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Lanthanum doped zirconium oxide-nanocomposite as sensitive electrochemical platforms for Tenofovir detection. Microchem J 2022. [DOI: 10.1016/j.microc.2022.108053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Vanderslott S, Van Ryneveld M, Marchant M, Lees S, Nolna SK, Marsh V. How can community engagement in health research be strengthened for infectious disease outbreaks in Sub-Saharan Africa? A scoping review of the literature. BMC Public Health 2021; 21:633. [PMID: 33794820 PMCID: PMC8012744 DOI: 10.1186/s12889-021-10348-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 01/27/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Community engagement (CE) is a well-established practical and scholarly field, recognised as core to the science and ethics of health research, for which researchers and practitioners have increasingly asked questions about desired standards and evaluation. In infectious disease outbreak contexts, questions may be more complex. However, it is unclear what body of knowledge has been developed for CE specifically as it applies to emerging infectious diseases. This scoping review seeks to describe (1) How CE has been conceptualised and understood; and (2) What conclusions have research teams reached on the effectiveness of CE in these settings, including challenges and facilitators. METHODS We used a scoping review framework by Arksey and O'Malley (Int J Soc Res Methodol 8:19-32, 2005) to structure our review. We conducted a brainstorming session and initial trial search to inform the protocol, search terms, and strategy. Three researchers discussed, developed and applied agreed screening tools and selection criteria to the final search results. Five researchers used the screening tools to screen abstracts and full text for inclusion by consensus. Additional publications were sought from references of retrieved publications and an expert call for literature. We analysed and reported emerging themes qualitatively. RESULTS We included 59 papers from a total of 722 articles derived from our trial and final literature searches, as well as a process of "citation chasing" and an expert call for grey literature. The core material related exclusively to health research trials during the 2014-2016 West Africa Ebola outbreak. We synthesized reports on components of effectiveness of CE to identify and propose three themes as essential elements of effective CE. CONCLUSIONS While there is a large volume of literature documenting CE activities in infectious disease research settings generally, there are few accounts of effectiveness dimensions of CE. Our review proposes three themes to facilitate the effectiveness of CE initiatives as essential elements of CE activities in infectious diseases studies: (1) Communication towards building collaborative relationships; (2) Producing contextual knowledge; and (3) Learning lessons over time. As there were relatively few in-depth accounts of CE from our literature review, documentation and accounts of CE used in health research should be prioritised.
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Affiliation(s)
- Samantha Vanderslott
- Oxford Vaccine Group & Oxford Martin School, University of Oxford, 34 Broad St, Oxford, OX1 2BD, UK.
| | - Manya Van Ryneveld
- School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, 7535, Republic of South Africa
| | - Mark Marchant
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Shelley Lees
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Sylvie Kwedi Nolna
- Department of Public Health, University of Yaounde I, Rue Melen, Yaounde, Cameroon
| | - Vicki Marsh
- KEMRI Wellcome Trust Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, NDM, Oxford University, Oxford, UK
- Kenya Medical Research Institute - Wellcome Trust Research Programme, Kilifi, Kenya
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Folayan MO, Peterson K. HIV prevention clinical trials' community engagement guidelines: inequality, and ethical conflicts. Glob Bioeth 2020; 31:47-66. [PMID: 32921972 PMCID: PMC7448920 DOI: 10.1080/11287462.2020.1773061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In 2004 and 2005, the first clinical trials were launched to investigate the use of tenofovir for HIV prevention in Cambodia, Cameroon, Nigeria and Thailand. Controversies erupted over the ethical integrity of the research protocol. We reflect on the events that led to the controversies and identified that scientific and ethical concerns raised by members of local communities at each of these sites were erased by trialists, causing crisis that led to premature shut down the early PrEP trials. In the aftermath of these trials, the World Health Organisation, UNAIDS, and AVAC developed ethics guidelines intended to recognize the concerns as authentic, and developed guidelines to improve researchers’ engagement of communities in biomedical HIV prevention trial design and implementation. Our findings suggest that the ethics guidelines are limited in its ability to address power inequalities that leads to voice erasures and non-recognition of local competencies. Rather the ethical documents enabled trialists to gain a new sense of authority through the interpretations of ethical research conduct enabling trialists regain power that can further entrench inequality and voice erasures. To address concerns with what seems an intractable problem, we suggested models of engagement for off-shored research may be the option.
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Affiliation(s)
- Morenike O Folayan
- New HIV Vaccine and Microbicide Advocacy Society, Nigeria.,Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Kristin Peterson
- Department of Anthropology, University of California, Irvine, USA
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Ateudjieu J, Hurst S, Yakum MN, Tangwa GB. Biomedical research ethics in Cameroon: a survey to assess training needs of medical residents and students. BMC MEDICAL EDUCATION 2019; 19:5. [PMID: 30606193 PMCID: PMC6318839 DOI: 10.1186/s12909-018-1431-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 12/14/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Training curricula in research ethics for potential and future researchers should be implemented and constantly updated. This requires data regarding training needs. METHODS We conducted a cross-sectional survey on residents, fifth and sixth-year medical students registered in the 2006-2007 academic year at the Faculty of Medicine and Biomedical Sciences (FMBS) of the University of Yaounde 1, Cameroon. RESULTS Two-fifths (40.4%) of respondents (response rate 70.9%) reported training in research ethics. Less than half were aware of specific regulatory texts relevant to research ethics. Among those who reported conducting a research project 66.7% declared having obtained informed consent from participants and 32.9% having submitted their protocol to an Ethics Review Committee. Participants identified training priorities in research ethics and responsibilities of key actors in the protection of research participants. CONCLUSION There is a need to improve the training and attitude of medical students and residents in order to prepare them to respect and protect research participants.
