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Mthimkhulu D, Dong KL, Ngcobo MW, Mindry D, Zulu A, Langa N, Maphalala L, Pillay V, Mthembu M, Miall A, Tran W, Dillen A, Wan F, Ahmed A, Stockman JK, Hussain M, Ndung’u T, Dubé K. 'It is scary to pause treatment': perspectives on HIV cure-related research and analytical treatment interruptions from women diagnosed during acute HIV in Durban, South Africa. HIV Res Clin Pract 2025; 26:2455917. [PMID: 39862155 PMCID: PMC11829625 DOI: 10.1080/25787489.2025.2455917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2024] [Revised: 01/06/2025] [Accepted: 01/15/2025] [Indexed: 01/27/2025]
Abstract
BACKGROUND HIV remains a major challenge in KwaZulu-Natal, South Africa, particularly for young women who face disproportionate risks and barriers to prevention and treatment. Most HIV cure trials, however, occur in high-income countries. OBJECTIVE To examine the perspectives of young women diagnosed with acute HIV in a longitudinal study, focusing on their perceptions on ATI-inclusive HIV cure trials and the barriers and facilitators to participation. MATERIALS AND METHODS Between October 2022 and February 2024, we conducted closed-ended surveys and in-depth interviews with 20 women aged 19-33 living with HIV, who were willing but ineligible or unable to participate in an HIV cure trial. RESULTS Many participants reported mental health challenges, including major depression (40%), moderate to severe anxiety (35%), and low self-esteem (35%). While women diagnosed during acute HIV supported pausing antiretroviral treatment (ART) during analytical treatment interruption (ATI) to advance HIV cure research, concerns about health risks and HIV-related stigma were significant barriers to enrollment. Trust in the research team and close monitoring were seen as positive factors, while fears around sharing of HIV/ATI status and transmission to sex partners complicated decision-making. Participants expressed a need for psychological counseling and access to community resources to manage ATI-related stressors. CONCLUSIONS Understanding women's perspectives on HIV cure research, especially ATI trials, is vital. Building trust and addressing psychosocial challenges through a healing-centered approach can facilitate trial participation. Socio-behavioral research before and during HIV cure trials will be essential to inform participant-centered protocol design.
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Affiliation(s)
- Deli Mthimkhulu
- Integration of TB in Education and Care for HIV/AIDS (ITEACH), Durban, South Africa
| | - Krista L. Dong
- Ragon Institute of Mass General, MIT and Harvard, Cambridge, MA, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Cambridge, MA, USA
| | | | - Deborah Mindry
- Center for Gender and Health Justice, University of California Global Health Institute, Los Angeles, CA, USA
| | - Ayanda Zulu
- Integration of TB in Education and Care for HIV/AIDS (ITEACH), Durban, South Africa
| | - Ntombifuthi Langa
- Integration of TB in Education and Care for HIV/AIDS (ITEACH), Durban, South Africa
| | - Luyanda Maphalala
- Females Rising through Education, Support and Health (FRESH), Durban, South Africa
| | - Vanessa Pillay
- Females Rising through Education, Support and Health (FRESH), Durban, South Africa
| | - Maud Mthembu
- School of Applied Human Sciences, Department of Social Work, University of KwaZulu-Natal (UKZN), Durban, South Africa
| | - Annie Miall
- Ragon Institute of Mass General, MIT and Harvard, Cambridge, MA, USA
- Females Rising through Education, Support and Health (FRESH), Durban, South Africa
| | - Whitney Tran
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego (UCSD), La Jolla, CA, USA
| | - Ana Dillen
- Department of Ecology and Evolutionary Biology, University of California Los Angeles (UCLA), CA, USA
| | - Fang Wan
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego (UCSD), La Jolla, CA, USA
| | - Ali Ahmed
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego (UCSD), La Jolla, CA, USA
| | - Jamila K. Stockman
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego (UCSD), La Jolla, CA, USA
| | - Maryam Hussain
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego (UCSD), La Jolla, CA, USA
| | - Thumbi Ndung’u
- Ragon Institute of Mass General, MIT and Harvard, Cambridge, MA, USA
- HIV Pathogenesis Programme (HPP), The Doris Duke Medical Research Institute, UKZN, Durban, South Africa
- Africa Health Research Institute (AHRI), Durban, South Africa
- Division of Infection and Immunity, University College London, London, UK
| | - Karine Dubé
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego (UCSD), La Jolla, CA, USA
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Noorman MAJ, de Wit JBF, Marcos TA, Stutterheim SE, Jonas KJ, den Daas C. The Importance of Social Engagement in the Development of an HIV Cure: A Systematic Review of Stakeholder Perspectives. AIDS Behav 2023; 27:3789-3812. [PMID: 37329470 PMCID: PMC10589186 DOI: 10.1007/s10461-023-04095-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/19/2023]
Abstract
As research into the development of an HIV cure gains prominence, assessing the perspectives of stakeholders becomes imperative. It empowers stakeholders to determine priorities and influence research processes. We conducted a systematic review of the empirical literature on stakeholder perspectives. PubMed, Embase, Web of Science, and Scopus were searched for empirical, peer-reviewed articles, published before September 2022. Our analysis of 78 papers showed that stakeholders could be divided into three categories: people with HIV, key populations, and professionals. Following thematic synthesis, two main themes were distinguished: stakeholders' perspectives on HIV cure research and stakeholders' perspectives on HIV cure. Research on perspectives on HIV cure research showed that stakeholders' hypothetical willingness to participate (WTP) in HIV cure research was relatively high, while actual WTP was found to be lower. Studies also identified associated (individual) characteristics of hypothetical WTP, as well as facilitators and barriers to hypothetical participation. Additionally, we reported research on experiences of actual HIV cure research participation. Our analysis of stakeholder perceptions of HIV cure showed that most stakeholders preferred a cure that could eliminate HIV and outlined positive associated impacts. Furthermore, we observed that most included studies were conducted among PWHIV, and in the Global North. To empower stakeholders, we recommend that future research include an even greater diversity of stakeholders and incorporate theories of behavior to further explore how stakeholders decide to meaningfully engage in every stage of HIV cure research.
