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Li H, Shah SK, Healy E, Agot K, Neary J, Wilson K, Badia J, Atieno WO, Moraa H, Meischke H, Kibugi J, Inwani I, Chhun N, Mukumbang FC, John‐Stewart G, Kohler P, Beima‐Sofie K. "[T]he laws need to change to reflect current society": Insights from stakeholders involved in development, review or implementation of policies about adolescent consent for HIV testing, care and research in Kenya. J Int AIDS Soc 2023; 26:e26057. [PMID: 36642867 PMCID: PMC9841068 DOI: 10.1002/jia2.26057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/20/2022] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Engaging adolescents in HIV care and research promotes the development of interventions tailored to their unique needs. Guidelines generally require parental permission for adolescents to receive HIV care/testing or participate in research, with exceptions. Nevertheless, parental permission requirements can restrict adolescent involvement in care and research. To better appreciate prospects for policy reform, we sought to understand the perspectives of stakeholders involved in the development, review and implementation of policies related to adolescents living with HIV. METHODS Semi-structured individual interviews (IDIs) were conducted from October 2019 to March 2020 with 18 stakeholders with expertise in the (1) development of policy through membership in the Law Society of Kenya or work as a health policy official; (2) review of policy through ethics review committee service; or (3) implementation of policy through involvement in adolescent education. IDIs were conducted in English by Kenyan social scientists, audio-recorded and transcribed verbatim. We used thematic analysis to identify themes around how policies can be reformed to improve adolescent engagement in HIV care and research. RESULTS Our analysis identified three major themes. First, policies should be flexible rather than setting an age of consent. Stakeholders noted that adolescents' capacity for engagement in HIV care and research depended on context, perceived risks and benefits, and "maturity"-and that age was a poor proxy for the ability to understand. Second, policies should evolve with changing societal views about adolescent autonomy. Participants recognized a generational shift in how adolescents learn and mature, suggesting the need for a more frequent review of HIV care and research guidelines. Third, adults should empower adolescent decision-making. Stakeholders felt that caregivers can gradually involve adolescents in decision-making to equip them to gain ownership over their health and lives, improving their confidence and capacity. CONCLUSIONS Revising relevant laws to consider context, alternative measures of maturity, and evolving societal views about adolescence, along with supporting caregivers to assist in developing adolescent autonomy may promote more equitable and representative participation of adolescents in HIV care and research. Additional research should explore how to support caregivers and other adults to empower adolescents and improve stakeholder engagement in a more routine process of policy reform.
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Affiliation(s)
- Huangqianyu Li
- Department of Health ServicesUniversity of WashingtonSeattleWashingtonUSA
| | - Seema K. Shah
- Department of PediatricsNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA,Bioethics Program at Lurie Children's HospitalChicagoIllinoisUSA
| | - Elise Healy
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Kawango Agot
- Impact Research and Development OrganizationKisumuKenya
| | - Jillian Neary
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
| | - Kate Wilson
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Jacinta Badia
- Impact Research and Development OrganizationKisumuKenya
| | | | - Hellen Moraa
- Department of Pediatrics and Child HealthUniversity of NairobiNairobiKenya
| | - Hendrika Meischke
- Department of Health ServicesUniversity of WashingtonSeattleWashingtonUSA
| | - James Kibugi
- Impact Research and Development OrganizationKisumuKenya
| | - Irene Inwani
- University of Nairobi/Kenyatta National HospitalNairobiKenya
| | - Nok Chhun
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | | | - Grace John‐Stewart
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA,Department of MedicineUniversity of WashingtonSeattleWashingtonUSA,Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA,Department of PediatricsUniversity of WashingtonSeattleWashingtonUSA
| | - Pamela Kohler
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA,Department of ChildFamily and Population Health NursingUniversity of WashingtonSeattleWashingtonUSA
