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Korolkova A, Ndukwe SO, Dee L, Deeks SG, Peluso MJ, Hoh R, Rodriguez A, Sugarman J, Rodriguez Garcia L, Dubé K, Sauceda JA. Recall and Appraisal of the Risks, Benefits, and Objectives of Interrupting HIV Treatment in an HIV Cure-Related Study. AIDS Behav 2024:10.1007/s10461-024-04485-x. [PMID: 39287733 DOI: 10.1007/s10461-024-04485-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2024] [Indexed: 09/19/2024]
Abstract
The goal of HIV cure research is to either eliminate HIV from the body or durably suppress it in the absence of antiretroviral therapy (ART). This research often requires participants to interrupt ART. However, there are numerous risks associated with ART interruptions and therefore it is critical to understand how people with HIV (PWH) who participate recall the elements of consent, to safeguard their rights and welfare. Participants were recruited from the SCOPE Analytic Treatment Interruption (SCOPE-ATI: NCT04359186) study at the University of California San Francisco. We interviewed 12 SCOPE-ATI participants to assess their recall of informed consent elements and therapeutic misconception, using the Brief Informed Consent Evaluation Protocol (BICEP). Interviewees were primarily older adults, male, White, and non-Hispanic/Latinx. Their responses indicated that they understood the primary purpose of the SCOPE-ATI study to be scientific research. Nearly all participants demonstrated high recall of key elements of consent and no therapeutic misconception. We also found that the role of study staff was a major factor in participants' appraisal of risks and that associated psychosocial risks of pausing ART were of minimal concern (e.g., anxiety off ART, possible forward HIV transmission to sex partners). As HIV cure research expands, it is important to reiterate the duty of the investigative team to clearly communicate with participants about the associated risks and to assess their understanding throughout these studies.
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Affiliation(s)
- Anastasia Korolkova
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego (UCSD), La Jolla, CA, USA
| | - Samuel O Ndukwe
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego (UCSD), La Jolla, CA, USA
| | - Lynda Dee
- AIDS Action Baltimore, Baltimore, MD, USA
- Delaney AIDS Research Enterprise (DARE) Community Engagement Coordinator, UCSF, San Francisco, CA, USA
| | - Steven G Deeks
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Michael J Peluso
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Rebecca Hoh
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Antonio Rodriguez
- Division of HIV, Infectious Diseases and Global Medicine, Department of Medicine, University of California San Francisco (UCSF), San Francisco, CA, USA
| | - Jeremy Sugarman
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
| | | | - Karine Dubé
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego (UCSD), La Jolla, CA, USA
- Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John A Sauceda
- Division of Prevention Sciences, Department of Medicine, UCSF, San Francisco, CA, USA.
- Division of Prevention Sciences, School of Medicine, University of California San Francisco, 550 16th Street, #3172, San Francisco, CA, 94158, USA.
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Dubé K, Campbell CK, Eskaf S, Sauceda JA, Ndukwe S, Henley L, Persaud D, Deeks SG, Auerbach JD, Saberi P. Willingness of Racially Diverse Young Adults Living with HIV to Participate in HIV Cure Research: A Cross-Sectional Survey in the United States. AIDS Res Hum Retroviruses 2023; 39:381-399. [PMID: 36226414 PMCID: PMC10387162 DOI: 10.1089/aid.2022.0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Nearly half of new HIV cases in the United States are among youth. Little is known about the willingness of young adults living with HIV (YLWH) to participate in HIV cure-related research. In 2021, we recruited 271 YLWH aged 18-29 for an online survey. We asked questions about willingness to participate in HIV cure research, perceived risks and benefits, acceptable trade-offs, and perceptions on analytical treatment interruptions. We conducted descriptive analyses to summarize data and bivariate analyses to explore correlations by demographics. Most respondents (mean age = 26) identified as men (86%) and Black Americans (69%). YLWH expressed high willingness to consider participating in cell- and gene-based approaches (75%) and immune-based approaches (71%). Approximately 45% would be willing to let their viral load become detectable for a period of time during an HIV cure study, 27% would not be willing, and 28% did not know. The social risk most likely to deter participation was the possibility of transmitting HIV to sex partners while off HIV medications (65% of respondents would be deterred a great deal or a lot). Compared to the 25-29 age group (n = 192), the 18-24 age group (n = 79) was more likely to indicate that having to disclose HIV status would matter a great deal in considering participation in HIV cure research (38% vs. 21%, p = .003). Inclusion and engagement of YLWH are critical for advancing novel HIV curative agents. Our article concludes with possible considerations for engaging YLWH in HIV cure research. Physical, clinical, and social risks will need to be kept to a minimum, and research teams will need to proactively mitigate the possibility of transmitting HIV to sex partners while off HIV medications.