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Affiliation(s)
- Jerome Ateudjieu
- M.A. SANTE (Meilleur Accès Aux Soins de Santé), Yaoundé, Cameroon
| | - Samia Hurst
- Geneva University Medical School, Institute for Biomedical Ethics, Geneva, Switzerland
| | | | - Godfrey B. Tangwa
- Department of Phylosophy, University of Yaounde 1, Yaounde, Cameroon
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Singh H, Rao SV, Kakkar AK, Singh J, Manohar HD. Posttrial Access to Medical Interventions: Intricacies, Challenges, and Solutions. Int J Appl Basic Med Res 2019; 9:3-8. [PMID: 30820412 PMCID: PMC6385540 DOI: 10.4103/ijabmr.ijabmr_218_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 01/02/2019] [Indexed: 12/02/2022] Open
Abstract
With the recent increase in clinical trials, lower- and middle-income countries are preferred trial sites due to lower budgets and easy availability of potential participants. On trial completion, benefits to participants cease and it may affect their health adversely. Therefore, entitlement to posttrial access (PTA) of interventions is imperative. The Declaration of Helsinki and several other guidelines mandate that trial participants have access to experimentally proven efficacious drugs and that the research protocol should mention PTA provision mechanisms. A controversial question about PTA is whether, experimentally proven therapy should be made accessible to the control group as well as the community from which the participants were enrolled, especially if no satisfactory standard treatment exists. PTA has significant implications for various stakeholders - trial participants, investigators, sponsors, regulatory authorities, and governments and has been discussed and well addressed in recent guidelines issued by the Indian Council of Medical research. This article focuses on the PTA, guidelines related to PTA, disputes, different stakeholder perspectives, and practical difficulties in its implementation. It also looks at PTA from the Indian perspective and considers possible solutions to deal with the controversies.
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Affiliation(s)
- Harmanjit Singh
- Department of Pharmacology, Government Medical College and Hospital, Chandigarh, India
| | - Sunil Vishwas Rao
- Department of Pharmacology, Karpaga Vinayaga Institute of Medical Sciences and Research Center, Kanchipuram, Tamil Nadu, India
| | - Ashish Kumar Kakkar
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jagjit Singh
- Department of Pharmacology, Government Medical College and Hospital, Chandigarh, India
| | - Hasitha Daina Manohar
- Department of Pharmacology, Karpaga Vinayaga Institute of Medical Sciences and Research Center, Kanchipuram, Tamil Nadu, India
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MacQueen KM, Auerbach JD. It is not just about "the trial": the critical role of effective engagement and participatory practices for moving the HIV research field forward. J Int AIDS Soc 2018; 21 Suppl 7:e25179. [PMID: 30334608 PMCID: PMC6193314 DOI: 10.1002/jia2.25179] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/06/2018] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Judith D Auerbach
- Department of Medicine, University of California, San Francisco, CA, USA
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Baron D, Essien T, Pato S, Magongo M, Mbandazayo N, Scorgie F, Rees H, Delany‐Moretlwe S. Collateral benefits: how the practical application of Good Participatory Practice can strengthen HIV research in sub-Saharan Africa. J Int AIDS Soc 2018; 21 Suppl 7:e25175. [PMID: 30334610 PMCID: PMC6193316 DOI: 10.1002/jia2.25175] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/20/2018] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION The Good Participatory Practice (GPP): Guidelines for Biomedical HIV Prevention Trials, second edition (2011) were developed to provide clinical trial sponsors and implementers with a formal stakeholder engagement framework. As one of the largest African research institutes, Wits Reproductive Health and HIV Institute (Wits RHI) became an early adopter of GPP by implementing its principles within large-scale national and regional clinical trials. This article examines Wits RHI's lessons learned from implementing GPP, its ongoing efforts to institutionalize GPP, and the yet to be realized potential in creating fully sustainable structures for meaningful stakeholder engagement in HIV prevention research, implementation science and beyond. DISCUSSION For the past seven years, Wits RHI has undertaken both centralized leadership roles in implementing GPP across multi-party regional research consortia as well as overseeing GPP for smaller investigator-driven trials. Through this iterative roll-out of GPP, key lessons have emerged. Obtaining upfront funding to support GPP activities throughout and between the research life cycle, and a trained multi-disciplinary team of GPP practitioners have helped facilitate an enabling environment for GPP implementation. We further recommend formally integrating stakeholder engagement into study documents, including monitoring and evaluation plans with indicators and performance metrics, to assist teams to track and refine their GPP strategies. Finally, institutionalizing resources and supporting organization-wide GPP along with ongoing support can help build efficiencies and maximize economies of scale toward a pragmatic and innovative application of the GPP Guidelines. CONCLUSIONS Thanks to a growing global network of GPP practitioners and a burgeoning GPP Community of Practice, there has been substantive progress in making GPP an integral component of clinical HIV prevention research. The Wits RHI experience highlights the possibilities and the challenges to translating the GPP principles into concrete practices within specific clinical trials and across a research institute. Realizing the full potential of GPP, including direct and indirect - 'collateral benefits' will require the collective buy-in and support from sponsors, implementers and community stakeholders across the research field. As the HIV prevention research field expands, however, a more conscious and systematic implementation of GPP is timely.
