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Sandfort TGM, Kreniske P, Mbeda C, Reynolds D, Tshabalala G, Madiwati B, Ogendo A, Dominquez K, Panchia R, Gondwe D, Hamilton EL, Guo X, Cummings V. Interest in I-PrEP and Willingness to Participate in Clinical Trials Among Men and Transfeminine Persons Who have Sex with Men in Sub-Saharan Africa: Quantitative and Qualitative Findings from HPTN 075. AIDS Behav 2024; 28:2361-2377. [PMID: 38761334 PMCID: PMC11199096 DOI: 10.1007/s10461-024-04334-x] [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] [Accepted: 03/27/2024] [Indexed: 05/20/2024]
Abstract
This study explored interest in injectable PrEP (I-PrEP) and willingness to participate in clinical trials testing new biomedical HIV prevention strategies among men and transfeminine persons who have sex with men (MSM & TGP), using data collected in the HIV Prevention Trials Network (HPTN) 075 study, which took place at sites in Kenya, Malawi, and South Africa. Data result from a survey among 267 18-44 years old HIV negative participants, complemented with semi-structured interviews with 80 purposively recruited persons. Correlations coefficients were calculated to identify demographic and psychosocial factors associated with interest in I-PrEP. Qualitative interviews were analyzed using concept-driven and subsequent data-driven coding. Most surveyed participants expressed an interest in I-PrEP. Quantitatively, only being interested in other HIV prevention measures was associated with interest in I-PrEP. Qualitatively, most participants preferred I-PrEP to O-PrEP and remained interested in I-PrEP despite barriers such as the somewhat invasive nature of the procedure and potential side effects of I-PrEP. Interest in I-PrEP was driven by the possibility of avoiding sexual or HIV stigma. Access to healthcare and altruism-such as assisting in the development of new HIV prevention methods-positively impacted willingness to participate in clinical trials. With I-PrEP favored by most participants, it is potentially a critical tool to prevent HIV infection among MSM & TGP in sub-Saharan Africa, with the mitigation of stigma as a major advance. Recruitment of MSM & TGP in biobehavioral clinical trials seems feasible, with altruistic reasons and receiving I-PrEP and free medical care as major motivators.
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Affiliation(s)
- Theodorus G M Sandfort
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, New York State Psychiatric Institute and Columbia University, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA.
| | - Philip Kreniske
- Community Health and Social Sciences Department, Graduate School of Public Health and Health Policy, City University of New York (CUNY), New York, USA
| | - Calvin Mbeda
- Kenya Medical Research Institute (KEMRI) CDC, Kisumu, Kenya
| | | | - Gugulethu Tshabalala
- Perinatal HIV Research Unit, University of the Witwatersrand, Soweto, South Africa
| | | | - Arthur Ogendo
- Kenya Medical Research Institute (KEMRI) CDC, Kisumu, Kenya
| | | | - Ravindre Panchia
- Perinatal HIV Research Unit, University of the Witwatersrand, Soweto, South Africa
| | - Daniel Gondwe
- College of Medicine-Johns Hopkins Research Project, Blantyre, Malawi
| | | | - Xu Guo
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Vanessa Cummings
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Nakalega R, Akello C, Gati B, Nakabiito C, Nolan M, Kamira B, Etima J, Nakyanzi T, Kemigisha D, Nanziri SC, Nanyonga S, Nambusi MJ, Mulumba E, Biira F, Nabunya HK, Akasiima SA, Nansimbe J, Maena J, Babirye JA, Ngure K, Mujugira A. Ethical considerations for involving adolescents in biomedical HIV prevention research. BMC Med Ethics 2021; 22:127. [PMID: 34556099 PMCID: PMC8461968 DOI: 10.1186/s12910-021-00695-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/07/2021] [Indexed: 12/03/2022] Open
Abstract
Background Involvement of adolescent girls in biomedical HIV research is essential to better understand efficacy and safety of new prevention interventions in this key population at high risk of HIV infection. However, there are many ethical issues to consider prior to engaging them in pivotal biomedical research. In Uganda, 16–17-year-old adolescents can access sexual and reproductive health services including for HIV or other sexually transmitted infections, contraception, and antenatal care without parental consent. In contrast, participation in HIV prevention research involving investigational new drugs requires adolescents to have parental or guardian consent. Thus, privacy and confidentiality concerns may deter adolescent participation. We describe community perspectives on ethical considerations for involving adolescent girls in the MTN 034 study in Uganda. Methods From August 2017 to March 2018, we held five stakeholder engagement meetings in preparation for the MTN 034 study in Kampala, Uganda (NCT03593655): two