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Affiliation(s)
- Maaike A J Noorman
- Department of Interdisciplinary Social Science, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands.
| | - John B F de Wit
- Department of Interdisciplinary Social Science, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
| | - Tamika A Marcos
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Sarah E Stutterheim
- Department of Health Promotion and Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Kai J Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Chantal den Daas
- Institute of Applied Health Sciences, Health Psychology Group, University of Aberdeen, Aberdeen, UK
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Dubé K, Mthimkhulu D, Ngcobo W, Mindry D, Maphalala L, Pillay V, Tran W, Korolkova A, Ndung’u T, Dong K. 'With this study, we have hope that something is coming': community members' perceptions of HIV cure-related research in Durban, South Africa - a qualitative focus group study. HIV Res Clin Pract 2023; 24:2243046. [PMID: 37555592 PMCID: PMC10433450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
BACKGROUND Developing a cure for HIV remains a global scientific priority. In 2022, the Females Rising through Education, Support and Health (FRESH) cohort launched an HIV cure-related trial involving an analytical treatment interruption (ATI) in Durban, South Africa. OBJECTIVES To explore community perspectives about HIV cure-related research. METHODS Between July-August 2022, we conducted three focus groups with community members. We transcribed audio recordings verbatim and used content analysis to analyze the data. RESULTS Twenty community members (13 women and 7 men) participated in three focus groups (HIV status not included). Participants viewed HIV cure-related research as a way to address the issue of defaulting on (not taking) HIV treatment. Participants expressed hesitancy around ATIs, since these contradict longstanding treatment adherence messages. Participants shared concerns around the risk of side effects from experimental interventions balanced against potential efficacy. They advocated for trial participants to have the right to decide whether to inform their sex partners about their HIV status and ATI participation, rather than research teams making disclosure mandatory. Focus group participants also emphasized the importance of using simple language to explain HIV cure-related research. CONCLUSIONS With HIV cure trials set to launch across Africa in the future, there is a critical need to better understand and respond to local community needs and preferences and to adopt this as standard practice prior to regional trial implementation.
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Affiliation(s)
- Karine Dubé
- University of California San Diego (UCSD) School of Medicine, Division of Infectious Diseases and Global Public Health (IDGPH), La Jolla, CA, USA
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Deli Mthimkhulu
- Integration of Tuberculosis in Education and Care for HIV/AIDS (ITEACH), Durban, South Africa
| | - Wiseman Ngcobo
- Integration of Tuberculosis in Education and Care for HIV/AIDS (ITEACH), Durban, South Africa
| | - Deborah Mindry
- Center for Gender and Health Justice, University of California Global Health Institute, Los Angeles, CA, USA
| | - Luyanda Maphalala
- Females Rising through Education, Support and Health (FRESH), Durban, South Africa
| | - Vanessa Pillay
- Females Rising through Education, Support and Health (FRESH), Durban, South Africa
| | - Whitney Tran
- University of California San Diego (UCSD) School of Medicine, Division of Infectious Diseases and Global Public Health (IDGPH), La Jolla, CA, USA
| | - Ana Korolkova
- University of California San Diego (UCSD) School of Medicine, Division of Infectious Diseases and Global Public Health (IDGPH), La Jolla, CA, USA
| | - Thumbi Ndung’u
- HIV Pathogenesis Programme (HPP), The Doris Duke Medical Research Institute, University of KwaZulu-Natal (UKZN), Durban, South Africa
- Africa Health Research Institute (AHRI), Durban, South Africa
- Division of Infection and Immunity, University College London, London, UK
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
| | - Krista Dong
- Ragon Institute of Massachusetts General Hospital (MGH), Massachusetts Institute of Technology (MIT) and Harvard, Cambridge, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Cambridge, MA, USA
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Abstract
PURPOSE OF REVIEW Recent years have seen major investments into HIV cure research, seeking a permanent cure or remission. The purpose of this review is to consider how this important research agenda could be broadened to include issues of acceptability and appropriateness for different populations. RECENT FINDINGS We discuss how the definitions of cure such as functional cure (remission) or complete cure (viral elimination) could be interpreted differently by various populations. We also discuss the different methods of cure and the importance of including Africa in cure research to ensure that emerging remedies could be trialled and utilized on the continent that bears the brunt of the AIDS pandemic. SUMMARY We propose that the social science research of HIV cure acceptability should be done concurrently with the basic and clinical sciences, to ensure that cure methods consider stakeholder preferences.