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Affiliation(s)
- Deborah Baron
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
- Department of Health Behavior at the UNC Gillings School of Global Public HealthJohannesburgSouth Africa
| | | | - Sinazo Pato
- International Partnership for MicrobicidesJohannesburgSouth Africa
| | - Miliswa Magongo
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | - Fiona Scorgie
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Helen Rees
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
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Hankins C, Macklin R, Warren M. Translating PrEP effectiveness into public health impact: key considerations for decision-makers on cost-effectiveness, price, regulatory issues, distributive justice and advocacy for access. J Int AIDS Soc 2015; 18:19973. [PMID: 26198343 PMCID: PMC4509900 DOI: 10.7448/ias.18.4.19973] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 04/06/2015] [Accepted: 04/15/2015] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The extraordinary feat of proving the effectiveness of oral pre-exposure prophylaxis (PrEP) in clinical trials in different populations in a variety of settings may prove to have been easier than ensuring it is used well. Decision-makers must make difficult choices to realize the promise of antiretroviral prophylaxis for their countries. This paper outlines key economic, regulatory and distributive justice issues that must be addressed for effective and acceptable PrEP implementation. DISCUSSION In considering the role that PrEP can play in combination prevention programmes, decision-makers must determine who can benefit most from PrEP, how PrEP can be provided safely and efficiently, and what kind of health system support will ensure successful implementation. To do this, they need contextualized information on disease burden by population, analyses of how PrEP services might best be delivered, and projections of the human resource and infrastructure requirements for each potential delivery model. There are cost considerations, varying cost-effectiveness results and regulatory challenges. The principles of ethics can inform thorny discussions about who should be prioritized for oral PrEP and how best to introduce it fairly. We describe the cost-effectiveness of PrEP in different populations at higher risk of HIV exposure, its price in low- and middle-income countries, and the current regulatory situation. We explore the principles of ethics that can inform resource allocation decision-making about PrEP anchored in distributive justice, at a time when universal access to antiretroviral treatment remains to be assured. We then highlight the role of advocacy in moving the PrEP agenda forward. CONCLUSIONS The time is ripe now for decisions about whether, how and for whom PrEP should be introduced into a country's HIV response. It has the potential to contribute significantly to high impact HIV prevention if it is tailored to those who can most benefit from it and if current regulatory and pricing barriers can be overcome. Advocacy at all levels can help inform decision-making and push the access agenda to avert HIV infections among those at highest risk of HIV exposure. The benefits will accrue beyond the individual level to slow HIV transmission at the population level.
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Affiliation(s)
- Catherine Hankins
- Department of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, England; ;
| | - Ruth Macklin
- Epidemiology & Population Health, Albert Einstein College of Medicine New York, NY, USA
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Cáceres CF, Mayer KH, Baggaley R, O'Reilly KR. PrEP Implementation Science: State-of-the-Art and Research Agenda. J Int AIDS Soc 2015; 18:20527. [PMID: 26198351 PMCID: PMC4581083 DOI: 10.7448/ias.18.4.20527] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Cáceres CF, Koechlin F, Goicochea P, Sow PS, O'Reilly KR, Mayer KH, Godfrey-Faussett P. The promises and challenges of pre-exposure prophylaxis as part of the emerging paradigm of combination HIV prevention. J Int AIDS Soc 2015; 18:19949. [PMID: 26198341 PMCID: PMC4509895 DOI: 10.7448/ias.18.4.19949] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/26/2015] [Accepted: 04/15/2015] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Towards the end of the twentieth century, significant success was achieved in reducing incidence in several global HIV epidemics through ongoing prevention strategies. However, further progress in risk reduction was uncertain. For one thing, it was clear that social vulnerability had to be addressed, through research on interventions addressing health systems and other structural barriers. As soon as antiretroviral treatment became available, researchers started to conceive that antiretrovirals might play a role in decreasing either susceptibility in uninfected people or infectiousness among people living with HIV. In this paper we focus on the origin, present status, and potential contribution of pre-exposure prophylaxis (PrEP) within the combination HIV prevention framework. DISCUSSION After a phase of controversy, PrEP efficacy trials took off. By 2015, daily oral PrEP, using tenofovir alone or in combination with emtricitabine, has been proven efficacious, though efficacy seems heavily contingent upon adherence to pill uptake. Initial demonstration projects after release of efficacy results have shown that PrEP can be implemented in real settings and adherence can be high, leading to high effectiveness. Despite its substantial potential, beliefs persist about unfeasibility in real-life settings due to stigma, cost, adherence, and potential risk compensation barriers. CONCLUSIONS The strategic synergy of behavioural change communication, biomedical strategies (including PrEP), and structural programmes is providing the basis for the combination HIV prevention framework. If PrEP is to ever become a key component of that framework, several negative beliefs must be confronted based on emerging evidence; moreover, research gaps regarding PrEP implementation must be filled, and appropriate prioritization strategies must be set up. Those challenges are significant, proportional to the impact that PrEP implementation may have in the global response to HIV.