with 140 community representatives, two with 125 adolescents, and one with 50 adolescents and parents. Discussions were moderated by the study team. Proceedings were documented by notetakers. Summary notes described community perspectives of adolescent participation in HIV research including convergent, divergent or minority views, challenges, and proposed solutions. Results Most community members perceived parental or guardian consent as a principal barrier to study participation due to concerns about adolescent disclosure of pre-marital sex, which is a cultural taboo. Of 125 adolescent participants, 119 (95%) feared inadvertent disclosure of sexual activity to their parents. Community stakeholders identified the following critical considerations for ethical involvement of adolescents in HIV biomedical research: (1) involving key stakeholders in recruitment, (2) ensuring confidentiality of sensitive information about adolescent sexual activity, (3) informing adolescents about information to be disclosed to parents or guardians, (4) offering youth friendly services by appropriately trained staff, and (5) partnering with community youth organizations to maximize recruitment and retention. Conclusions Stakeholder engagement with diverse community representatives prior to conducting adolescent HIV prevention research is critical to collectively shaping the research agenda, successfully recruiting and retaining adolescents in HIV clinical trials and identifying practical strategies to ensure high ethical standards during trial implementation.
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Affiliation(s)
- Rita Nakalega
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda.
| | - Carolyne Akello
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Brenda Gati
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Clemensia Nakabiito
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Monica Nolan
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Betty Kamira
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Juliane Etima
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Teopista Nakyanzi
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Doreen Kemigisha
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Sophie C Nanziri
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Stella Nanyonga
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Maria Janine Nambusi
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Emmie Mulumba
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Florence Biira
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Hadijah Kalule Nabunya
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Simon Afrika Akasiima
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Joselyne Nansimbe
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Joel Maena
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Juliet Allen Babirye
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Kenneth Ngure
- Department of Global Health, University of Washington, Seattle, USA.,Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Andrew Mujugira
- Department of Global Health, University of Washington, Seattle, USA.,Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.,Department of Epidemiology and Biostatistics, College of Health Sciences, Makerere University, Kampala, Uganda
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Neilan AM, Salvant Valentine S, Knopf AS. Case 27-2021: A 16-Year-Old Boy Seeking Human Immunodeficiency Virus Prophylaxis. N Engl J Med 2021; 385:1034-1041. [PMID: 34496178 DOI: 10.1056/nejmcpc1909626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Anne M Neilan
- From the Departments of Medicine and Pediatrics, Massachusetts General Hospital, and the Departments of Medicine and Pediatrics, Harvard Medical School - both in Boston (A.M.N.); the Division of HIV-AIDS Prevention, National Center for HIV-AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta (S.S.V.); and Community and Health Systems, Indiana University School of Nursing, Indianapolis (A.S.K.)
| | - Sheila Salvant Valentine
- From the Departments of Medicine and Pediatrics, Massachusetts General Hospital, and the Departments of Medicine and Pediatrics, Harvard Medical School - both in Boston (A.M.N.); the Division of HIV-AIDS Prevention, National Center for HIV-AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta (S.S.V.); and Community and Health Systems, Indiana University School of Nursing, Indianapolis (A.S.K.)
| | - Amelia S Knopf
- From the Departments of Medicine and Pediatrics, Massachusetts General Hospital, and the Departments of Medicine and Pediatrics, Harvard Medical School - both in Boston (A.M.N.); the Division of HIV-AIDS Prevention, National Center for HIV-AIDS, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta (S.S.V.); and Community and Health Systems, Indiana University School of Nursing, Indianapolis (A.S.K.)