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Affiliation(s)
- Evelyn Y. Bonney
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Helena Lamptey
- Departments of Medicine and Molecular Microbiology, Washington University School of Medicine in St Louis, Missouri, USA
| | - George B. Kyei
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
- Departments of Medicine and Molecular Microbiology, Washington University School of Medicine in St Louis, Missouri, USA
- Medical and Scientific Research Center, University of Ghana Medical Center, Accra, Ghana
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Sylla L, Patel H, Louella M, Simoni J, Dubé K. Community HIV clinicians' perceptions about HIV cure-related research in the Northwestern United States. HIV Res Clin Pract 2022; 23:61-75. [PMID: 35904107 PMCID: PMC9836364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: Research on stakeholder perspectives of HIV cure research has involved people with HIV (PWH), who generally cite the importance of HIV clinician advice in making decisions about trial participation. However, there has been little exploration of non-researcher community HIV clinician perspectives, which are clearly critical to the success of HIV cure-related research.Objective: We aimed to learn how community HIV clinicians perceive HIV cure research and identify factors that would lead them to support or discourage HIV cure trial participation by their patients.Methods: We recruited a purposive sample of 12 community HIV clinicians in metro-Seattle, WA to participate in structured interviews. We completed 11 interviews via teleconference and received one written response. We used conventional content analysis to analyze the data.Results: Overall, community HIV clinicians were supportive of patient participation in HIV cure trials. Factors affecting support included knowledge of local trials, ease of referral, patient immune function and health stability, study risks and benefits, burden of study requirements, patient characteristics, patient life stability, potential impact on engagement in care, study communication plans, and beliefs that patients should have the autonomy to decide to participate. Participants had concerns about trials requiring treatment delays or interruptions and HIV transmission risk. While their knowledge of the field was limited, they were interested in learning more about open HIV cure trials.Conclusions: It would benefit the HIV cure research community if those leading HIV cure trials make stronger efforts to engage community clinicians who care for PWH, but are not active researchers, early in the trial design process. Such engagement prior to launching HIV cure trials will improve trial designs, leading to better enrollment and retention within these important studies.
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Affiliation(s)
- Laurie Sylla
- defeatHIV Collaboratory, 1100 Fairview Avenue North, E5-110, Seattle, WA, 98109, USA,University of Washington, School of Medicine, Division of Allergy and Infectious Diseases, Mountain West AIDS Education & Training Center, Mailstop 359932, Seattle, WA 98104
| | - Hursch Patel
- University of North Carolina Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC, 27599, USA
| | - Michael Louella
- defeatHIV Collaboratory, 1100 Fairview Avenue North, E5-110, Seattle, WA, 98109, USA
| | - Jane Simoni
- University of Washington, Departments of Psychology and Global Health, 3909 Stevens Way CE, Box 351525, Seattle, WA, USA
| | - Karine Dubé
- University of North Carolina Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC, 27599, USA
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Morales-Olivares R, Aguirre-Nuñez C, Nuñez-Carrasco L, Ulloa-León F. Subjective Well-Being and Schools in South Africa: A Post-COVID-19 Analysis. Front Psychol 2022; 13:891590. [PMID: 35814149 PMCID: PMC9257172 DOI: 10.3389/fpsyg.2022.891590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/10/2022] [Indexed: 11/24/2022] Open
Abstract
From the analysis of the Wave 5 National Income Dynamics Study - Coronavirus Rapid Mobile Survey 2021 dataset, the study conducted in South Africa, we developed a model of analysis based on three dimensions, namely, subjective well-being, material living conditions, and importance attributed to education during the COVID-19 pandemic. A cross-sectional analysis of the data for Gauteng area indicates that the dimension of subjective well-being of families in South Africa-even in relation to the factors such as conditions of deprivation (e.g., hunger)-does not necessarily influence the importance the respondents attach to their children's education, this as reflected in whether or not they send them to school when COVID-19 restrictions allowed for schools to come back to face-to-face teaching. Subjective well-being of parents and guardians is, however, a predictor of concern about their children's education and future. Our working hypothesis is that, although there is little evidence that subjective well-being has a significant association with the respondents' willingness for their children to continue their schooling, there is a significant indirect effect of subjective well-being-which is especially determined by the gender as well as of the living material conditions-and the greater or lesser importance that the respondents attribute to their children's education. Likewise, and in more general terms, subjective well-being is clearly related to gender, with women having the lowest levels of subjective well-being.