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Affiliation(s)
- Carlos F Cáceres
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
- Network for Multidisciplinary Studies in ARV-Based HIV Prevention (NEMUS), Lima, Peru;
| | | | - Pedro Goicochea
- Network for Multidisciplinary Studies in ARV-Based HIV Prevention (NEMUS), Lima, Peru
- Center for AIDS Prevention Studies, University of California - San Francisco, San Francisco, CA, USA
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Beyrer C, Crago AL, Bekker LG, Butler J, Shannon K, Kerrigan D, Decker MR, Baral SD, Poteat T, Wirtz AL, Weir BW, Barré-Sinoussi F, Kazatchkine M, Sidibé M, Dehne KL, Boily MC, Strathdee SA. An action agenda for HIV and sex workers. Lancet 2015; 385:287-301. [PMID: 25059950 PMCID: PMC4302059 DOI: 10.1016/s0140-6736(14)60933-8] [Citation(s) in RCA: 145] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The women, men, and transgender people who sell sex globally have disproportionate risks and burdens of HIV in countries of low, middle, and high income, and in concentrated and generalised epidemic contexts. The greatest HIV burdens continue to be in African female sex workers. Worldwide, sex workers still face reduced access to needed HIV prevention, treatment, and care services. Legal environments, policies, police practices, absence of funding for research and HIV programmes, human rights violations, and stigma and discrimination continue to challenge sex workers' abilities to protect themselves, their families, and their sexual partners from HIV. These realities must change to realise the benefits of advances in HIV prevention and treatment and to achieve global control of the HIV pandemic. Effective combination prevention and treatment approaches are feasible, can be tailored for cultural competence, can be cost-saving, and can help to address the unmet needs of sex workers and their communities in ways that uphold their human rights. To address HIV in sex workers will need sustained community engagement and empowerment, continued research, political will, structural and policy reform, and innovative programmes. But such actions can and must be achieved for sex worker communities everywhere.
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Affiliation(s)
- Chris Beyrer
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA.
| | | | - Linda-Gail Bekker
- Desmond Tutu HIV Research Centre, University of Cape Town, Cape Town, South Africa
| | - Jenny Butler
- United Nations Population Fund, New York, NY, USA
| | - Kate Shannon
- BC Center for Excellence in HIV/AIDS, University of British Columbia, Vancouver, BC, Canada
| | - Deanna Kerrigan
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michele R Decker
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | - Stefan D Baral
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | - Tonia Poteat
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | - Andrea L Wirtz
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA; Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Brian W Weir
- Center for Public Health and Human Rights, Johns Hopkins University, Baltimore, MD, USA
| | | | - Michel Kazatchkine
- UN Special Envoy for HIV in eastern Europe and central Asia, Geneva, Switzerland
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Bekker LG, Johnson L, Cowan F, Overs C, Besada D, Hillier S, Cates W. Combination HIV prevention for female sex workers: what is the evidence? Lancet 2015; 385:72-87. [PMID: 25059942 DOI: 10.1016/s0140-6736(14)60974-0] [Citation(s) in RCA: 161] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Sex work occurs in many forms and sex workers of all genders have been affected by HIV epidemics worldwide. The determinants of HIV risk associated with sex work occur at several levels, including individual biological and behavioural, dyadic and network, and community and social environmental levels. Evidence indicates that effective HIV prevention packages for sex workers should include combinations of biomedical, behavioural, and structural interventions tailored to local contexts, and be led and implemented by sex worker communities. A model simulation based on the South African heterosexual epidemic suggests that condom promotion and distribution programmes in South Africa have already reduced HIV incidence in sex workers and their clients by more than 70%. Under optimistic model assumptions, oral pre-exposure prophylaxis together with test and treat programmes could further reduce HIV incidence in South African sex workers and their clients by up to 40% over a 10-year period. Combining these biomedical approaches with a prevention package, including behavioural and structural components as part of a community-driven approach, will help to reduce HIV infection in sex workers in different settings worldwide.
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Affiliation(s)
- Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Republic of South Africa.
| | - Leigh Johnson
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Republic of South Africa
| | - Frances Cowan
- Research Department of Infection and Population Health, University College London, London, UK; Centre for Sexual Health and HIV/AIDS Research (CeSHHAR) Zimbabwe, Harare, Zimbabwe
| | - Cheryl Overs
- Michael Kirby Centre for Public Health and Human Rights, Melbourne, Australia
| | - Donela Besada
- The Desmond Tutu HIV Foundation, Cape Town, Republic of South Africa
| | - Sharon Hillier
- University of Pittsburgh Department of Obstetrics, Gynecology and Reproductive Sciences, Pittsburgh, PA, USA
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Brown B, Kinsler J, Folayan MO, Allen K, Cáceres CF. Post-approval monitoring and oversight of U.S.-initiated human subjects research in resource-constrained countries. JOURNAL OF BIOETHICAL INQUIRY 2014; 11:119-123. [PMID: 24839155 DOI: 10.1007/s11673-014-9525-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 03/21/2014] [Indexed: 06/03/2023]
Abstract
The history of human subjects research and controversial procedures in relation to it has helped form the field of bioethics. Ethically questionable elements may be identified during research design, research implementation, management at the study site, or actions by a study's investigator or other staff. Post-approval monitoring (PAM) may prevent violations from occurring or enable their identification at an early stage. In U.S.-initiated human subjects research taking place in resource-constrained countries with limited development of research regulatory structures, arranging a site visit from a U.S. research ethics committee (REC) becomes difficult, thus creating a potential barrier to regulatory oversight by the parent REC. However, this barrier may be overcome through the use of digital technologies, since much of the world has at least remote access to the Internet. Empirical research is needed to pilot test the use of these technologies for research oversight to ensure the protection of human subjects taking part in research worldwide.
