa has one of the highest incidences of infection with HIV globally, but more people in this region are living longer owing to increased access to antiretroviral therapy. However, along with increased care and treatment, this population is expected to have an increase in HIV-associated cancers, as is being seen in the USA and other developed countries. To support translational research in HIV-associated cancers, Stellenbosch University in Cape Town, South Africa, was funded to house the state-of-the-art AIDS and Cancer Specimen Resource Sub-Saharan Africa Regional Biorepository (SSA RBR) to proactively obtain, manage and process biospecimens and associated clinical data representing both AIDS-defining and non-AIDS-defining cancers for research. The SSA RBR furthermore functions as the biorepository for AIDS Malignancy Consortium sub-Saharan clinical trial activities in this region. Although the site had much experience with cryopreservation and storage of specimens, capacity building revolving around operations under International Society for Environmental and Biological Resources/National Cancer Institute best practices took place in such areas as custodianship v. ownership, data sharing and facilities management. The process from selection until launch took 14 months.
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Tindana P, de Vries J. Broad Consent for Genomic Research and Biobanking: Perspectives from Low- and Middle-Income Countries. Annu Rev Genomics Hum Genet 2016; 17:375-93. [PMID: 26905784 DOI: 10.1146/annurev-genom-083115-022456] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Genomic research and biobanking are increasingly being conducted in the context of collaborations between researchers in high-income countries and those in low- and middle-income countries. Although these scientific advancements have presented unique opportunities for researchers to contribute to cutting-edge scientific projects and address important health problems, they have also challenged existing ethical and regulatory frameworks, particularly in sub-Saharan Africa. Broad consent is a model that allows the use of human biological samples and associated data in future research that may be unrelated to the original study. Drawing on emerging perspectives in low- and middle-income countries, we argue that broad consent is equivalent to consent to governance and that a robust governance framework for genomics and biobanking should seek to promote global health and research equity and take into account five key elements: respect, authentic community engagement and trust building, the preservation of privacy and confidentiality, feedback of results, and capacity strengthening.
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Affiliation(s)
- Paulina Tindana
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana;
| | - Jantina de Vries
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, 7925 Cape Town, South Africa;
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Munung NS, Marshall P, Campbell M, Littler K, Masiye F, Ouwe-Missi-Oukem-Boyer O, Seeley J, Stein DJ, Tindana P, de Vries J. Obtaining informed consent for genomics research in Africa: analysis of H3Africa consent documents. JOURNAL OF MEDICAL ETHICS 2016; 42:132-137. [PMID: 26644426 PMCID: PMC4752624 DOI: 10.1136/medethics-2015-102796] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 09/07/2015] [Accepted: 09/15/2015] [Indexed: 05/29/2023]
Abstract
BACKGROUND The rise in genomic and biobanking research worldwide has led to the development of different informed consent models for use in such research. This study analyses consent documents used by investigators in the H3Africa (Human Heredity and Health in Africa) Consortium. METHODS A qualitative method for text analysis was used to analyse consent documents used in the collection of samples and data in H3Africa projects. Thematic domains included type of consent model, explanations of genetics/genomics, data sharing and feedback of test results. RESULTS Informed consent documents for 13 of the 19 H3Africa projects were analysed. Seven projects used broad consent, five projects used tiered consent and one used specific consent. Genetics was mostly explained in terms of inherited characteristics, heredity and health, genes and disease causation, or disease susceptibility. Only one project made provisions for the feedback of individual genetic results. CONCLUSION H3Africa research makes use of three consent models-specific, tiered and broad consent. We outlined different strategies used by H3Africa investigators to explain concepts in genomics to potential research participants. To further ensure that the decision to participate in genomic research is informed and meaningful, we recommend that innovative approaches to the informed consent process be developed, preferably in consultation with research participants, research ethics committees and researchers in Africa.