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Affiliation(s)
- Karine Dubé
- Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Chadwick K. Campbell
- Department of Medicine, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Shadi Eskaf
- Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - John A. Sauceda
- Department of Medicine, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Samuel Ndukwe
- Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Laney Henley
- Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Deborah Persaud
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Steven G. Deeks
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, University of California, San Francisco (UCSF). San Francisco, California, USA
| | - Judith D. Auerbach
- Department of Medicine, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Parya Saberi
- Department of Medicine, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), San Francisco, California, USA
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Campbell CK, Dubé K, Sauceda JA, Sevelius JM, Green-Ajufo B, Brown B, Ndukwe S, Saberi P. Cash Transfer Apps are a Feasible, Acceptable, and More Equitable Method for Compensating Participants in HIV Research. J Acquir Immune Defic Syndr 2023; 93:e9-e11. [PMID: 36976553 PMCID: PMC10272053 DOI: 10.1097/qai.0000000000003199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Affiliation(s)
- Chadwick K. Campbell
- Herbert Wertheim School of Public Health and Human Longevity; University of California San Diego; La Jolla, CA; USA
| | - Karine Dubé
- UNC Gillings School of Global Public Health; University of North Carolina at Chapel Hill; Chapel Hill, NC; USA
| | - John A. Sauceda
- Division of Prevention Science, Department of Medicine; University of California San Francisco, San Francisco, CA; USA
| | - Jae M. Sevelius
- Division of Prevention Science, Department of Medicine; University of California San Francisco, San Francisco, CA; USA
| | - Barbara Green-Ajufo
- Division of Prevention Science, Department of Medicine; University of California San Francisco, San Francisco, CA; USA
| | - Brandon Brown
- Center for Healthy Communities, Division of Clinical Sciences, School of Medicine; University of California, Riverside; Riverside, CA; USA
| | - Samuel Ndukwe
- UNC Gillings School of Global Public Health; University of North Carolina at Chapel Hill; Chapel Hill, NC; USA
| | - Parya Saberi
- Herbert Wertheim School of Public Health and Human Longevity; University of California San Diego; La Jolla, CA; USA
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Campbell JI, Musiimenta A, Natukunda S, Eyal N, Haberer JE. "The research assistants kept coming to follow me up; I counted myself as a lucky person": Social support arising from a longitudinal HIV cohort study in Uganda. PLoS One 2022; 17:e0262989. [PMID: 35077497 PMCID: PMC8789171 DOI: 10.1371/journal.pone.0262989] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 01/10/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Participation in longitudinal research studies in resource-limited settings often involves frequent interactions with study staff and other participants, as well as receipt of incentives and transportation reimbursements. Social support-receipt of material and emotional resources from one's social network-has been linked to antiretroviral adherence in sub-Saharan Africa. The extent to which social support arises from study participation, its range and depth, and its implications for observational study conduct, have not been extensively described. METHODS We conducted individual open-ended and semi-structured interviews with participants in a longitudinal, observational antiretroviral therapy adherence monitoring study in Mbarara, Uganda. Participants were asked about their experiences in the longitudinal study and their interactions with research staff. We also interviewed study research assistants (RAs). Deductive and inductive coding were used to identify content related to the experience of study participation. Codes were organized into themes, and relationships between themes were used to develop overarching categories. RESULTS Sixty longitudinal study participants and 6 RAs were interviewed. Instrumental and emotional social support emerged as pervasive and valued aspects of longitudinal study participation. Instrumental support that participants received consisted of enhanced linkage to medical care, health education, and direct and indirect material benefits. Emotional support consisted of perceptions of feeling "cared for" and social interactions that permitted escape from HIV-related stigma. Both instrumental and emotional support often arose through the close relationships participants formed with research staff and with each other. Study-derived social support motivated some participants to adhere to antiretroviral therapy-an unanticipated effect potentially influencing the longitudinal study's primary observational outcome. CONCLUSIONS Longitudinal study participation resulted in instrumental and emotional social support for participants. The depth of support participants experienced has implications for observational study design in resource-limited settings, including need to assess potential effects on study outcomes; consideration of social support during risk/benefit assessment in study ethics review and consent; and vigilance for consequences of social support loss when studies end.