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Affiliation(s)
- Brandon Brown
- Program in Public Health, Department of Population Health & Disease Prevention, University of California, Irvine, 653 E. Peltason Drive, 2024 AIRB, Irvine, CA, 92697-3957, USA,
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Asante KP, Agyemang CT, Zandoh C, Saah J, Febir LG, Donlebo CK, Owusu-Agyei S. Community engagement in biomedical research in an African setting: the Kintampo Health Research Centre experience. BMC Health Serv Res 2013; 13:383. [PMID: 24090148 PMCID: PMC4015992 DOI: 10.1186/1472-6963-13-383] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 09/30/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Community engagement (CE) is becoming relevant in health research activities; however, models for CE in health research are limited in developing countries. The Kintampo Health Research Centre (KHRC) conducts research to influence health policy locally and also internationally. Since its establishment in 1994 with the mandate of conducting relevant public health studies in the middle part of Ghana, KHRC has embarked on a series of clinical and operational studies involving community members. In these studies, community members have been engaged through community durbars before, during and also after all study implementations. Lessons learnt from these activities suggested the need to embark on further CE processes that could serve as a model for emerging research institutions based in African communities. METHODS Interactive community durbars, workshops, in-depth discussions, focus group discussions and radio interactions were used as the main methods in the CE process. RESULTS Community members outlined areas of research that they perceived as being of interest to them. Though community members expressed continual interest in our traditional areas of research in communicable, maternal, neonatal and child health, they were interested in new areas such as non- communicable diseases such as diabetes and hypertension. Misconceptions about KHRC and its research activities were identified and clarified. This research provided KHRC the opportunity to improve communication guidelines with the community and these are being used in engaging the community at various stages of our research, thus improving on the design and implementation of research. CONCLUSION KHRC has developed a culturally appropriate CE model based on mutual understanding with community members. The experience obtained in the CE process has contributed to building CE capacity in KHRC. Other health research institutions in developing countries could consider the experiences gained.
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Affiliation(s)
- Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Brong Ahafo Region, Ghana
| | - Charlotte Tawiah Agyemang
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Brong Ahafo Region, Ghana
| | - Charles Zandoh
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Brong Ahafo Region, Ghana
| | - Jacob Saah
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Brong Ahafo Region, Ghana
| | - Lawrence Gyabaa Febir
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Brong Ahafo Region, Ghana
| | - Casimir Kabio Donlebo
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Brong Ahafo Region, Ghana
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre, Ghana Health Service, P. O. Box 200, Kintampo, Brong Ahafo Region, Ghana
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Dutta MJ. Disseminating HIV pre-exposure prophylaxis information in underserved communities. Am J Prev Med 2013; 44:S133-6. [PMID: 23253754 DOI: 10.1016/j.amepre.2012.09.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 09/04/2012] [Accepted: 09/19/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Mohan J Dutta
- Center for Culture-Centered Approach to Research and Evaluation (CARE), National University of Singapore, Singapore.
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16
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Patton C, Kim HJ. The cost of science : knowledge and ethics in the HIV pre-exposure prophylaxis trials. JOURNAL OF BIOETHICAL INQUIRY 2012. [PMID: 23180330 DOI: 10.1007/s11673-012-9383-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Over the past decade AIDS research has turned toward the use of pharmacology in HIV prevention, including pre-exposure prophylaxis (PrEP): the use of HIV medication as a means of preventing HIV acquisition in those who do not have it. This paper explores the contradictory reasons offered in support of PrEP-to empower women, to provide another risk-reduction option for gay men-as the context for understanding the social meaning of the experimental trials that appear to show that PrEP works in gay men and heterosexual couples but not single women. The PrEP debates reveal the different ideas about "demedicalization" in the earlier gay health and women's health movements and highlight the relationship between health activism and critique of research ethics in the context of a global pharmaceutical market.
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Affiliation(s)
- Cindy Patton
- Sociology and Anthropology and Canada Research Chair in Community, Culture and Health, Simon Fraser University, Burnaby, Canada.