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Affiliation(s)
| | - Carlos Aguirre-Nuñez
- Escuela de Construcción, Facultad de Arquitectura, Diseño y Construcción, Universidad de Las Américas, Santiago, Chile
| | - Lorena Nuñez-Carrasco
- Department of Sociology, University of the Witwatersrand, Johannesburg, South Africa
| | - Felipe Ulloa-León
- Escuela de Construcción, Facultad de Arquitectura, Diseño y Construcción, Universidad de Las Américas, Santiago, Chile
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Dubé K, Kanazawa J, Taylor J, Dee L, Jones N, Roebuck C, Sylla L, Louella M, Kosmyna J, Kelly D, Clanton O, Palm D, Campbell DM, Onaiwu MG, Patel H, Ndukwe S, Henley L, Johnson MO, Saberi P, Brown B, Sauceda JA, Sugarman J. Ethics of HIV cure research: an unfinished agenda. BMC Med Ethics 2021; 22:83. [PMID: 34193141 PMCID: PMC8243312 DOI: 10.1186/s12910-021-00651-1] [Citation(s) in RCA: 10] [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: 12/09/2020] [Accepted: 06/23/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The pursuit of a cure for HIV is a high priority for researchers, funding agencies, governments and people living with HIV (PLWH). To date, over 250 biomedical studies worldwide are or have been related to discovering a safe, effective, and scalable HIV cure, most of which are early translational research and experimental medicine. As HIV cure research increases, it is critical to identify and address the ethical challenges posed by this research. METHODS We conducted a scoping review of the growing HIV cure research ethics literature, focusing on articles published in English peer-reviewed journals from 2013 to 2021. We extracted and summarized key developments in the ethics of HIV cure research. Twelve community advocates actively engaged in HIV cure research provided input on this summary and suggested areas warranting further ethical inquiry and foresight via email exchange and video conferencing. DISCUSSION Despite substantial scholarship related to the ethics of HIV cure research, additional attention should focus on emerging issues in six categories of ethical issues: (1) social value (ongoing and emerging biomedical research and scalability considerations); (2) scientific validity (study design issues, such as the use of analytical treatment interruptions and placebos); (3) fair selection of participants (equity and justice considerations); (4) favorable benefit/risk balance (early phase research, benefit-risk balance, risk perception, psychological risks, and pediatric research); (5) informed consent (attention to language, decision-making, informed consent processes and scientific uncertainty); and (6) respect for enrolled participants and community (perspectives of people living with HIV and affected communities and representation). CONCLUSION HIV cure research ethics has an unfinished agenda. Scientific research and bioethics should work in tandem to advance ethical HIV cure research. Because the science of HIV cure research will continue to rapidly advance, ethical considerations of the major themes we identified will need to be revisited and refined over time.
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Affiliation(s)
- Karine Dubé
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7469 USA
| | - John Kanazawa
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7469 USA
| | - Jeff Taylor
- HIV + Aging Research Project – Palm Springs (HARP–PS), Palm Springs, CA USA
- AntiViral Research Center (AVRC) Community Advisory Board (CAB), San Diego, CA USA
- Collaboratory of AIDS Researchers for Eradication (CARE) CAB, Chapel Hill, NC USA
| | - Lynda Dee
- AIDS Action Baltimore, Baltimore, MD USA
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board (CAB), San Francisco, CA USA
| | - Nora Jones
- BEAT-HIV Collaboratory CAB, Philadelphia, PA USA
| | | | | | | | - Jan Kosmyna
- AIDS Clinical Trials Group (ACTG) Community Scientific Subcommittee (CSS) Ethics Working Group, Nationwide, USA
| | - David Kelly
- AIDS Clinical Trials Group (ACTG) Community Scientific Subcommittee (CSS) Ethics Working Group, Nationwide, USA
| | - Orbit Clanton
- AIDS Clinical Trials Group Global CAB, Washington, D.C. USA
| | - David Palm
- Collaboratory of AIDS Researchers for Eradication (CARE) CAB, Chapel Hill, NC USA
- Institute of Global Health and Infectious Diseases HIV Treatment and Prevention CAB, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Danielle M. Campbell
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board (CAB), San Francisco, CA USA
- Charles R. Drew College of Medicine and Science, Los Angeles, CA USA
| | - Morénike Giwa Onaiwu
- AIDS Clinical Trials Group (ACTG) Community Scientific Subcommittee (CSS) Ethics Working Group, Nationwide, USA
- Center for the Study of Women, Gender, and Sexuality (School of Humanities), Rice University, Houston, TX USA
| | - Hursch Patel
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7469 USA
| | - Samuel Ndukwe
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7469 USA
| | - Laney Henley
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7469 USA