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Shah SK, Essack Z, Byron K, Slack C, Reirden D, van Rooyen H, Jones NR, Wendler DS. Adolescent Barriers to HIV Prevention Research: Are Parental Consent Requirements the Biggest Obstacle? J Adolesc Health 2020; 67:495-501. [PMID: 32636140 PMCID: PMC7508889 DOI: 10.1016/j.jadohealth.2020.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 04/17/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE One third of people newly living with HIV/AIDS are adolescents. Research on adolescent HIV prevention is critical owing to differences between adolescents and adults. Parental permission requirements are often considered a barrier to adolescent enrollment in research, but whether adolescents view this barrier as the most important one is unclear. METHODS Adolescents were approached in schools in KwaZulu-Natal, South Africa, and at a sexually transmitted infection clinic at the Children's Hospital of Aurora, Colorado. Surveys with a hypothetical vignette about participation in a pre-exposure prophylaxis trial were conducted on smartphones or tablets with 75 adolescents at each site. We calculated descriptive statistics for all variables, using 2-sample tests for equality of proportions with continuity correction. Statistical significance was calculated at p < 0.05. Multivariate analyses were also conducted. RESULTS Most adolescents thought side effects (77%) and parental consent requirements (69%) were very important barriers to research participation. When asked to rank barriers, adolescents did not agree on a single barrier as most important, but the largest group of adolescents ranked parental consent requirements as most important (29.5%). Parental consent was seen as more of a barrier for adolescents in South Africa than in the United States. Concerns about being experimented on or researchers' mandatory reporting to authorities were ranked much lower. Finally, most (71%, n = 106) adolescents said they would want to extra support from another adult if parental permission was not required. CONCLUSION Adolescents consider both parental permission requirements and side effects important barriers to their enrollment in HIV prevention research. Legal reform and better communication strategies may help address these barriers.
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Affiliation(s)
- Seema K Shah
- Division of AIDS, Department of Bioethics, NIH Clinical Center, Bethesda, Maryland; Department of Pediatrics, Smith Child Health Research, Outreach, and Advocacy Center, Lurie Children's Hospital, Northwestern University Medical School, Chicago, Illinois.
| | - Zaynab Essack
- Centre for Community-Based Research, Human Sciences Research Council (HSRC), Sweetwaters, KwaZulu-Natal, South Africa; HIV AIDS Vaccines Ethics Group (HAVEG), School of Applied Human Sciences, College of Humanities, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Katherine Byron
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland
| | - Catherine Slack
- HIV AIDS Vaccines Ethics Group (HAVEG), School of Applied Human Sciences, College of Humanities, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Daniel Reirden
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Heidi van Rooyen
- Centre for Community-Based Research, Human Sciences Research Council (HSRC), Sweetwaters, KwaZulu-Natal, South Africa; Faculty of Health Sciences, School of Clincial Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Nathan R Jones
- University of Wisconsin Survey Center, Madison, Wisconsin
| | - David S Wendler
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland
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Landers SE, Francis JKR, Morris MC, Mauro C, Rosenthal SL. Adolescent and Parent Perceptions about Participation in Biomedical Sexual Health Trials. Ethics Hum Res 2020; 42:2-11. [PMID: 32421948 DOI: 10.1002/eahr.500048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Given the burden of HIV and other sexually transmitted infections among adolescents who are legal minors, it is critical that they be included in biomedical sexual health trials to ensure that new prevention and treatment interventions are safe, effective, and acceptable for their use. However, adolescents are often not well represented in clinical trials. We provide an overview of the available evidence regarding adolescent and parent willingness for adolescents to participate in biomedical sexual health trials, parental involvement in the permission-consent process, management of differences and discord among adolescents and parents, and parental involvement throughout the study period. We also outline recommendations for current practice and areas for future research.