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Kiawi E, McLellan-Lemal E, Mosoko J, Chillag K, Raghunathan PL. "Research participants want to feel they are better off than they were before research was introduced to them": engaging cameroonian rural plantation populations in HIV research. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2012; 12:8. [PMID: 22726937 PMCID: PMC3460749 DOI: 10.1186/1472-698x-12-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 06/14/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND During a period of evolving international consensus on how to engage communities in research, facilitators and barriers to participation in HIV prevention research were explored in a rural plantation community in the coastal region of Cameroon. METHODS A formative rapid assessment using structured observations, focus group discussions (FGD), and key informant interviews (KIIs) was conducted with a purposive non-probabilistic sample of plantation workers and their household members. Eligibility criteria included living or working >1 year within the plantation community and age >18 years. Both rapid and in-depth techniques were used to complete thematic analysis. RESULTS Sixty-five persons participated in the study (6 FGDs and 12 KIIs). Participants viewed malaria and gastrointestinal conditions as more common health concerns than HIV. They identified three factors as contributing to HIV risk: concurrent sexual relationships, sex work, and infrequent condom use. Interviewees perceived that the community would participate in HIV research if it is designed to: (1) improve community welfare, (2) provide comprehensive health services and treatment for illnesses, (3) protect the personal information of participants, especially those who test positive for HIV, (4) provide participant incentives, (5) incorporate community input, and (6) minimize disruptions to "everyday life". Barriers to participation included: (1) fear of HIV testing, (2) mistrust of researchers given possible disrespect or intolerance of plantation community life and lack of concern for communication, (3) time commitment demands, (3) medical care and treatment that would be difficult or costly to access, and (4) life disruptions along with potential requirements for changes in behaviour (i.e., engage in or abstain from alcohol use and sex activities). CONCLUSIONS Consistent with UNAIDS guidelines for good participatory practice in HIV prevention research, study participants placed a high premium on researchers' politeness, trust, respect, communication, tolerance and empathy towards their community. Plantation community members viewed provision of comprehensive health services as an important community benefit likely to enhance HIV research participation.
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Affiliation(s)
- Emmanuel Kiawi
- Centers for Disease Control and Prevention-Cameroon, c/o US Embassy, BP 817, Yaoundé, Cameroon.
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Abstract
'Researcher identity' affects global health research in profound and complex ways. Anthropologists in particular have led the way in portraying the multiple, and sometimes tension-generating, identities that researchers ascribe to themselves, or have ascribed to them, in their places of research. However, the central importance of researcher identity in the ethical conduct of global health research has yet to be fully appreciated. The capacity of researchers to respond effectively to the ethical tensions surrounding their identities is hampered by lack of conceptual clarity, as to the nature and scope of the issues involved. This paper strives to provide some clarification of these ethical tensions by considering researcher identity from the perspective of (1) Guillemin and Heggen's (2009) key distinction between procedural ethics and ethics in practice, and (2) our own distinction between perceptions of identity that are either symmetrical or asymmetrical, with the potential to shift research relationships toward greater or lesser ethical harmony. Discussion of these concepts is supported with ethnographic examples from relevant literature and from our own (United States (US) Government-funded) research in South Africa. A preliminary set of recommendations is provided in an effort to equip researchers with a greater sense of organization and control over the ethics of researcher identity. The paper concludes that the complex construction of researcher identity needs to be central among the ethical concerns of global health researchers, and that the conceptual tools discussed in the paper are a useful starting point for better organizing and acting on these ethical concerns.
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Ditmore MH, Allman D. 'Who is Helsinki?' Sex workers advise improving communication for good participatory practice in clinical trials. HEALTH EDUCATION RESEARCH 2011; 26:466-475. [PMID: 21263066 PMCID: PMC3099186 DOI: 10.1093/her/cyq087] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 12/11/2010] [Indexed: 05/30/2023]
Abstract
After premature closures in 2004 of biomedical human immunodeficiency virus (HIV) prevention trials involving sex workers in Africa and Asia, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and Global Advocacy for HIV Prevention (AVAC) undertook consultations to establish better participatory guidelines for such trials in order to address ethical concerns. This study investigated sex workers' knowledge and beliefs about research ethics and good participatory practices (GPP) and the perspectives of sex workers on research participation. A 33-question survey based on criteria identified by UNAIDS and AVAC was translated into three other languages. Participants were recruited through mailing lists and contacts with existing sex work networks. In total, 74 responses from Europe, the Americas and Asia were received. Thirty percent of respondents reported first-hand involvement in biomedical HIV prevention trials. Seventy percent indicated a lack of familiarity with codes of ethics for research. This paper focuses exclusively on communication issues described in survey responses. Communication was an important theme: the absence of clear communication between trial participants and investigators contributed to premature trial closures in at least two sites. Sex workers had recommendations for how researchers might implement GPP through improved communication, including consultation at the outset of planning, explaining procedures in non-technical terms and establishing clear channels for feedback from participants.
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20
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Sprinting Research and Spot Jogging Regulation: The State of Bioethics in Cameroon. Camb Q Healthc Ethics 2011; 20:356-66. [DOI: 10.1017/s0963180111000041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cameroon is a Central African country lying at latitude 6°N and longitude 12°E. The country has a surface area of circa 475,442 square kilometers, and is bordered by several other African countries: Nigeria, Chad, the Central African Republic, the Republic of Congo, Equatorial Guinea, and Gabon. With a population of nearly 20 million inhabitants, Cameroon is a very diverse country, geographically, culturally, and linguistically.