| | - Mallory O. Johnson
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA USA
| | - Parya Saberi
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA USA
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside, Riverside, CA USA
| | - John A. Sauceda
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA USA
| | - Jeremy Sugarman
- Johns Hopkins Berman Institute for Bioethics, Baltimore, MD USA
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Ntlhamu MI, Ndhlala AR, Masoko P. Exploring the anti-HIV-1 reverse transcriptase, anti-inflammatory, anti-cancer activities and cytotoxicity of two fermented commercial herbal concoctions sold in Limpopo Province of South Africa. BMC Complement Med Ther 2021; 21:151. [PMID: 34039320 PMCID: PMC8157459 DOI: 10.1186/s12906-021-03321-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The use of herbal concoctions is very popular in South Africa, including Limpopo Province. The herbal concoctions are claimed to be capable of treating numerous illnesses such as ulcers, cancer, HIV/AIDS, diabetes, certain STDs, blood cleansing to mention but a few. The focus of this study was to evaluate the anti-HIV 1 reverse transcriptase, anti-inflammatory and anti-cancerous activities as well as cytotoxic effects of 2 fermented herbal concoctions used for the treatment of the related ailments in Limpopo province of South Africa. METHOD Two fermented herbal concoctions obtained from a herbalist in Polokwane were extracted with 80% acetone. The anti-HIV activity of the herbal concoctions was determined using the anti-HIV reverse transcriptase assay. The anti-cancer and cytotoxic effects of the herbal concoctions were evaluated using cancerous Human Colon (HT-29) cells and the normal human Hepatoma cells (C3A) respectively. RESULTS Notable anti-HIV reverse transcriptase activity was observed from the 80% acetone fraction of herbal concoction 1 (IC50 38.031 μg/mL) which exhibited better activity than the positive control Lamivudine (IC50 40.90 μg/mL). There was variation in the anti-inflammation activity as determined by the sPL2, 15-LOX and COX enzyme assays. The only concerning matter was the high COX-1 activity in some of the extracts, which is not desirable due to the mucosal protection action of COX-1 enzyme. The herbal concoctions did not exhibit cytotoxic effects on normal human cells, however, toxicity against cancerous cells was observed. CONCLUSION The herbal concoctions displayed some considerable pharmacological effects against various ailments as claimed by the herbalist. More work to ascertain the toxicity of both concoctions against cancerous cells need to be followed as this could lead to the discovery of anticancer drugs.
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Affiliation(s)
- Matimba I Ntlhamu
- Department of Biochemistry, Microbiology and Biotechnology, Faculty of Science and Agriculture, University of Limpopo, Private Bag X1106, Sovenga, Limpopo, 0727, South Africa
| | - Ashwell R Ndhlala
- Green Biotechnologies Research Centre of Excellence, Faculty of Science and Agriculture, University of Limpopo, Private Bag X1106, Sovenga, Limpopo, 0727, South Africa.
| | - Peter Masoko
- Department of Biochemistry, Microbiology and Biotechnology, Faculty of Science and Agriculture, University of Limpopo, Private Bag X1106, Sovenga, Limpopo, 0727, South Africa.
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Dubé K, Willenberg L, Dee L, Sylla L, Taylor J, Roebuck C, Palm D, Campbell D, Newton L, Patel H, Perry KE, Kanazawa J, Gerrard J, Brown B, Saberi P, Sauceda JA, Peluso MJ. Re-examining the HIV 'functional cure' oxymoron: Time for precise terminology? J Virus Erad 2020; 6:100017. [PMID: 33251025 PMCID: PMC7646673 DOI: 10.1016/j.jve.2020.100017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 09/29/2020] [Accepted: 10/02/2020] [Indexed: 02/07/2023] Open
Abstract
For over a decade, the binary concepts of 'sterilizing' versus 'functional' cure have provided an organizing framework for the field of HIV cure-related research. In this article, we examine how the expression 'functional cure' is employed within the field, published literature, and community understanding of HIV cure research. In our synthesis of the different meanings attributed to 'functional cure' within contemporary biomedical discourse, we argue that employing the 'functional cure' terminology poses a series of problems. The expression itself is contradictory and inconsistently used across a wide array of HIV cure research initiatives. Further, the meaning and acceptability of 'functional cure' within communities of people living with and affected by HIV is highly variable. After drawing lessons from other fields, such as cancer and infectious hepatitis cure research, we summarize our considerations and propose alternative language that may more aptly describe the scientific objectives in question. We call for closer attention to language used to describe HIV cure-related research, and for continued, significant, and strategic engagement to ensure acceptable and more precise terminology.