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Affiliation(s)
- Sara E Landers
- Research coordinator in the Department of Pediatrics at Vagelos College of Physicians and Surgeons at Columbia University Irving Medical Center
| | - Jenny K R Francis
- Assistant professor in the Department of Pediatrics at the University of Texas Southwestern Medical Center
| | - Marilyn C Morris
- Associate professor in the Department of Pediatrics at Vagelos College of Physicians and Surgeons at Columbia University Irving Medical Center
| | - Christine Mauro
- Assistant professor in the Department of Biostatistics at the Mailman School of Public Health at Columbia University Irving Medical Center
| | - Susan L Rosenthal
- Professor of medical psychology in the Departments of Pediatrics and Psychiatry at Vagelos College of Physicians and Surgeons at Columbia University Irving Medical Center
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Groves AK, Hallfors DD, Iritani BJ, Rennie S, Odongo FS, Kwaro D, Amek N, Luseno WK. "I think the parent should be there because no one was born alone": Kenyan adolescents' perspectives on parental involvement in HIV research. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2018; 17:227-239. [PMID: 30319046 DOI: 10.2989/16085906.2018.1504805] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Despite a pressing need for adolescent HIV research in sub-Saharan Africa, ethical guidance for conducting research among minor adolescents is lacking. One ethical issue is the degree to which parents should be involved in the research process. The existing discourse is predominantly speculative and focuses on negative consequences of parental involvement. We use empirical data to describe the perspectives of Kenyan adolescents on parental involvement in consent and disclosure of HIV test results within a research study context. We conducted two rounds of focus group discussions with 40 adolescents in western Kenya to ask about minor adolescent participation in HIV research. We analysed data using codes and matrices. Kenyan adolescents were largely in favour of parental involvement during the research process. Half felt adolescent minors should solicit parental consent to participate, and nearly all said parents should learn the HIV test results of adolescent minors in order to provide necessary support. From their perspective, involvement of parents in research extends beyond obtaining their consent to providing essential support for youth, regardless of HIV status, both during and beyond the research study. Ethical guidelines that prioritise adolescent autonomy in research must consider reasons to involve parents considered important by adolescents themselves, particularly in low-resource settings.
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Affiliation(s)
- Allison K Groves
- a Department of Community Health and Prevention , Drexel University , Philadelphia , USA
| | | | - Bonita J Iritani
- b Pacific Institute for Research and Evaluation , Chapel Hill , USA
| | - Stuart Rennie
- c Department of Social Medicine , University of North Carolina , Chapel Hill , USA
| | - Fredrick S Odongo
- d Kenya Medical Research Institute , Centre for Global Health Research , Kisumu , Kenya
| | - Daniel Kwaro
- d Kenya Medical Research Institute , Centre for Global Health Research , Kisumu , Kenya
| | - Nyaguara Amek
- d Kenya Medical Research Institute , Centre for Global Health Research , Kisumu , Kenya
| | - Winnie K Luseno
- b Pacific Institute for Research and Evaluation , Chapel Hill , USA
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Day S, Blumberg M, Vu T, Zhao Y, Rennie S, Tucker JD. Stakeholder engagement to inform HIV clinical trials: a systematic review of the evidence. J Int AIDS Soc 2018; 21 Suppl 7:e25174. [PMID: 30334358 PMCID: PMC6192899 DOI: 10.1002/jia2.25174] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/20/2018] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Stakeholder engagement is an essential component of HIV clinical trials. We define stakeholder engagement as an input by individuals or groups with an interest in HIV clinical trials to inform the design or conduct of said trials. Despite its value, stakeholder engagement to inform HIV clinical trials has not been rigorously examined. The purpose of our systematic review is to examine stakeholder engagement for HIV clinical trials and compare it to the recommendations of the UNAIDS/AVAC Good Participatory Practice (GPP) guidelines. METHODS We used the PRISMA checklist and identified English language studies describing stakeholder engagement to inform HIV clinical trials. Four databases (PubMed, Ovid, CINAHL and Web of Science) and six journals were searched, with additional studies identified using handsearching and expert input. Two independent reviewers examined citations, abstracts and full texts. Data were extracted on country, engagement methods, stakeholder types and purpose of stakeholder engagement. Based on the GPP guidelines, we examined how frequently stakeholder engagement was conducted to inform clinical trial research question development, protocol development, recruitment, enrolment, follow-up, results and dissemination. RESULTS AND DISCUSSION Of the 917 citations identified, 108 studies were included in the analysis. Forty-eight studies (44.4%) described stakeholder engagement in high-income countries, thirty (27.8%) in middle-income countries and nine (8.3%) in low-income countries. Fourteen methods for stakeholder engagement were identified, including individual (e.g. interviews) and group (e.g. community advisory boards) strategies. Thirty-five types of stakeholders were engaged, with approximately half of the studies (60; 55.6%) engaging HIV-affected community stakeholders (e.g. people living with HIV, at-risk or related populations of interest). We observed greater frequency of stakeholder engagement to inform protocol development (49 studies; 45.4%) and trial recruitment (47 studies; 43.5%). Fewer studies described stakeholder engagement to inform post-trial processes related to trial results (3; 2.8%) and dissemination (11; 10.2%). CONCLUSIONS Our findings identify important directions for future stakeholder engagement research and suggestions for policy. Most notably, we found that stakeholder engagement was more frequently conducted to inform early stages of HIV clinical trials compared to later stages. In order to meet recommendations established in the GPP guidelines, greater stakeholder engagement across all clinical trial stages is needed.