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Affiliation(s)
| | - Patricia Marshall
- Center for Genetic Research Ethics and Law Department of Bioethics, School of Medicine, Case Western Reserve University, Cleaveland, Ohio, USA
| | - Megan Campbell
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Francis Masiye
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Odile Ouwe-Missi-Oukem-Boyer
- Centre de Recherche Médicale et Sanitaire (CERMES), Niamey, Niger
- Cameroon Bioethics Initiative (CAMBIN), Yaounde, Cameroon
| | - Janet Seeley
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - D J Stein
- MRC Unit on Anxiety & Stress Disorders Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Paulina Tindana
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Jantina de Vries
- Department of Medicine, University of Cape Town, Cape Town, South Africa
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Mungwira RG, Nyangulu W, Misiri J, Iphani S, Ng'ong'ola R, Chirambo CM, Masiye F, Mfutso-Bengo J. Is it ethical to prevent secondary use of stored biological samples and data derived from consenting research participants? The case of Malawi. BMC Med Ethics 2015; 16:83. [PMID: 26626016 PMCID: PMC4667408 DOI: 10.1186/s12910-015-0077-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 11/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper discusses the contentious issue of reuse of stored biological samples and data obtained from research participants in past clinical research to answer future ethical and scientifically valid research questions. Many countries have regulations and guidelines that guide the use and exportation of stored biological samples and data. However, there are variations in regulations and guidelines governing the reuse of stored biological samples and data in Sub-Saharan Africa including Malawi. DISCUSSION The current research ethics regulations and guidelines in Malawi do not allow indefinite storage and reuse of biological samples and data for future unspecified research. This comes even though the country has managed to answer pertinent research questions using stored biological samples and data. We acknowledge the limited technical expertise and equipment unavailable in Malawi that necessitates exportation of biological samples and data and the genuine concern raised by the regulatory authorities about the possible exploitation of biological samples and data by researchers. We also acknowledge that Malawi does not have bio-banks for storing biological samples and data for future research purposes. This creates room for possible exploitation of biological samples and data collected from research participants in primary research projects in Malawi. However, research ethics committees require completion and approval of material transfer agreements and data transfer agreements for biological samples and data collected for research purposes respectively and this requirement may partly address the concern raised by the regulatory authorities. Our concern though is that there is no such requirement for biological samples and data collected from patients for clinical or diagnostic purposes. In conclusion, we propose developing a medical data and material transfer agreement for biological samples and data collected from patients for clinical or diagnostic purposes in both public and private health facilities that may end up in research centers outside Malawi. We also propose revision of the current research ethics regulations and guidelines in Malawi in order to allow secondary use of biological samples and data collected from primary research projects as a way of maximizing the use of collected samples and data. Finally, we call for consultation of all stakeholders within the Malawi research community when regulatory authorities are developing policies that govern research in Malawi.
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Affiliation(s)
- Randy G Mungwira
- College of Medicine, School of Public Health, Master of Public Health Bioethics Major Students, University of Malawi, Blantyre, Malawi.
| | - Wongani Nyangulu
- College of Medicine, School of Public Health, Master of Public Health Bioethics Major Students, University of Malawi, Blantyre, Malawi.
| | - James Misiri
- College of Medicine, School of Public Health, Master of Public Health Bioethics Major Students, University of Malawi, Blantyre, Malawi.
| | - Steven Iphani
- College of Medicine, School of Public Health, Master of Public Health Bioethics Major Students, University of Malawi, Blantyre, Malawi.
| | - Ruby Ng'ong'ola
- College of Medicine, School of Public Health, Master of Public Health Bioethics Major Students, University of Malawi, Blantyre, Malawi.
| | - Chawanangwa M Chirambo
- College of Medicine, School of Public Health, Master of Public Health Bioethics Major Students, University of Malawi, Blantyre, Malawi.
| | - Francis Masiye
- Department of Medicine, University of Cape Town, Cape Town, Republic of South Africa. .,College of Medicine, School of Public Health, Center for Bioethics, University of Malawi, Blantyre, Malawi.
| | - Joseph Mfutso-Bengo
- College of Medicine, School of Public Health, Center for Bioethics, University of Malawi, Blantyre, Malawi.