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Yusuf H, Fields E, Arrington-Sanders R, Griffith D, Agwu AL. HIV Preexposure Prophylaxis Among Adolescents in the US: A Review. JAMA Pediatr 2020; 174:1102-1108. [PMID: 32391878 DOI: 10.1001/jamapediatrics.2020.0824] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
IMPORTANCE Many adolescents and young adults in the US are disproportionately affected by HIV. Several others who are uninfected are at risk and in need of effective preventive strategies. The uptake rate of preexposure prophylaxis (PrEP) for HIV prevention has remained low among US adolescents. This review assesses the current status of PrEP uptake among at-risk adolescents aged 13 to 19 years and recommendations for improving PrEP access, uptake, and future needed directions, including specific recommendations for health care professionals. OBSERVATIONS Of the 37 377 new HIV diagnoses made in 2018, 7734 diagnoses (21%) occurred in adolescents and young adults aged 12 to 24 years; of these, 1707 diagnoses (22%) occurred in adolescents aged 13 to 19 years. The greatest burden of HIV is found among young African American men who have sex with men, accounting for two-thirds of all HIV infections in adolescents and young adults. Preexposure prophylaxis awareness and engagement are lowest in adolescents with the greatest risk for HIV. Adolescent primary care clinicians and specialists do not routinely offer HIV testing as recommended by the Centers for Disease Control and Prevention or routinely assess sexual risk exposures of patients through sexual history taking. Clinicians' decision to prescribe PrEP for adolescents is often guided by their perceptions of the patient's HIV risk and their knowledge and acceptance of PrEP guidelines. State laws on consent, confidentiality, and the rights of the adolescent to independently access PrEP outside of parental influence differ across jurisdictions, often limiting access and uptake. CONCLUSIONS AND RELEVANCE Use of PrEP in adolescents at risk for HIV is an important component of HIV prevention. Optimizing uptake includes improving clinicians' knowledge about HIV risk and prevention strategies, enhancing sexual history taking and risk assessment through training and retraining, and improving PrEP knowledge and acceptance of prescribing among clinicians. Leveraging the ubiquity of social media, encouraging family support, and performing research aimed at finding lifestyle-congruent formulations can help mitigate HIV transmission in adolescents at greatest risk for HIV.
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Affiliation(s)
- Hasiya Yusuf
- Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Errol Fields
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Renata Arrington-Sanders
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - David Griffith
- Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of Infectious Diseases, Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Allison L Agwu
- Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Division of Infectious Diseases, Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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5
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Tingey L, Chambers R, Goklish N, Larzelere F, Patel H, Lee A, Rosenstock S. Predictors of Responsiveness Among American Indian Adolescents to a Community-Based HIV-Risk Reduction Intervention Over 12 Months. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:1979-1994. [PMID: 31399926 DOI: 10.1007/s10508-018-1385-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 12/15/2018] [Accepted: 12/18/2018] [Indexed: 06/10/2023]
Abstract
This analysis explored predictors of responsiveness to the Respecting the Circle of Life (RCL) intervention, a sexual and reproductive health program for American Indian (AI) youth. Data were collected over 12-month follow-up with 267 AI youth aged 13-19. We used mixed effects regression models to examine: (1) whether trajectory patterns of HIV/AIDS knowledge, condom beliefs, condom use self-efficacy, condom use intention and partner negotiation skills differed by baseline levels categorized into low, medium, and high scorers, and (2) the characteristics of youth who made no improvement over the post-intervention period. Results indicate the RCL intervention had greater longitudinal impact among subgroups with low and medium initial scores. High initial scores in knowledge, beliefs, efficacy, intention and skills predicted unresponsiveness to the RCL intervention. Youth differences in age, gender and school truancy (skipping/suspension) did not predict responsiveness to RCL. Results have important prevention science implications: (1) AI youth at greater risk (i.e., those with low initial levels of knowledge, beliefs, self-efficacy, intention and skills) are likely to respond to RCL and should be the target of replication and dissemination efforts. (2) Responsiveness analyses can guide adaptation of RCL and other sexual and reproductive health programs for AI youth to improve efficacy among unresponsive subgroups (i.e., high initial scorers). (3) RCL is equally likely to impact AI youth across different ages, genders and school status, thus validating population-wide implementation strategies.