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21
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Ndhlala AR, Finnie JF, Van Staden J. In vitro antioxidant properties, HIV-1 reverse transcriptase and acetylcholinesterase inhibitory effects of traditional herbal preparations sold in South Africa. Molecules 2010; 15:6888-904. [PMID: 20938401 PMCID: PMC6259252 DOI: 10.3390/molecules15106888] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 08/27/2010] [Accepted: 09/03/2010] [Indexed: 11/16/2022] Open
Abstract
The antioxidant potentials for fourteen multipurpose traditional herbal preparations sold in South Africa were determined using the DPPH radical scavenging, ferric reducing power and β-carotene-linoleic acid model system, the anti-HIV-1 reverse transcriptase (RT) enzyme inhibitory effects using an ELISA kit and acetylcholinesterase (AChE) enzyme inhibition using the microtitre plate assay. Nine of the herbal mixtures (Umzimba omubi, Umuthi wekukhwehlela ne zilonda, Mvusa ukunzi, Umpatisa inkosi, Imbiza ephuzwato, Vusa umzimba, Supreme one hundred, Sejeso herbal mixture Ingwe® and Ingwe® special muti) exhibited higher antioxidant potentials, while only four (Imbiza ephuzwato, Ingwe® muthi mixture, Sejeso herbal mixture Ingwe® and African potato extract™ showed potent activity against the RT enzyme. Nine mixtures (Imbiza ephuzwato, Umpatisa inkosi, African potato extract™, Sejeso herbal mixture Ingwe®, Vusa umzimba; Ingwe® muthi mixture, Ibhubezi™, Lion izifozonke Ingwe® and Ingwe® special muti) showed AChE enzyme inhibitory activity greater than 50%. The observed activity exhibited by some of the herbal mixtures gives some credence to the manufacturers' claims and goes part of the way towards validating their use against certain conditions such as oxidative stress, HIV/AIDS proliferation and some mental conditions. It is however, desirable to carry out further studies to determine the effects of mixing plant species/parts in one mixture on the antioxidant potency as well as isolating active constituents from the herbal mixtures.
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Affiliation(s)
| | | | - Johannes Van Staden
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +27 33 260 5130; Fax: +27 33 260 5897
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22
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Kingori P, Muchimba M, Sikateyo B, Amadi B, Kelly P. 'Rumours' and clinical trials: a retrospective examination of a paediatric malnutrition study in Zambia, southern Africa. BMC Public Health 2010; 10:556. [PMID: 20849580 PMCID: PMC2949770 DOI: 10.1186/1471-2458-10-556] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 09/17/2010] [Indexed: 11/24/2022] Open
Abstract
Background Many public health researchers conducting studies in resource-constrained settings have experienced negative 'rumours' about their work; in some cases they have been reported to create serious challenges and derail studies. However, what may appear superficially as 'gossip' or 'rumours' can also be regarded and understood as metaphors which represent local concerns. For researchers unaccustomed to having concerns expressed from participants in this manner, possible reactions can be to be unduly perturbed or conversely dismissive. This paper represents a retrospective examination of a malnutrition study conducted by an international team of researchers in Zambia, Southern Africa. The fears of mothers whose children were involved in the study and some of the concerns which were expressed as rumours are also presented. This paper argues that there is an underlying logic to these anxieties and to dismiss them simply as 'rumours' or 'gossip' would be to overlook the historic and socio-economic factors which have contributed to their production. Methods Qualitative interviews were conducted with the mothers whose children were involved in the study and with the research nurses. Twenty five face-to-face interviews and 2 focus group discussions (FGDs) were conducted with mothers. In addition, face-to-face interviews were conducted with research nurses participating in the trial. Results A prominent anxiety expressed as rumours by the mothers whose children were involved in the study was that recruitment into the trial was an indicator that the child was HIV-infected. Other anxieties included that the trial was a disguise for witchcraft or Satanism and that the children's body parts would be removed and sold. In addition, the liquid, milk-based food given to the children to improve their nutrition was suspected of being insufficiently nutritious, thus worsening their condition. The form which these anxieties took, such as rumours related to the stealing of body parts and other anxieties about a stigmatised condition, provide an insight into the historical, socio-economic and cultural influences in such settings. Conclusions Employing strategies to understand local concerns should accompany research aims to achieve optimal success. The concerns raised by the participants we interviewed are not unique to this study. They are produced in countries where the historic, socio-economic and cultural settings communicate anxieties in this format. By examining this study we have shown that by contextualizing these 'rumours', the concerns they express can be constructively addressed and in turn result in the successful conduct of research aims.
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Affiliation(s)
- Patricia Kingori
- Anthropologies of African Biosciences, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Tavistock Place, London WC13 7HT, UK.
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Mack N, Robinson ET, MacQueen KM, Moffett J, Johnson LM. The Exploitation of “Exploitation” in the Tenofovir PrEP Trial in Cameroon: Lessons Learned from Media Coverage of an HIV Prevention Trial. J Empir Res Hum Res Ethics 2010; 5:3-19. [DOI: 10.1525/jer.2010.5.2.3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Media coverage influences how clinical trials are perceived internationally and in communities where trials occur, affecting recruitment, retention, and political support for research. We conducted a discourse analysis of news coverage from 2004–2005 of a trial in Cameroon on oral PrEP for HIV prevention, to identify messages, communication techniques, and sources of messages that were amplified via media. We identified two parallel discourses: One on ethical concerns about the Cameroon trial, and a second, more general “science exploitation” discourse concerned with the potential for trials with vulnerable participant populations to be conducted unethically, benefiting only wealthy populations. Researchers should overtly address exploitation as an integral, ongoing component of research, particularly where historical or cultural conditions set the stage for controversy to emerge.