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Affiliation(s)
- Suzanne Day
- Institute for Global Health and Infectious DiseasesUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Meredith Blumberg
- Institute for Global Health and Infectious DiseasesUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Thi Vu
- Institute for Global Health and Infectious DiseasesUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Yang Zhao
- University of North Carolina – Project ChinaGuangzhouChina
| | - Stuart Rennie
- Department of Social MedicineUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Center for BioethicsUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Joseph D. Tucker
- Institute for Global Health and Infectious DiseasesUniversity of North Carolina at Chapel HillChapel HillNCUSA
- University of North Carolina – Project ChinaGuangzhouChina
- School of MedicineUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Faculty of Infectious DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
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Joseph PD, Caldwell PHY, Tong A, Hanson CS, Craig JC. Stakeholder Views of Clinical Trials in Low- and Middle-Income Countries: A Systematic Review. Pediatrics 2016; 137:e20152800. [PMID: 26812926 DOI: 10.1542/peds.2015-2800] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Clinical trials are necessary to improve the health care of children, but only one-quarter are conducted in the low- to middle-income countries (LMICs) in which 98% of the global burden of disease resides. OBJECTIVE To describe stakeholder beliefs and experiences of conducting trials in children in LMICs. DATA SOURCES Electronic databases were searched to August 2014. STUDY SELECTION Qualitative studies of stakeholder perspectives on conducting clinical trials among children in LMICs. DATA EXTRACTION Findingswere analyzed by using thematic synthesis. RESULTS Thirty-nine studies involving 3110 participants (children [n = 290], parents or caregivers [n = 1609], community representatives [n = 621], clinical or research team members [n = 376], regulators [n = 18], or sponsors [n = 15]) across 22 countries were included. Five themes were identified: centrality of community engagement (mobilizing community, representatives' pivotal role, managing expectations, and retaining involvement); cognizance of vulnerability and poverty (therapeutic opportunity and medical mistrust); contending with power differentials (exploitation, stigmatization, and disempowerment); translating research to local context (cultural beliefs, impoverishment constraints, and ethical pluralism); and advocating fair distribution of benefits (health care, sponsor obligation, and collateral community benefits). LIMITATIONS Studies not published in English were excluded. CONCLUSIONS Conducting trials in children in LMICs is complex due to social disadvantage, economic scarcity, idiosyncratic cultural beliefs, and historical disempowerment, all of which contribute to inequity, mistrust, and fears of exploitation. Effective community engagement in recruiting, building research capacities, and designing trials that are pragmatic, ethical, and relevant to the health care needs of children in LMICs may help to improve the equity and health outcomes of this vulnerable population.