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Affiliation(s)
- Lauren Tingey
- Department of International Health, Center for American Indian Health, Johns Hopkins University, 415 N. Washington St., Baltimore, MD, 21231, USA.
| | - Rachel Chambers
- Department of International Health, Center for American Indian Health, Johns Hopkins University, 415 N. Washington St., Baltimore, MD, 21231, USA
| | - Novalene Goklish
- Department of International Health, Center for American Indian Health, Johns Hopkins University, Whiteriver, AZ, USA
| | - Francene Larzelere
- Department of International Health, Center for American Indian Health, Johns Hopkins University, Whiteriver, AZ, USA
| | - Hima Patel
- Department of International Health, Center for American Indian Health, Johns Hopkins University, 415 N. Washington St., Baltimore, MD, 21231, USA
| | - Angelita Lee
- Department of International Health, Center for American Indian Health, Johns Hopkins University, Whiteriver, AZ, USA
| | - Summer Rosenstock
- Department of International Health, Center for American Indian Health, Johns Hopkins University, 415 N. Washington St., Baltimore, MD, 21231, USA
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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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7
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Knopf A, Ott MA, Draucker CB, Fortenberry JD, Reirden DH, Arrington-Sanders R, Schneider J, Straub D, Baker R, Bakoyannis G, Zimet GD. Innovative Approaches to Obtain Minors' Consent for Biomedical HIV Prevention Trials: Multi-Site Quasi-Experimental Study of Adolescent and Parent Perspectives. JMIR Res Protoc 2020; 9:e16509. [PMID: 32224493 PMCID: PMC7154935 DOI: 10.2196/16509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite the high burden of new HIV infections in minor adolescents, they are often excluded from biomedical HIV prevention trials, largely owing to the ethical complexities of obtaining consent for enrollment. Researchers and ethics regulators have a duty to protect adolescents-as a special category of human subjects, they must have protection that extends beyond those afforded to all human subjects. Typically, additional protection includes parental consent for enrollment. However, parental consent can present a risk of harm for minor adolescents. Research involving minor adolescents indicate that they are unwilling to join biomedical trials for stigmatized health problems, such as HIV, when parental consent is required. This presents a significant barrier to progress in adolescent HIV prevention by creating delays in research and the translation of new scientific evidence generated in biomedical trials in adult populations. OBJECTIVE This protocol aims to examine how parental involvement in the consent process affects the acceptability of hypothetical participation in biomedical HIV prevention trials from the perspectives of minor adolescents and parents of minor adolescents. METHODS In this protocol, we use a quasi-experimental design that involves a simulated consent process for 2 different HIV prevention trials. The first trial is modeled after an open-label study of the use of tenofovir disoproxil fumarate and emtricitabine as preexposure prophylaxis for HIV. The second trial is modeled after a phase IIa trial of an injectable HIV integrase inhibitor. There are 2 groups in the study-minor adolescents aged 14 to 17 years, inclusive, and parents of minor adolescents in the same age range. The adolescent participants are randomized to 1 of 3 consent conditions with varying degrees of parental involvement. After undergoing a simulated consent process, they rate their willingness to participate (WTP) in each of the 2 trials if offered the opportunity. The primary outcome is WTP, given the consent condition. Parents undergo a similar process but are asked to rate the acceptability of each of the 3 consent conditions. The primary outcome is acceptability of the consent method for enrollment. The secondary outcomes include the following: capacity to consent among both participant groups, the prevalence of medical mistrust, and the effects of the study phase (eg, phase IIa vs the open-label study) and drug administration route (eg, oral vs injection) on WTP (adolescents) and acceptability (parents) of the consent method. RESULTS Enrollment began in April 2018 and ended mid-September 2019. Data are being analyzed and dissemination is expected in April 2020. CONCLUSIONS The study will provide the needed empirical data about minor adolescents' and parents' perspectives on consent methods for minors. The evidence generated can be used to guide investigators and ethics regulators in the design of consent processes for biomedical HIV prevention trials. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/16509.