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Dandara C, Huzair F, Borda-Rodriguez A, Chirikure S, Okpechi I, Warnich L, Masimirembwa C. H3Africa and the African life sciences ecosystem: building sustainable innovation. OMICS-A JOURNAL OF INTEGRATIVE BIOLOGY 2015; 18:733-9. [PMID: 25454511 DOI: 10.1089/omi.2014.0145] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Interest in genomics research in African populations is experiencing exponential growth. This enthusiasm stems in part from the recognition that the genomic diversity of African populations is a window of opportunity for innovations in postgenomics medicine, ecology, and evolutionary biology. The recently launched H3Africa initiative, for example, captures the energy and momentum of this interest. This interdisciplinary socio-technical analysis highlights the challenges that have beset previous genomics research activities in Africa, and looking ahead, suggests constructive ways H3Africa and similar large scale science efforts could usefully chart a new era of genomics and life sciences research in Africa that is locally productive and globally competitive. As independent African scholars and social scientists, we propose that any serious global omics science effort, including H3Africa, aiming to build genomics research capacity and capability in Africa, needs to fund the establishment of biobanks and the genomic analyses platforms within Africa. Equally they need to prioritize community engagement and bioinformatics capability and the training of African scientists on these platforms. Historically, the financial, technological, and skills imbalance between Africa and developed countries has created exploitative frameworks of collaboration where African researchers have become merely facilitators of Western funded and conceived research agendas involving offshore expatriation of samples. Not surprisingly, very little funding was allocated to infrastructure and human capital development in the past. Moving forward, capacity building should materialize throughout the entire knowledge co-production trajectory: idea generation (e.g., brainstorming workshops for innovative hypotheses development by African scientists), data generation (e.g., genome sequencing), and high-throughput data analysis and contextualization. Additionally, building skills for political science scholarship that questions the unchecked assumptions of the innovation performers be they funders, scientists, and social scientists, would enable collective innovation that is truly sustainable, ethical, and robust.
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Affiliation(s)
- Collet Dandara
- 1 Pharmacogenetics Research Group, Division of Human Genetics, Department of Clinical Laboratory Sciences and Institute for Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, University of Cape Town , South Africa
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Barchi F, Matlhagela K, Jones N, Kebaabetswe PM, Merz JF. "The keeping is the problem": A qualitative study of IRB-member perspectives in Botswana on the collection, use, and storage of human biological samples for research. BMC Med Ethics 2015; 16:54. [PMID: 26286519 PMCID: PMC4544805 DOI: 10.1186/s12910-015-0047-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 08/04/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Concurrent with efforts to establish national and regional biorepositories in Africa is widespread endorsement of ethics committees as stewards of the interests of individual donors and their communities. To date, ethics training programs for IRB members in Botswana have focused on ethical principles and international guidelines rather than on the ethical dimensions of specific medical technologies and research methodologies. Little is known about the knowledge and concerns of current and prospective IRB members in Botswana with respect to export, reuse, storage, and benefit-sharing of biospecimens. METHODS This qualitative study examined perspectives of IRB members in Botswana about the collection and use of biospecimens in research. Forty-one IRB members representing five committees in Botswana participated in discussions groups in March 2013. Transcriptions of audiotapes and field notes were analyzed to identify issues of concern that might be alleviated through education and capacity-building, and areas that required ongoing discussion or additional regulatory guidance. RESULTS Areas of concern included lack of understanding among patients and providers about the use of biospecimens in clinical care and research; reuse of biospecimens, particularly issues of consent, ownership and decision-making; export of specimens and loss of control over reuse and potential benefits; and felt need for regulatory guidance and IRB-member training. Local belief systems about bodily integrity and strong national identity in the construct of benefits may be at odds with initiatives that involve foreign biorepositories or consider such collections to be global public goods. CONCLUSION Education is needed to strengthen IRB-member capacity to review and monitor protocols calling for the collection and use of biospecimens, guided by clear national policy on priority-setting, partnerships, review, and oversight. Engagement with local stakeholders is needed to harmonize fundamentally different ways of understanding the human body and community identity with the aims of contemporary biomedicine.