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Affiliation(s)
- Pathma D Joseph
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Paediatrics and Child Health, and The Pharmacy Department, The Children's Hospital at Westmead, Sydney, Australia
| | - Patrina H Y Caldwell
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Paediatrics and Child Health, and
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia; and
| | - Camilla S Hanson
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia; and
| | - Jonathan C Craig
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia; Sydney School of Public Health, The University of Sydney, Sydney, Australia; and
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Rubincam C, Lacombe-Duncan A, Newman PA. Taking culture seriously in biomedical HIV prevention trials: a meta-synthesis of qualitative studies. Expert Rev Vaccines 2015; 15:331-47. [PMID: 26560332 DOI: 10.1586/14760584.2016.1118349] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
A substantial gap exists between widespread acknowledgement of the importance of incorporating cultural sensitivity in biomedical HIV prevention trials and empirical evidence to guide the operationalization of cultural sensitivity in these trials. We conducted a systematic literature search and qualitative meta-synthesis to explore how culture is conceptualized and operationalized in global biomedical HIV prevention trials. Across 29 studies, the majority (n = 17) were conducted in resource-limited settings. We identified four overarching themes: (1) semantic cultural sensitivity - challenges in communicating scientific terminology into local vernaculars; (2) instrumental cultural sensitivity - understanding historical experiences to guide tailoring of trial activities; (3) budgetary, logistical, and personnel implications of operationalizing cultural sensitivity; and (4) culture as an asset. Future investigations should address how sociocultural considerations are operationalized across the spectrum of trial preparedness, implementation, and dissemination in particular sociocultural contexts, including intervention studies and evaluations of the effectiveness of methods used to operationalize culturally sensitive practices.
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Affiliation(s)
- Clara Rubincam
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Canada
| | - Ashley Lacombe-Duncan
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Canada
| | - Peter A Newman
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Canada
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Moodley N, Gray G. Global evidence reaffirms the case for routine HPV and potential HIV adolescent vaccination in South Africa. Future Virol 2014. [DOI: 10.2217/fvl.13.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
ABSTRACT: The availability of two prophylactic HPV vaccines, coupled with a potential prophylactic HIV vaccine delivered to adolescents through a school-based sexual and reproductive health platform represents a potentially significant, potent long-term primary prevention strategy against two sexually transmitted infections: HPV and HIV infection within a highly susceptible group. South Africa has earmarked the re-engineering of school health services. This initiative ensures a ‘health presence in every school’ focused on developing a social, sexual and reproductive health platform within secondary schools addressing HIV/AIDS prevention, teenage pregnancies and social concerns such as drug abuse. Despite this opportunistic platform for HIV and HPV vaccines introduction among adolescents, much work remains to overcome existing ethical and financial and programmatic barriers.
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Affiliation(s)
- Nishila Moodley
- Perinatal HIV Research Unit, University of the Witwatersrand, Soweto, South Africa
| | - Glenda Gray
- Perinatal HIV Research Unit, University of the Witwatersrand, Soweto, South Africa
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Volk JE, Hessol NA, Gray GE, Kublin JG, Churchyard GJ, Mlisana K, Nchabeleng M, Buchbinder SP, Bekker LG. The HVTN503/Phambili HIV vaccine trial: a comparison of younger and older participants. Int J STD AIDS 2013; 25:332-40. [PMID: 24104693 DOI: 10.1177/0956462413506892] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
By comparing younger to older participants enrolled in a HIV vaccine efficacy trial, we aimed to gain insights into the inclusion of adolescents in future trials. This was a sub-analysis of a multisite HIV vaccine randomized clinical trial in South Africa, conducted January-September 2007. Motivations for trial enrolment, social harms, adverse events and loss to follow-up were compared between younger (18-20 years old) and older participants (21-35 years old). Both younger (n = 238) and older participants (n = 563) were equally likely to report enrolling for altruistic reasons. Younger females were less likely than older participants to join for trial reimbursement (p = 0.005), while younger males were more likely to enrol because the vaccine may provide protection from HIV-acquisition (p < 0.001). There were no significant differences in the number of social harms reported. Compared to males over 20 years old, 18-20-year-old females were less likely to experience adverse events (OR = 0.1, CI 0.01-0.80) and no more likely to be lost to follow-up (OR = 0.7, CI 0.39-1.25), while 18-20-year-old males were no more likely to experience adverse events (OR = 1.3, CI 0.58-2.83) or loss to follow-up (OR = 0.8, CI 0.51-1.41). Our data support the inclusion of younger participants who are at risk for HIV in future HIV vaccine efficacy trials.
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Affiliation(s)
- Jonathan E Volk
- Bridge HIV, Department of Public Health, San Francisco, CA, USA
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Abrams A, Kredo T. Vaccine research, adolescents and Africa. Hum Vaccin Immunother 2012; 9:108-11. [PMID: 23108358 DOI: 10.4161/hv.22143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Amber Abrams
- South African Cochrane Centre, at the South African Medical Research Council, Cape Town, South Africa.