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Affiliation(s)
- Amelia Knopf
- Department of Community & Health Services, School of Nursing, Indiana University, Indianapolis, IN, United States
| | - Mary A Ott
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Claire Burke Draucker
- Department of Community & Health Services, School of Nursing, Indiana University, Indianapolis, IN, United States
| | - J Dennis Fortenberry
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Daniel H Reirden
- Children's Hospital Colorado, School of Medicine, The University of Colorado, Aurora, CO, United States
| | - Renata Arrington-Sanders
- Division of General Pediatrics & Adolescent Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - John Schneider
- Department of Medicine, The University of Chicago, Chicago, IL, United States
| | - Diane Straub
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Rebecca Baker
- Department of Community & Health Services, School of Nursing, Indiana University, Indianapolis, IN, United States
| | - Giorgos Bakoyannis
- Department of Biostatistics, School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Gregory D Zimet
- Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, IN, United States
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Francis JKR, de Roche AM, Mauro C, Landers SE, Chang J, Catallozzi M, Breitkopf CR, Rosenthal SL. Adolescent-Parent Dyadic Retention in an Interview Study and Changes in Willingness to Participate in a Hypothetical Microbicide Safety Study. J Pediatr Adolesc Gynecol 2018; 31:592-596. [PMID: 29906513 PMCID: PMC6218291 DOI: 10.1016/j.jpag.2018.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 05/17/2018] [Accepted: 06/04/2018] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE In this study we describe adolescent and parent retention and changes in willingness to participate (WTP) in research among adolescents, parents, and adolescent-parent dyads. DESIGN AND SETTING Adolescent-parent dyads were recruited to participate in a longitudinal study to assess research participation attitudes using simultaneous individual interviews of the adolescent and parent with a return visit 1 year later using the same interview. PARTICIPANTS Adolescents (14-17 years old) and their parents. INTERVENTIONS None. MAIN OUTCOME MEASURES The relationship between participant characteristics and dyad retention was assessed. WTP was measured on a Likert scale and dichotomized (willing/unwilling) to assess changes in WTP attitudes over time for adolescents, parents, and dyads. RESULTS Eighty-three percent of the 300 dyads were retained. Dyads in which there was successful contact with the parent before follow-up were more likely to be retained (odds ratio, 4.88; 95% confidence interval, 2.57-9.26). For adolescents at baseline, 59% were willing to participate and 55% were willing to participate at follow-up (McNemar S = 0.91; P = .34). For parents at baseline, 51% were willing to participate and 57% were willing to participate at follow-up (McNemar S = 5.12; P = .02). For dyads at baseline, 57% were concordant (in either direction) and 70% of dyads were concordant at follow-up (McNemar S = 10.56; P = .001). CONCLUSION Over 1 year, parent contact might positively influence successful adolescent retention. Parents become more willing to let their adolescents participate over time, with dyads becoming more concordant about research participation.
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Affiliation(s)
- Jenny K R Francis
- Department of Pediatrics, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York; NewYork-Presbyterian Hospital, New York, New York.