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Affiliation(s)
- Karine Dubé
- UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | | | - Lynda Dee
- AIDS Action Baltimore, Baltimore, MD, USA
- amfAR Institute for HIV Cure Research Community Advisory Board (CAB), Palm Springs, CA, USA
- Delaney AIDS Research Enterprise (DARE) CAB, Baltimore,MD and Los, Angeles, CA, USA
- Martin Delaney Collaboratory CAB, Baltimore, MD; Seattle, WA; Palm Springs, CA; Ithaca, NY, Los Angeles, CA, USA
| | - Laurie Sylla
- Martin Delaney Collaboratory CAB, Baltimore, MD; Seattle, WA; Palm Springs, CA; Ithaca, NY, Los Angeles, CA, USA
- DefeatHIV CAB, Seattle, WA, USA
| | - Jeff Taylor
- amfAR Institute for HIV Cure Research Community Advisory Board (CAB), Palm Springs, CA, USA
- Martin Delaney Collaboratory CAB, Baltimore, MD; Seattle, WA; Palm Springs, CA; Ithaca, NY, Los Angeles, CA, USA
- HIV + Aging Research Project – Palm Springs (HARP-PS), Palm Springs, CA, USA
- University of California AntiViral Research Center CAB, San Diego, CA, USA
- Collaboratory of AIDS Researchers for Eradication (CARE) CAB, Chapel Hill, USA
| | - Christopher Roebuck
- Martin Delaney Collaboratory CAB, Baltimore, MD; Seattle, WA; Palm Springs, CA; Ithaca, NY, Los Angeles, CA, USA
- BEAT-HIV CAB, Philadelphia, PA, USA
- Department of Science and Technology Studies, Cornell University, Ithaca, NY, USA
| | - David Palm
- Martin Delaney Collaboratory CAB, Baltimore, MD; Seattle, WA; Palm Springs, CA; Ithaca, NY, Los Angeles, CA, USA
- Collaboratory of AIDS Researchers for Eradication (CARE) CAB, Chapel Hill, USA
- Institute of Global Health and Infectious Diseases (IGHID), University of North Carolina at Chapel Hill, NC, USA
| | - Danielle Campbell
- Delaney AIDS Research Enterprise (DARE) CAB, Baltimore,MD and Los, Angeles, CA, USA
- Martin Delaney Collaboratory CAB, Baltimore, MD; Seattle, WA; Palm Springs, CA; Ithaca, NY, Los Angeles, CA, USA
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA, UCLA, Los Angeles, CA, USA
| | - Luke Newton
- UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Hursch Patel
- UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Kelly E. Perry
- UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - John Kanazawa
- UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Jo Gerrard
- University of California Riverside School of Medicine, Riverside, CA, USA
| | - Brandon Brown
- Center for Healthy Communities, Department of Social Medicine and Population Health, University of California Riverside School of Medicine, Riverside, CA, USA
| | - Parya Saberi
- Division of Prevention Science, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - John A. Sauceda
- Division of Prevention Science, Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Michael J. Peluso
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, CA, USA
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10
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Dubé K, Simoni J, Louella M, Sylla L, Mohamed ZH, Patel H, Luter S, Collier AC. Acceptability of Cell and Gene Therapy for Curing HIV Infection Among People Living with HIV in the Northwestern United States: A Qualitative Study. AIDS Res Hum Retroviruses 2019; 35:649-659. [PMID: 30990052 PMCID: PMC6602097 DOI: 10.1089/aid.2019.0021] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Multiple strategies to cure HIV infection are under investigation, including cell and gene therapy (C>) approaches. Research, and ultimately treatment, with these novel strategies will require patients' willingness to participate. To elicit the perspectives of people living with HIV specific to these novel approaches, we conducted 4 focus group discussions with a diverse group of 19 English-speaking men and women living with HIV in care at a large academic HIV clinic in the northwestern United States. Thematic analysis indicated participants expressed initial fear about C> research. They articulated specific concerns about risks, including analytical treatment interruptions, and thought only a person in desperate straits would participate. They voiced significant mistrust of research in general and believed there was already a cure from HIV that was being withheld from the poor. Overall, they were satisfied with their health and quality of life on antiretroviral therapy. These findings suggest the importance of community engagement and educational efforts about C> for HIV cure to ensure optimal collaborative partnerships.