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Affiliation(s)
| | - Angella Musiimenta
- Department of Information Technology, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Nir Eyal
- School of Public Health, Rutgers University, Piscataway, New Jersey, United States of America
- Department of Philosophy, Rutgers University, New Brunswick, New Jersey, United States of America
- Center for Population-Level Bioethics, Rutgers University, New Brunswick, New Jersey, United States of America
| | - Jessica E. Haberer
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
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Polonijo AN, Dubé K, Galea JT, Greene KY, Taylor J, Christensen C, Brown B. Attitudes Toward Payment for Research Participation: Results from a U.S. Survey of People Living with HIV. AIDS Behav 2022; 26:3267-3278. [PMID: 35386050 PMCID: PMC9474466 DOI: 10.1007/s10461-022-03660-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2022] [Indexed: 02/04/2023]
Abstract
Little is known about how payment affects individuals' decisions to participate in HIV research. Using data from a U.S. survey of people living with HIV (N = 292), we examined potential research participants' attitudes toward payment, perceived study risk based on payment amount, and preferred payment forms, and how these factors vary by sociodemographic characteristics. Most respondents agreed people should be paid for HIV research participation (96%) and said payment would shape their research participation decisions (80%). Men, less formally educated individuals, and members of some minoritized racial-ethnic groups were less likely to be willing to participate in research without payment. Higher payment was associated with higher perceived study risks, while preferences for form of payment varied by age, gender, education, race-ethnicity, and census region of residence. Findings suggest payment may influence prospective research participants' risk-benefit calculus and participation, and that a one-size-fits-all approach to payment could differentially influence participation among distinct sociodemographic groups.
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Affiliation(s)
- Andrea N. Polonijo
- grid.266096.d0000 0001 0049 1282Department of Sociology and the Health Sciences Research Institute, University of California, Merced, 5200 North Lake Road, Merced, CA 95343 USA
| | - Karine Dubé
- grid.10698.360000000122483208Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Jerome T. Galea
- grid.170693.a0000 0001 2353 285XSchool of Social Work, University of South Florida, Tampa, FL USA ,grid.170693.a0000 0001 2353 285XCollege of Public Health, University of South Florida, Tampa, FL USA ,grid.38142.3c000000041936754XDepartment of Global Health and Social Medicine, Harvard University, Boston, MA USA
| | - Karah Yeona Greene
- grid.170693.a0000 0001 2353 285XSchool of Social Work, University of South Florida, Tampa, FL USA
| | - Jeff Taylor
- HIV+Aging Research Project–Palm Springs, Palm Springs, CA USA
| | | | - Brandon Brown
- grid.266097.c0000 0001 2222 1582Department of Social Medicine, Population and Public Health, University of California, Riverside, Riverside, CA USA
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Galea JT, Greene KY, Nguyen B, Polonijo AN, Dubé K, Taylor J, Christensen C, Zhang Z, Brown B. Evaluating the Impact of Incentives on Clinical Trial Participation: Protocol for a Mixed Methods, Community-Engaged Study. JMIR Res Protoc 2021; 10:e33608. [PMID: 34817381 PMCID: PMC8663586 DOI: 10.2196/33608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/21/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Monetary incentives in research are frequently used to support participant recruitment and retention. However, there are scant empirical data regarding how researchers decide upon the type and amount of incentives offered. Likewise, there is little guidance to assist study investigators and institutional review boards (IRBs) in their decision-making on incentives. Monetary incentives, in addition to other factors such as the risk of harm or other intangible benefits, guide individuals' decisions to enroll in research studies. These factors emphasize the need for evidence-informed guidance for study investigators and IRBs when