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Gillette E, Nyandiko W, Chory A, Scanlon M, Aluoch J, Choudhury N, Lagat D, Ashimosi C, Biegon W, Munyoro D, Lidweye J, Nyagaya J, Wilets I, DeLong A, Kantor R, Vreeman R, Naanyu V. Ethical Considerations for Engaging Children and Adolescents Living with HIV in Research in African Countries: A Systematic Review. J Empir Res Hum Res Ethics 2023; 18:346-362. [PMID: 37872659 DOI: 10.1177/15562646231208991] [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] [Indexed: 10/25/2023]
Abstract
Research engaging children and adolescents living with HIV (CALWH) is critical for youth-friendly services and HIV care, and researchers need to ensure that such engagement is ethical. We conducted a systematic review to identify key ethical considerations for the engagement of CALWH in research. The review focused on primary research articles conducted in African countries that examined ethical issues in CALWH engaged in research. Ten studies met the inclusion criteria; the following seven key domains were extracted: 1) justifications for engaging CALWH in research; 2) community involvement; 3) informed consent/assent; 4) caregiver involvement; 5) perceptions of benefits; 6) perception of the risks of involvement; and 7) confidentiality. These domains can inform the ethical engagement of CALWH in research.
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Affiliation(s)
- Emma Gillette
- Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Winstone Nyandiko
- Moi University College of Health Sciences, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ashley Chory
- Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Scanlon
- Indiana University Center for Global Health, Indianapolis, Indiana, USA
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Nandini Choudhury
- Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Lagat
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Whitney Biegon
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Dennis Munyoro
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Janet Lidweye
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jack Nyagaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ilene Wilets
- Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Rachel Vreeman
- Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Violet Naanyu
- Moi University College of Health Sciences, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
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MacDonald KR, Enane LA, McHenry MS, Davis NL, Whipple EC, Ott MA. Ethical Aspects of Involving Adolescents in HIV Research: A Systematic Review of the Empiric Literature. J Pediatr 2023; 262:113589. [PMID: 37399918 PMCID: PMC11119419 DOI: 10.1016/j.jpeds.2023.113589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To evaluate the ethics of involving adolescents in HIV research, we conducted a systematic review of the empiric literature. METHODS Electronic databases Ovid Medline, Embase, and CINAHL were systematically searched using controlled vocabulary terms related to ethics, HIV, specified age groups, and empiric research studies. We reviewed titles and abstracts, including studies that collected qualitative or quantitative data, evaluated ethical issues in HIV research, and included adolescents. Studies were appraised for quality, data were extracted, and studies were analyzed using narrative synthesis. RESULTS We included 41 studies: 24 qualitative, 11 quantitative, 6 mixed methods; 22 from high-income countries (HIC), 18 from low- or middle-income countries (LMIC), and 1 from both HIC and LMIC. Adolescent, parent, and community perspectives assert the benefits of involving minors in HIV research. Participants in LMIC expressed mixed views regarding parental consent requirements and confidentiality, given adolescents' both increasing autonomy and continued need for adult support. In studies in HIC, sexual or gender minority youth would not participate in research if parental consent were required or if there were confidentiality concerns. There was variation in the comprehension of research concepts, but adolescents generally demonstrated good comprehension of informed consent. Informed consent processes can be improved to increase comprehension and study accessibility. Vulnerable participants face complex social barriers that should be considered in study design. CONCLUSIONS Data support the inclusion of adolescents in HIV research. Empiric research can inform consent processes and procedural safeguards to ensure appropriate access.
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Affiliation(s)
- Katherine R MacDonald
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - Leslie A Enane
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN
| | - Megan S McHenry
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN
| | - Neilkant L Davis
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Elizabeth C Whipple
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN
| | - Mary A Ott
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN
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Eke AC, Gebreyohannes RD, Powell AM. Understanding clinical outcome measures reported in HIV pregnancy studies involving antiretroviral-naive and antiretroviral-experienced women. THE LANCET. INFECTIOUS DISEASES 2023; 23:e151-e159. [PMID: 36375478 PMCID: PMC10040432 DOI: 10.1016/s1473-3099(22)00687-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/02/2022] [Accepted: 10/04/2022] [Indexed: 11/13/2022]
Abstract
HIV infection is a clinically significant public health disease and contributes to increased risk of maternal and fetal morbidity and mortality. HIV pregnancy studies use outcome measures as metrics to show how people with HIV feel, function, or survive. These endpoints are crucial for tracking the evolution of HIV illness over time, assessing the effectiveness of antiretroviral therapy (ART), and comparing outcomes across studies. Although the need for ideal outcome measures is widely acknowledged, selecting acceptable outcome measures for these HIV pregnancy studies can be challenging. We discuss the many outcome measures that have been implemented over time to assess HIV in pregnancy studies, their benefits, and drawbacks. Finally, we offer suggestions for improving the reporting of outcome measures in HIV in pregnancy studies. Medical professionals can best care for pregnant women living with HIV receiving ART by having a thorough understanding of these outcome metrics.