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Affiliation(s)
- Karine Dubé
- UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jane Simoni
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Psychology, University of Washington, Seattle, Washington
| | - Michael Louella
- defeatHIV Community Advisory Board (CAB), Seattle, Washington
- University of Washington Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Laurie Sylla
- defeatHIV Community Advisory Board (CAB), Seattle, Washington
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Zahra H. Mohamed
- Department of Global Health, University of Washington, Seattle, Washington
| | - Hursch Patel
- UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stuart Luter
- UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ann C. Collier
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
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11
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Moodley K, Staunton C, Rossouw T, de Roubaix M, Duby Z, Skinner D. The psychology of "cure" - unique challenges to consent processes in HIV cure research in South Africa. BMC Med Ethics 2019; 20:9. [PMID: 30678664 PMCID: PMC6346569 DOI: 10.1186/s12910-019-0348-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 01/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Consent processes for clinical trials involving HIV prevention research have generated considerable debate globally over the past three decades. HIV cure/eradication research is scientifically more complex and consequently, consent processes for clinical trials in this field are likely to pose a significant challenge. Given that research efforts are now moving toward HIV eradication, stakeholder engagement to inform appropriate ethics oversight of such research is timely. This study sought to establish the perspectives of a wide range of stakeholders in HIV treatment and research to inform consent processes for cure research. METHODS In total, 68 South African stakeholders participated in two qualitative research modalities. In-depth interviews (IDIs) were conducted with a purposive sample of 42 individuals - audiotaped with consent. Twenty-six stakeholders participated in three focus group discussions (FGDs). Thematic analysis of transcribed IDIs and FGDs was conducted. RESULTS The majority of respondents indicated that there could be unique challenges in HIV cure research requiring special attention. In particular, given the complexity of cure science, translation of concepts into lay language would be critical for potential participants to adequately appreciate risks and benefits in early phase research with experimental interventions. Furthermore, to aid understanding of risks and benefits against a background of desperation for a cure, specially trained facilitators would be required to assist with a psychological assessment prior to consent to avoid curative misconceptions. Long-term participant engagement to assess durability of a cure would mean that the consent process would be prolonged, necessitating annual re-consent. Building trust to maintain such long-term relationships would be critical to retain study participants. CONCLUSION Unique consent requirements for cure research in South Africa would include significant efforts to maximise understanding of trial procedures, risks and the need for long-term follow-up. However, the psychological dimension of cure must not be underestimated. Beyond an understanding of cure science, the emotional impact of HIV cure advances the discourse from cure to healing. Consequently, the consent process for cure research would need to be enhanced to include psychological support and counselling. This has several important implications for research ethics review requirements for consent in HIV cure research.
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Affiliation(s)
- Keymanthri Moodley
- Centre for Medical Ethics and Law, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Ciara Staunton
- Centre for Medical Ethics and Law, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Theresa Rossouw
- Institute for Cellular and Molecular Medicine, Department of Immunology, University of Pretoria, Pretoria, South Africa
| | - Malcolm de Roubaix
- Centre for Medical Ethics and Law, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Zoe Duby
- Centre for Medical Ethics and Law, Department of Medicine, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Donald Skinner
- HIV AIDS STDs and TB, Human Sciences Research Council, Cape Town, South Africa
- Dept. of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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12
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Staunton C, de Roubaix M, Baatjies D, Black G, Hendricks M, Rossouw T, Moodley K. Ethical challenges in developing an educational video to empower potential participants during consent processes in HIV cure research in South Africa. J Virus Erad 2018; 4:99-102. [PMID: 29682301 PMCID: PMC5892675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Obtaining consent for HIV research is complex, particularly in low- and middle-income countries. Low levels of education, complexity of science and research processes, confusion about basic elements of research, and socio-economic conditions that make access to medical care difficult have collectively led to concerns about the adequacy of the consent process. Given the exponential growth of HIV prevention and treatment research in South Africa, HIV researchers are increasingly facing challenges obtaining authentic informed consent from potential participants. It is anticipated that HIV cure research, despite being in its infancy in South Africa, will introduce a new discourse into a population that is often struggling to understand the differences between 'cure', 'preventive and therapeutic vaccines' and other elements of the research process. Coupled with this, South Africa has a complex history of 'illegitimate' or 'false cures' for HIV. It is therefore logical to anticipate that HIV cure research may face significant challenges during consent processes. HIV prevention research in South Africa has demonstrated the importance of early community engagement in educating potential research participants and promoting community acceptance of research. Consequently, in an attempt to extrapolate from this experience of engaging with communities early regarding cure research, a 15-minute educational video entitled 'I have a dream: a world without HIV' was developed to educate and ultimately empower potential research participants to make informed choices during consent processes in future HIV cure clinical trials. To aid others in the development of educational interventions, this paper discusses the challenges faced in developing this educational video.