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24
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Grant RM. Antiretroviral agents used by HIV-uninfected persons for prevention: pre- and postexposure prophylaxis. Clin Infect Dis 2010; 50 Suppl 3:S96-101. [PMID: 20397962 PMCID: PMC3663282 DOI: 10.1086/651479] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Prophylactic use of antimicrobial agents and microbicides has been proven for many infections, including surgical, gastrointestinal, upper respiratory, and meningococcal infections. Antiretroviral therapy for pregnant women prevents mother-to-child transmission of human immunodeficiency virus (HIV), which has become rare in settings where access to therapy is widespread. Postexposure prophylaxis after needlestick injury or significant sexual exposure is recommended on the basis of animal studies and case-control observational studies, although use of these interventions is limited to those who recognize exposure, have access, and have the power to use the interventions. Clinical trials are evaluating whether regular or preexposure use of antiretroviral therapy provides additional protection for persons at high risk of infection who are also offered standard prevention care, including HIV testing, counseling, condoms, and management of sexually transmitted infections. Trials are evaluating topical or oral use. Concerns have arisen with regard to optimal dosing strategies, costs, access, drug resistance, risk behavior, and the role of communities. Future implementation, if warranted, will be guided by the results of clinical trials in progress and engagement of communities exposed to HIV.
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Affiliation(s)
- Robert M Grant
- Gladstone Institute of Virology and Immunology and University of California, San Francisco, USA.
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25
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Macqueen KM, McLoughlin K, Alleman P, Burke HM, Mack N. Partnering for Care in HIV Prevention Trials. J Empir Res Hum Res Ethics 2008; 3:5-18. [PMID: 19385753 PMCID: PMC4439185 DOI: 10.1525/jer.2008.3.4.5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
QUALITATIVE CASE STUDIES WERE conducted at seven international sites conducting HIV prevention research in Africa, Asia, and the Americas to identify strategies for ensuring that health needs of research participants identified in the course of research are adequately addressed. Key factors were identified that contribute to the balance between direct care and healthcare referrals at a research site, as well as the overall quality of the healthcare made available to research participants. The case studies exemplify the concept of "moral negotiation" in research (Weijer & LeBlanc, 2006), that is, a process where researchers and sponsors negotiate with increasingly empowered local communities and host countries to achieve meaningful and substantive benefits from biomedical research for all stakeholders.
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26
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French N, Kaleebu P, Pisani E, Whitworth JAG. Human immunodeficiency virus (HIV) in developing countries. ANNALS OF TROPICAL MEDICINE AND PARASITOLOGY 2007; 100:433-54. [PMID: 16899147 DOI: 10.1179/136485906x97390] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The human immunodeficiency virus (HIV) is causing the most destructive epidemic of recent times, having been responsible for the deaths of more than 25 million people since it was first recognised in 1981. This global epidemic remains out of control, with reported figures for 2005 of 40 million people infected with HIV. During 2005 there were 4.9 million new infections, showing that transmission is not being prevented, and there were 3.1 million deaths from the acquired immunodeficiency syndrome (AIDS), reflecting the lack of a definitive cure and the limited access to suppressive antiretroviral treatment in the developing countries that are most severely affected. The current state of the epidemic and the response to date are here reviewed. Present and future opportunities for prevention, treatment and surveillance are discussed, with particular reference to progress towards an HIV vaccine, the expansion of the provision of highly active antiretroviral therapy, and the need to focus control programmes on HIV as an infectious disease, rather than as a development issue.
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Affiliation(s)
- N French
- Wellcome Trust/LEPRA Karonga Prevention Study, P.O. Box 46, Chilumba, Malawi
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27
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Mills E, Nixon S, Singh S, Dolma S, Nayyar A, Kapoor S. Enrolling women into HIV preventive vaccine trials: an ethical imperative but a logistical challenge. PLoS Med 2006; 3:e94. [PMID: 16478295 PMCID: PMC1370922 DOI: 10.1371/journal.pmed.0030094] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Mills and colleagues argue that the challenge of enrolling women into HIV vaccine trials must be overcome in order for trials to be considered ethical, valid, and generalizable.
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Affiliation(s)
| | | | | | | | | | - Sushma Kapoor
- * To whom correspondence should be addressed. E-mail:
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28
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Mills EJ, Singh S, Singh JA, Orbinski JJ, Warren M, Upshur RE. Designing research in vulnerable populations: lessons from HIV prevention trials that stopped early. BMJ 2005; 331:1403-6. [PMID: 16339256 PMCID: PMC1309660 DOI: 10.1136/bmj.331.7529.1403] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2005] [Indexed: 11/03/2022]
Abstract
Activist groups have been successful in promoting research and better treatment for people with HIV infection, but they can also stop trials if their views are not considered
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Affiliation(s)
- Edward J Mills
- Department of Clinical Epidemiology and Biostatistics, McMaster University, HSC-2C12, 1200 Main Street West, Hamilton, ON, Canada L8N 3Z5.
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29
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Grant RM, Buchbinder S, Cates W, Clarke E, Coates T, Cohen MS, Delaney M, Flores G, Goicochea P, Gonsalves G, Harrington M, Lama JR, MacQueen KM, Moore JP, Peterson L, Sanchez J, Thompson M, Wainberg MA. AIDS. Promote HIV chemoprophylaxis research, don't prevent it. Science 2005; 309:2170-1. [PMID: 16195446 DOI: 10.1126/science.1116204] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Robert M Grant
- Gladstone Institute of Virology and Immunology, San Francisco, CA, USA.
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