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Affiliation(s)
- Francis Barchi
- Institute for Health, Health Care Policy, and Aging Research Rutgers, The State University of New Jersey, 112 Paterson Street, New Brunswick, NJ, 08901-1293, USA.
| | - Keikantse Matlhagela
- Faculty of Medicine, University of Botswana, Plot 4775, Notwane Road, Gaborone, Botswana.
| | - Nicola Jones
- Botswana-UPenn Partnership, 244G - Room 103, University of Botswana Main Campus, Gaborone, Botswana.
| | - Poloko M Kebaabetswe
- Faculty of Medicine, University of Botswana, Plot 4775, Notwane Road, Gaborone, Botswana.
| | - Jon F Merz
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, 3401 Market Street, Suite 320, Philadelphia, PA, 19104-3319, USA.
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Mendy M, Caboux E, Sylla BS, Dillner J, Chinquee J, Wild C. Infrastructure and facilities for human biobanking in low- and middle-income countries: a situation analysis. Pathobiology 2015; 81:252-260. [PMID: 25792214 DOI: 10.1159/000362093] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To collect information on biobanking facilities in low- and middle-income countries (LMICs) as a first step towards establishing an LMIC biobank and cohort building network (BCNet) to support research, with a focus on cancer control. METHOD Sixty centres were identified from sources including cancer centres, universities, hospitals, and public health facilities and invited to participate in a survey between December 2012 and March 2013. RESULTS Of the 27 centres (45%) that responded, most have existed for <10 years. They store between 1,000 and 1,000,000 research samples as well as samples remaining after clinical diagnosis. Sample storage is mostly in freezers, although 45% (9/20) of the centres do not have regular access to electricity. Biobank managers, sample management systems, and mechanisms for follow-up using linkages are uncommon. Many (80%; 21/26) of the centres have regulations to govern research, but regulations for the use of biobank resources (samples and data) are not well developed. CONCLUSIONS Biobanking facilities are being developed in LMICs. Shortcomings in international visibility, sample sharing regulations, standardization, quality assurance, and sample management systems could be alleviated by international networking. Stakeholders need to work together to increase access to high-quality biological resources for scientific research.
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Affiliation(s)
- Maimuna Mendy
- International Agency for Research on Cancer, Lyon, France
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Nnamuchi O. Biobank/Genomic Research in Nigeria: Examining Relevant Privacy and Confidentiality Frameworks. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2015; 43:776-786. [PMID: 26711417 DOI: 10.1111/jlme.12319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Nigeria's commitment to genomic research and biobanking is beyond dispute. Proof, if there is need for one, is that the country is one of only six nations (others are Canada, China, Japan, the United Kingdom, and the United States) involved in the International HapMap Project. The HapMap Project is an innovative enterprise aimed at developing a haplotype map of the human genome, a tool that is helpful to studying the genetic basis of disease as well as the genetic or hereditary factors that contribute to variation in response to environmental factors, in susceptibility to infection, and in the effectiveness of, and adverse responses to, drugs and vaccines. In addition, the country is home to H3Africa biobank (with 45, 358 human samples in storage), affiliated with the Institute of Human Virology of Nigeria (IHVN), and several others. Benefits accruing from genomic research and biobanking are enormous; so also is protection of research subjects. The protection envisaged centers primarily on, inter alia, securing informed consent, safeguarding privacy and maintaining confidentiality of health information - all of which are enshrined in ethicolegal regimes in Nigeria. But whether these frameworks are consistent with international best practices is not at all clear, hence the need for this paper.