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Affiliation(s)
- Ciara Staunton
- Centre for Medical Ethics and Law, Stellenbosch University,
South Africa,Corresponding author: Ciara Staunton,
Centre for Medical Ethics and Law, Department of Medicine, Faculty of Health Sciences,
Stellenbosch University,
South Africa
| | - Malcolm de Roubaix
- Centre for Medical Ethics and Law, Stellenbosch University,
South Africa
| | - Dianno Baatjies
- Centre for Medical Ethics and Law, Stellenbosch University,
South Africa
| | - Gill Black
- Sustainable Livelihoods Foundation,
South Africa
| | - Melany Hendricks
- Centre for Medical Ethics and Law, Stellenbosch University,
South Africa
| | - Theresa Rossouw
- Department of Immunology, University of Pretoria,
South Africa
| | - Keymanthri Moodley
- Centre for Medical Ethics and Law, Stellenbosch University,
South Africa
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13
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Staunton C, de Roubaix M, Baatjies D, Black G, Hendricks M, Rossouw T, Moodley K. Ethical challenges in developing an educational video to empower potential participants during consent processes in HIV cure research in South Africa. J Virus Erad 2018. [DOI: 10.1016/s2055-6640(20)30251-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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14
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Zhang A, Pan X, Wu F, Zhao Y, Hu F, Li L, Cai W, Tucker JD. What Would an HIV Cure Mean to You? Qualitative Analysis from a Crowdsourcing Contest in Guangzhou, China. AIDS Res Hum Retroviruses 2018; 34:80-87. [PMID: 28891318 DOI: 10.1089/aid.2017.0188] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Much HIV cure social science research has focused on high-income countries. Local key population perspectives, especially from people living with HIV (PLHIV), are needed in low- and middle-income countries. We organized an open contest soliciting responses from key populations, including PLHIV, about what a cure would mean in their lives. Tailored in-person events and social media were used to engage PLHIV, men who have sex with men (MSM), people who inject drugs, and local residents. We received 471 contributions over 4 months. Our thematic analysis showed that many people perceived that a cure would sterilize HIV and bring about new life for PLHIV. Many individuals believed a cure would decrease PLHIV discrimination and many MSM perceived a cure would decrease MSM discrimination. Some participants noted that a cure could help improve interpersonal relations, particularly with families and partners. Many individuals envisioned HIV cure as a panacea to bring about social stability. Some participants also anticipated changes in attitudes toward sex that may result in increased condomless sex. Our findings suggest a continued need for careful management of patient expectations and community engagement.
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Affiliation(s)
- Alice Zhang
- School of Medicine, University of Maryland-Baltimore, Baltimore, Maryland
- University of North Carolina Project-China, Guangzhou, China
| | - Xin Pan
- School of Medicine, University of Maryland-Baltimore, Baltimore, Maryland
| | - Feng Wu
- School of Medicine, University of Maryland-Baltimore, Baltimore, Maryland
- Center for Medical Anthropology and Behavioral Health, School of Anthropology and Sociology, Sun Yat-sen University, Guangzhou, China
| | - Yang Zhao
- University of North Carolina Project-China, Guangzhou, China
| | - Fengyu Hu
- School of Medicine, University of Maryland-Baltimore, Baltimore, Maryland
| | - Linghua Li
- Department of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Weiping Cai
- Department of Infectious Diseases, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Joseph D. Tucker
- University of North Carolina Project-China, Guangzhou, China
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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15
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Dubé K, Sylla L, Dee L, Taylor J, Evans D, Bruton CD, Gilberston A, Gralinski L, Brown B, Skinner A, Weiner BJ, Greene SB, Corneli A, Adimora AA, Tucker JD, Rennie S. Research on HIV cure: Mapping the ethics landscape. PLoS Med 2017; 14:e1002470. [PMID: 29220353 PMCID: PMC5722280 DOI: 10.1371/journal.pmed.1002470] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In an essay, Karine Dubé and coauthors discuss the ethics of preclinical and clinical studies relevant to achieving an HIV cure.
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Affiliation(s)
- Karine Dubé
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Laurie Sylla
- defeatHIV Community Advisory Board (CAB), Seattle, Washington, United States of America
| | - Lynda Dee
- amfAR Institute for HIV Cure Research CAB, San Francisco, California, United States of America
- Delaney AIDS Research Enterprise (DARE) CAB, San Francisco, California, United States of America
- AIDS Action Baltimore, Baltimore, Maryland, United States of America
| | - Jeff Taylor
- amfAR Institute for HIV Cure Research CAB, San Francisco, California, United States of America
- Collaboratory of AIDS Researchers for Eradication (CARE) CAB, Palm Springs, California, and Chapel Hill, North Carolina, United States of America
| | - David Evans
- Delaney AIDS Research Enterprise (DARE) CAB, San Francisco, California, United States of America
- Project Inform, San Francisco, California, United States of America
| | - Carl Dean Bruton
- Collaboratory of AIDS Researchers for Eradication (CARE) CAB, Palm Springs, California, and Chapel Hill, North Carolina, United States of America
- AIDS Clinical Trials Group (ACTG) CAB, Chapel Hill, North Carolina, United States of America
| | - Adam Gilberston
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Lisa Gralinski
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Brandon Brown
- University of California Riverside, Riverside, California, United States of America
| | - Asheley Skinner
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
- Duke Clinical Research Institute (DCRI), Durham, North Carolina, United States
| | - Bryan J. Weiner
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Sandra B. Greene
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Amy Corneli
- Duke Clinical Research Institute (DCRI), Durham, North Carolina, United States
| | - Adaora A. Adimora
- UNC Institute of Global Health and Infectious Diseases (IGHID), Chapel Hill, North Carolina, United States of America
| | - Joseph D. Tucker
- UNC Institute of Global Health and Infectious Diseases (IGHID), Chapel Hill, North Carolina, United States of America
- UNC Project China, Guangzhou, China
| | - Stuart Rennie
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- UNC Center for Bioethics, Chapel Hill, North Carolina, United States of America
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