| | - Ariel M de Roche
- Department of Pediatrics, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York
| | - Christine Mauro
- Department of Biostatistics, Columbia University Medical Center, Mailman School of Public Health, New York, New York
| | - Sara E Landers
- Department of Pediatrics, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York
| | - Jane Chang
- Department of Pediatrics, Weill Cornell Medical College, New York, New York
| | - Marina Catallozzi
- Department of Pediatrics, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York; NewYork-Presbyterian Hospital, New York, New York; Heilbrunn Department of Population & Family Health, Columbia University Medical Center, Mailman School of Public Health, New York, New York
| | | | - Susan L Rosenthal
- Department of Pediatrics, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York; NewYork-Presbyterian Hospital, New York, New York; Department of Psychiatry, Columbia University Medical Center, Vagelos College of Physicians and Surgeons, New York, New York
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9
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Tsevat RK, Breitkopf CR, Landers SE, de Roche AM, Mauro C, Ipp LS, Catallozzi M, Rosenthal SL. Adolescents' and Parents' Attitudes Toward Adolescent Clinical Trial Participation: Changes Over One Year. J Empir Res Hum Res Ethics 2018; 13:383-390. [PMID: 30103655 PMCID: PMC6146060 DOI: 10.1177/1556264618790889] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little is known about how adolescents' and parents' thoughts about participation in clinical trials change over time. In this study, adolescent (14-17 years)-parent dyads were asked about willingness to participate in a hypothetical reproductive health study. A year later, they were asked how their thoughts about the study had changed. Qualitative responses were coded and analyzed using framework analysis. Thirty-two percent of adolescents and 18% of parents reported changes in thoughts; reasons included general changes in perception, clearer understanding, new knowledge or experiences, increased maturity/age of adolescents, and changes in participants independent of the study. Adolescents and parents may benefit from learning about studies multiple times, and investigators should account for development and new experiences to optimize adolescent research enrollment.
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Affiliation(s)
- Rebecca K. Tsevat
- Columbia University Vagelos College of Physicians and Surgeons (USA)
| | | | - Sara E. Landers
- Columbia University Vagelos College of Physicians and Surgeons (USA)
| | - Ariel M. de Roche
- Columbia University Vagelos College of Physicians and Surgeons (USA)
| | | | - Lisa S. Ipp
- NewYork-Presbyterian Hospital (USA)
- Weill Cornell Medical College (USA)
| | - Marina Catallozzi
- Columbia University Vagelos College of Physicians and Surgeons (USA)
- Columbia University Mailman School of Public Health (USA)
- NewYork-Presbyterian Hospital (USA)
| | - Susan L. Rosenthal
- Columbia University Vagelos College of Physicians and Surgeons (USA)
- NewYork-Presbyterian Hospital (USA)
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10
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Eweka I, Fleuriscar J, Fleuriscar J, Adeyemi-Jones A, Dillon B, Albritton T. Medical students reflect on the future of Pre-Exposure Prophylaxis use among adolescents and young adults. Prev Med 2018; 113:122-123. [PMID: 29792894 DOI: 10.1016/j.ypmed.2018.05.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 05/18/2018] [Accepted: 05/21/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Ivie Eweka
- City University of New York (CUNY) School of Medicine, City College of New York, 160 Convent Avenue, New York, NY 10031, United States.
| | - Jean Fleuriscar
- City University of New York (CUNY) School of Medicine, City College of New York, 160 Convent Avenue, New York, NY 10031, United States.
| | - Jacqueline Fleuriscar
- City University of New York (CUNY) School of Medicine, City College of New York, 160 Convent Avenue, New York, NY 10031, United States.
| | - Adenike Adeyemi-Jones
- City University of New York (CUNY) School of Medicine, City College of New York, 160 Convent Avenue, New York, NY 10031, United States.
| | - Brianna Dillon
- City University of New York (CUNY) School of Medicine, City College of New York, 160 Convent Avenue, New York, NY 10031, United States.
| | - Tashuna Albritton
- City University of New York (CUNY) School of Medicine, City College of New York, 160 Convent Avenue, New York, NY 10031, United States.