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Affiliation(s)
- Obiajulu Nnamuchi
- Assistant Professor in the Faculty of Law at the University of Nigeria. He is also the President of the Centre for Health, Bioethics and Human Rights (CHBHR) and Director of its section on Bioethics. Dr. Nnamuchi's scholarship focuses on the intersection of health and human rights, global health, health governance and financing, and law and ethics of medical practice
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Andanda P, Govender S. Regulation of Biobanks in South Africa. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2015; 43:787-800. [PMID: 26711418 DOI: 10.1111/jlme.12320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The availability of biological samples and data is critical for the establishment of biobanks for health research purposes. Such availability should be ensured in accordance with relevant national legislation and ethical principles. In this article, we consider the extent to which the current legal and ethical regulatory frameworks in South Africa are capable of governing the use of stored biological samples in a manner that facilitates health research while at the same time protecting the interests of sample donors. These two attributes are essential for establishing biobanks in the country. Our evaluation of the frameworks is based on desk review of the current literature with a special focus on oversight mechanisms in place that ensure compliance with national legislation and ethical review processes to facilitate future and secondary uses of data, the extent to which informed consent policies foster sharing of research samples, data and protocols as well as mechanisms for safeguarding confidentiality. We established that there is an urgent need to streamline South Africa's legal and ethical frameworks because they are currently ambiguous and disjointed. There is equally a need to bring the frameworks in line with the current developments at the national and international levels.
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Affiliation(s)
- Pamela Andanda
- Professor of Law at the University of the Witwatersrand, Johannesburg. She holds LL.B. and LL.M. degrees from the University of Nairobi and a Ph.D. in law from the University of the Witwatersrand, Johannesburg
| | - Sandra Govender
- Director of Research and Development at Justice College (Pretoria). She holds B.Proc., LL.B., and LL.M. degrees from the University of Natal, Bcom (hons.) from the University of Cape Town and a Ph.D. in law from the University of the Witwatersrand, Johannesburg
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Tindana P, Molyneux CS, Bull S, Parker M. Ethical issues in the export, storage and reuse of human biological samples in biomedical research: perspectives of key stakeholders in Ghana and Kenya. BMC Med Ethics 2014; 15:76. [PMID: 25326753 PMCID: PMC4210627 DOI: 10.1186/1472-6939-15-76] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 10/09/2014] [Indexed: 11/25/2022] Open
Abstract
Background For many decades, access to human biological samples, such as cells, tissues, organs, blood, and sub-cellular materials such as DNA, for use in biomedical research, has been central in understanding the nature and transmission of diseases across the globe. However, the limitations of current ethical and regulatory frameworks in sub-Saharan Africa to govern the collection, export, storage and reuse of these samples have resulted in inconsistencies in practice and a number of ethical concerns for sample donors, researchers and research ethics committees. This paper examines stakeholders’ perspectives of and responses to the ethical issues arising from these research practices. Methods We employed a qualitative strategy of inquiry for this research including in-depth interviews and focus group discussions with key research stakeholders in Kenya (Nairobi and Kilifi), and Ghana (Accra and Navrongo). Results The stakeholders interviewed emphasised the compelling scientific importance of sample export, storage and reuse, and acknowledged the existence of some structures governing these research practices, but they also highlighted the pressing need for a number of practical ethical concerns to be addressed in order to ensure high standards of practice and to maintain public confidence in international research collaborations. These concerns relate to obtaining culturally appropriate consent for sample export and reuse, understanding cultural sensitivities around the use of blood samples, facilitating a degree of local control of samples and sustainable scientific capacity building. Conclusion Drawing on these findings and existing literature, we argue that the ethical issues arising in practice need to be understood in the context of the interactions between host research institutions and local communities and between collaborating institutions. We propose a set of ‘key points-to-consider’ for research institutions, ethics committees and funding agencies to address these issues.
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Affiliation(s)
- Paulina Tindana
- Navrongo Health Research Centre, Ghana Health Service, P,O, Box 114, Navrongo, Ghana.
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