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Zuch M, Mason-Jones AJ, Mathews C, Henley L. Changes to the law on consent in South Africa: implications for school-based adolescent sexual and reproductive health research. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2012; 12:3. [PMID: 22490444 PMCID: PMC3353180 DOI: 10.1186/1472-698x-12-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 04/10/2012] [Indexed: 11/10/2022]
Abstract
BACKGROUND The National Health Act, No 61, 2003 in South Africa is the first effort made by the government to protect health-related research participants under law. Implemented on March 1, 2012, the law mandates active consent from a parent or legal guardian for all research conducted with research participants under the age of 18 years. This paper focuses on the Act's implications for school-based adolescent sexual and reproductive health research. DISCUSSION Although well intentioned, the added legal protections in the National Health Act may have the unintended consequence of reducing participation rates in school-based adolescent sexual and reproductive health research, thereby excluding the most at-risk students. The Act may also compromise adolescents' right to dignity and privacy, especially considering the personal nature of research on sex and sexuality. Devolved, discretionary decision-making, which empowers local human research ethics committees to permit a wider range of protective measures, including passive consent, independent adolescent consent or community consultation ought to be considered. The continued and direct involvement of young people in their sexual and reproductive health and well-being is an important principle to uphold. SUMMARY This paper calls for a re-examination of section 71's ethical guidelines relating to informed consent in the National Health Act, No 61, 2003 in South Africa in order to better serve the interests of South African adolescents in sexual and reproductive health research.
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Affiliation(s)
- Melanie Zuch
- Brown University, Medical Research Council, PO Box 19070, Cape Town, Tygerberg 7505, South Africa
| | - Amanda J Mason-Jones
- Adolescent Health Research Unit, University of Cape Town, Specialist Scientist, Health Systems Research Unit, Medical Research Council, PO Box 19070, Cape Town, Tygerberg 7505, South Africa
| | - Catherine Mathews
- School of Public Health and Family Medicine, University of Cape Town, Health Systems Research Unit, Medical Research Council, PO Box 19070, Cape Town, Tygerberg 7505, South Africa
| | - Lesley Henley
- School of Child and Adolescent Health, University of Cape Town, Cape Town, Rondebosch 7700, South Africa
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Dhalla S, Poole G. Motivators of enrolment in HIV vaccine trials: a review of HIV vaccine preparedness studies. AIDS Care 2011; 23:1430-47. [PMID: 21722022 DOI: 10.1080/09540121.2011.555750] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
HIV vaccine preparedness studies (VPS) are important precursors to HIV vaccine trials. As well, they contribute to an understanding of motivators and barriers for participation in hypothetical HIV vaccine trials. Motivators can take the form of altruism and a desire for social benefits. Perceived personal benefits, including psychological, personal, and financial well-being, may also motivate participation. The authors performed a systematic review of HIV VPS using the Cochrane Database for Systematic Reviews, Medline, PubMed, Embase, and Google Scholar. The authors independently searched the literature for individual HIV VPS that examined motivators of participation in a hypothetical HIV vaccine trial, using the same search strategy. As the denominators employed in the literature varied across studies, the denominators were standardized to the number of respondents per survey item, regardless of their willingness to participate (WTP) in an HIV vaccine trial. The authors retrieved eight studies on social benefits (i.e., altruism) and 11 studies on personal benefits conducted in the Organization for Economic Co-operation and Development (OECD) countries, as well as 19 studies on social benefits and 20 studies on personal benefits in the non-OECD countries. Various different forms of altruism were found to be the major motivators for participation in an HIV vaccine trial in both the OECD and the non-OECD countries. In a large number of studies, protection from HIV was cited as a personal motivator for participation in a hypothetical HIV vaccine trial in the OECD and the non-OECD countries. Knowledge of motivators can inform and target recruitment for HIV vaccine trials, although it must be remembered that hypothetical motivators may not always translate into motivators in an actual vaccine trial.
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Affiliation(s)
- Shayesta Dhalla
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.
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