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11
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Fisher CB, Fried AL, Ibrahim Puri L, Macapagal K, Mustanski B. "Free Testing and PrEP without Outing Myself to Parents:" Motivation to participate in oral and injectable PrEP clinical trials among adolescent men who have sex with men. PLoS One 2018; 13:e0200560. [PMID: 30044845 PMCID: PMC6059443 DOI: 10.1371/journal.pone.0200560] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 06/28/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Adolescent men who have sex with men (AMSM) account for disproportionately high numbers of new HIV diagnoses. Non-adherence to daily use limiting the effectiveness of oral PrEP (Truvada) has led to current trials with adult MSM testing Cabotegravir, a long-term injectable medication. Once comparative studies with young adult MSM have established relative safety and efficacy of these medications, there will be a need for such comparative trials involving adolescents. Trends in state laws and IRB protocol review indicate that many of these studies will permit youth to provide independent consent for participation. Understanding the motivations of AMSM to participate in HIV biomedical prevention studies is important to ensure their agreement is voluntary without misunderstanding and undue influence. This study examined AMSM attitudes toward participation in oral/injectable PrEP RCTs to inform protections of youth's rights and welfare in future studies. METHODS We administered to 198 ethnically diverse U.S. AMSM, 14-17 years, a web-based survey including demographic and sexual health questions, description of a year-long oral versus injectable PrEP RCT and 26 Likert-type and one open-ended item assessing motivations for and against participation including: perceived benefits and risks of PrEP; free HIV/STI testing and counseling; confidentiality concerns; random assignment; and benefit to others. RESULTS Sixty-two percent indicated they were likely to participate in the study. The majority endorsed daily HIV protection, free HIV/STI testing, sexual health counseling, not having to rely on partner's condom use, and altruism as reasons to participate. Reasons against participation included medication side effects, concern taking the pill daily and clinic visits would reveal their sexual orientation and behaviors to parents. Over half erroneously assumed they would be assigned to the condition best for them and 39% indicated free access to services would lead them to participate even if they did not want to. Multiple regression indicated these factors accounted for 55% of the variance in participation choice. Nether age or ethnicity yielded significance. CONCLUSIONS Results suggest future biomedical HIV prevention research will need to develop procedures to address AMSM's confidentiality concerns, enhance youth's understanding of random assignment, the continued importance of medication adherence and partner condom use during trial participation, and availability of alternative sexual health services to avoid the potentially undue influence of access to free sexual health services.
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Affiliation(s)
- Celia B. Fisher
- Center for Ethics Education, Fordham University, New York, New York, United States of America
| | - Adam L. Fried
- Clinical Psychology Department, Midwestern University, Glendale, Arizona, United States of America
| | - Leah Ibrahim Puri
- Center for Ethics Education, Fordham University, New York, New York, United States of America
| | - Kathryn Macapagal
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Brian Mustanski
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
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12
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Rosenthal SL, Morris MC, Hoffman LF, Zimet GD. Inclusion of Adolescents in STI/HIV Biomedical Prevention Trials: Autonomy, Decision Making, and Parental Involvement. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2018; 6:299-307. [PMID: 30393589 DOI: 10.1037/cpp0000209] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Susan L Rosenthal
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons, New York, New York, United States.,Department of Psychiatry, Columbia University Medical Center - College of Physicians and Surgeons, New York, New York, United States.,NewYork Presbyterian Hospital, New York, New York, United States
| | - Marilyn C Morris
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons, New York, New York, United States.,NewYork Presbyterian Hospital, New York, New York, United States
| | - Lily F Hoffman
- Department of Pediatrics, Columbia University Medical Center - College of Physicians and Surgeons, New York, New York, United States
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States
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13
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Francis JKR, Dapena Fraiz L, de Roche AM, Catallozzi M, Radecki Breitkopf C, Rosenthal SL. Management of Adolescent-Parent Dyads' Discordance for Willingness to Participate in a Reproductive Health Clinical Trial. J Empir Res Hum Res Ethics 2017; 13:42-49. [PMID: 29226745 DOI: 10.1177/1556264617745409] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The objective of this study is to understand the resolution of discordance between adolescent-parent dyads about participation in research. Adolescent (14-17 years) and parent dyads were recruited from NYC pediatric clinics to assess attitudes toward research participation. A subset of dyads participated in videotaped discussions about participation in a hypothetical study. Videos from dyads that held strongly discordant opinions about participation ( n = 30) were content-coded and analyzed using a thematic framework approach. Strategies used to resolve discordance included asserting authority, granting autonomy, or recognizing inaccurate assumptions using a variety of communication behaviors. Missed opportunities to enroll initially discordant dyads may be avoided by allowing time for adolescents and parents to elicit information, clarify a situation, or convince the other.