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Affiliation(s)
- Ahizechukwu C Eke
- Division of Maternal Foetal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Rahel D Gebreyohannes
- Department of Obstetrics and Gynaecology, Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Anna M Powell
- Department of Gynaecology & Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Raciti CG, Marsha J, Nafiseh AA, Masese ER, Apondi E, McHenry MS. "If it benefits someone, it will be good:" perspectives on research participation from pregnant women living with HIV. AIDS Care 2023; 35:366-373. [PMID: 35341423 PMCID: PMC10775893 DOI: 10.1080/09540121.2022.2057411] [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: 10/26/2021] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
Pregnant women living with HIV (PWLHIV) are becoming increasingly involved in HIV research; however, the ethical concerns regarding their decision-making related to research participation are understudied. This qualitative study aimed to understand the perspectives and lived research experiences of PWLHIV, intending to identify important considerations to inform best practices. This study used semi-structured interviews (SSIs) of PWLHIV who participated in research studies in Eldoret, Kenya. All interviews were audio-recorded, transcribed, and translated. Qualitative analyses were performed, with line-by-line coding, constant comparison, axial coding, and triangulation to identify central concepts. Twelve PWLHIV participated. Overall, participants had positive experiences with HIV research. Most participants had difficulty distinguishing the differences between the research process and enhanced clinical care. They reported a willingness to participate in future HIV research studies and indicated altruism as the primary motivator. Participants identified their preferences and experiences with recruitment, consenting, reimbursement, and enrolment of infants in HIV research. The largest barrier for participating in HIV research was identified as a concern that participation would lead to HIV disclosure. By understanding the lived experiences of PWLHIV who participate in HIV research, future researchers can design studies and consenting processes to optimize ethical research practices.
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Affiliation(s)
- Catherine G Raciti
- Richard M. Fairbanks School of Public Health, Indiana University Purdue University- Indianapolis
| | - Joy Marsha
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Eric R Masese
- Department of Sociology, Psychology and Anthropology, Moi University School of Arts and Social Sciences, Eldoret, Kenya
| | - Edith Apondi
- Department of Pediatrics, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Megan S. McHenry
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Pediatrics, Indiana University School of Medicine
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Oyungu E, El Kebbi O, Vreeman R, Nyandiko W, Monahan PO, Tu W, Khaitan A, Desta Z, Slogrove AL, Humphrey JM, Were E, Patel RC, Carlucci JG, Wools-Kaloustian K, McHenry MS. Predicting neurodevelopmental risk in children born to mothers living with HIV in Kenya: protocol for a prospective cohort study (Tabiri Study). BMJ Open 2022; 12:e061051. [PMID: 35379648 PMCID: PMC8981283 DOI: 10.1136/bmjopen-2022-061051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION For the growing number of children with in utero and postpartum exposure to HIV and/or antiretrovirals, it is unclear which exposures or risk factors play a significant role in predicting worse neurodevelopmental outcomes. This protocol describes a prospective longitudinal cohort study of infants born to mothers living with HIV and those born to mothers without HIV. We will determine which risk factors are most predictive of child neurodevelopment at 24 months. We aim to create a risk assessment tool to help predict which children are at risk for worse neurodevelopment outcomes. METHODS AND ANALYSIS This study leverages an existing Kenyan cohort to prospectively enrol 500 children born to mothers living with HIV and 500 to those without HIV (n=1000 total) and follow them from birth to age 24 months. The following factors will be measured every 6 months: infectious morbidity and biological/sociodemographic/psychosocial risk factors. We will compare these factors between the two groups. We will then measure and compare neurodevelopment within children in both groups at 24 months of age using the Child Behaviour Checklist and the Bayley Scales of Infant and Toddler Development, third edition. Finally, we will use generalised linear mixed modelling to quantify associations with neurodevelopment and create a risk assessment tool for children ≤24 months. ETHICS AND DISSEMINATION The study is approved by the Moi University's Institutional Research and Ethics Committee (IREC/2021/55; Approval #0003892), Kenya's National Commission for Science, Technology and Innovation (NACOSTI, Reference #700244) and Indiana University's Institutional Review Board (IRB Protocol #110990). This study carries minimal risk to the children and their mothers, and all mothers will provide written consent for participation in the study. Results will be disseminated to maternal child health clinics within Uasin Gishu County, Kenya and via papers submitted to peer-reviewed journals and presentation at international conferences.
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Affiliation(s)
- Eren Oyungu
- Department of Medical Physiology, Moi University College of Health Sciences, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Ola El Kebbi
- Department of Emergency Medicine, American University of Beirut, Beirut, Lebanon
| | - Rachel Vreeman
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Arnold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Winstone Nyandiko
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Department of Child Health, Moi University College of Health Sciences, Eldoret, Kenya
| | - Patrick O Monahan
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Wanzhu Tu
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alka Khaitan
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Zeruesenay Desta
- Department of Clinical Pharmacology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Amy L Slogrove
- Department of Paediatrics & Child Health, Faculty of Medicine & Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - John M Humphrey
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Edwin Were
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Division of Obstetrics and Gynecology, Moi University College of Health Sciences, Eldoret, Kenya
| | - Rena C Patel
- University of Washington School of Medicine, Seattle, Washington, USA
| | - James G Carlucci
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kara Wools-Kaloustian
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Megan S McHenry
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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