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Affiliation(s)
| | | | | | - Marina Catallozzi
- 2 Columbia University Medical Center, New York, NY, USA.,3 New York-Presbyterian Hospital, New York City, USA
| | | | - Susan L Rosenthal
- 2 Columbia University Medical Center, New York, NY, USA.,3 New York-Presbyterian Hospital, New York City, USA
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14
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Catallozzi M, de Roche AM, Hu MC, Breitkopf CR, Chang J, Ipp LS, Francis JKR, Rosenthal SL. Adolescent and Parent Willingness to Participate in Microbicide Safety Studies. J Pediatr Adolesc Gynecol 2017; 30:82-87. [PMID: 27381236 PMCID: PMC5863908 DOI: 10.1016/j.jpag.2016.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/16/2016] [Accepted: 06/25/2016] [Indexed: 12/01/2022]
Abstract
STUDY OBJECTIVE To understand adolescents' and parents' willingness to participate (WTP) in a hypothetical phase I prevention study of sexually transmitted infections, discordance within adolescent-parent dyads, and expectations of each other during decision-making. DESIGN AND SETTING Adolescent-parent dyads were recruited to participate in a longitudinal study about research participation attitudes. PARTICIPANTS Adolescents (14-17 years old) and their parents (n = 301 dyads) participated. INTERVENTIONS None. MAIN OUTCOME MEASURES Individual interviews at baseline assessed WTP on a 6-level Likert scale. WTP was dichotomized (willing/unwilling) to assess discordance. RESULTS WTP was reported by 60% (182 of 301) of adolescents and 52% (156 of 300) of parents. In bivariate analyses, older adolescent age, sexual experience, and less involvement of parents in research processes were associated with higher level of WTP for adolescents; only sexual experience remained in the multivariable analysis. For parents, older adolescent age, perceived adolescent sexual experience, and conversations about sexual health were significant; only conversations remained. Dyadic discordance (44%, 132 of 300) was more likely in dyads in which the parent reported previous research experience, and less likely when parents reported higher family expressiveness. Adolescents (83%, 248 of 299) and parents (88%, 263 of 300) thought that the other would have similar views, influence their decision (adolescents 66%, 199 of 300; parents 75%, 224 of 300), and listen (adolescents 90%, 270 of 300; parents 96%, 287 of 300). There were no relationships between these perceptions and discordance. CONCLUSION Inclusion of adolescents in phase I clinical trials is necessary to ensure that new methods are safe, effective, and acceptable for them. Because these trials currently require parental consent, strategies that manage adolescent-parent discordance and support adolescent independence and parental guidance are critically needed.
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Affiliation(s)
- Marina Catallozzi
- Department of Pediatrics, Columbia University Medical Center-College of Physicians and Surgeons, New York, New York; New York-Presbyterian Hospital, New York, New York; Heilbrunn Department of Population & Family Health, Columbia University Medical Center-Mailman School of Public Health, New York, New York.
| | - Ariel M de Roche
- Department of Pediatrics, Columbia University Medical Center-College of Physicians and Surgeons, New York, New York
| | - Mei-Chen Hu
- Department of Psychiatry, Columbia University Medical Center-College of Physicians and Surgeons, New York, New York
| | | | - Jane Chang
- Department of Pediatrics, Weill Cornell Medical College, New York, New York
| | - Lisa S Ipp
- Department of Pediatrics, Weill Cornell Medical College, New York, New York
| | - Jenny K R Francis
- Department of Pediatrics, Columbia University Medical Center-College of Physicians and Surgeons, New York, New York; New York-Presbyterian Hospital, New York, New York
| | - Susan L Rosenthal
- Department of Pediatrics, Columbia University Medical Center-College of Physicians and Surgeons, New York, New York; New York-Presbyterian Hospital, New York, New York; Department of Psychiatry, Columbia University Medical Center-College of Physicians and Surgeons, New York, New York
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