determining the type and amount of incentives to provide to research participants. OBJECTIVE The specific aims of our research project are to (1) characterize key stakeholders' views on and assessments of incentives in biomedical HIV research; (2) reach consensus among stakeholders on the factors that are considered when choosing research incentives, including consensus on the relative importance of such factors; and (3) pilot-test the use of the guidance developed via aims 1 and 2 by presenting stakeholders with vignettes of hypothetical research studies for which they will choose corresponding incentive types. METHODS Our 2-year study will involve monthly, active engagement with a stakeholder advisory board of people living with HIV, researchers, and IRB members. For aim 1, we will conduct a nationwide survey (N=300) among people living with HIV to understand their views regarding the incentives used in HIV research. For aim 2, we will collect qualitative data by conducting focus groups with people living with HIV (n=60) and key informant interviews with stakeholders involved in HIV research (people living with HIV, IRB members, and biomedical HIV researchers: n=36) to extend and deepen our understanding of how incentives in HIV research are perceived. These participants will also complete a conjoint analysis experiment to gain an understanding of the relative importance of key HIV research study attributes and the impact that these attributes have on study participation. The data from the nationwide survey (aim 1) will be triangulated with the qualitative and conjoint analysis data (aim 2) to create 25 vignettes that describe hypothetical HIV research studies. Finally, individuals from each stakeholder group will select the most appropriate incentive that they feel should be used in each of the 25 vignettes (aim 3). RESULTS The stakeholder advisory board began monthly meetings in March 2021. All study aims are expected to be completed by December 2022. CONCLUSIONS By studying the role of incentives in HIV clinical trial participation, we will establish a decision-making paradigm to guide the choice of incentives for HIV research and, eventually, other types of similar research and facilitate the ethical recruitment of clinical research participants. TRIAL REGISTRATION ClinicalTrials.gov NCT04809636; https://clinicaltrials.gov/ct2/show/NCT04809636. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/33608.
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Affiliation(s)
- Jerome T Galea
- School of Social Work, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, United States
- College of Public Health, University of South Florida, Tampa, FL, United States
- Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | - Karah Y Greene
- School of Social Work, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, United States
| | - Brandon Nguyen
- Department of Social Medicine, Population and Public Health, University of California, Riverside, Riverside, CA, United States
| | - Andrea N Polonijo
- Department of Sociology, University of California, Merced, Merced, CA, United States
| | - Karine Dubé
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jeff Taylor
- HIV+Aging Research Project-Palm Springs, Palm Springs, CA, United States
| | | | - Zhiwei Zhang
- Department of Statistics, University of California, Riverside, Riverside, CA, United States
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, University of California, Riverside, Riverside, CA, United States
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Dubé K, Kanazawa J, Taylor J, Dee L, Jones N, Roebuck C, Sylla L, Louella M, Kosmyna J, Kelly D, Clanton O, Palm D, Campbell DM, Onaiwu MG, Patel H, Ndukwe S, Henley L, Johnson MO, Saberi P, Brown B, Sauceda JA, Sugarman J. Ethics of HIV cure research: an unfinished agenda. BMC Med Ethics 2021; 22:83. [PMID: 34193141 PMCID: PMC8243312 DOI: 10.1186/s12910-021-00651-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 06/23/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The pursuit of a cure for HIV is a high priority for researchers, funding agencies, governments and people living with HIV (PLWH). To date, over 250 biomedical studies worldwide are or have been related to discovering a safe, effective, and scalable HIV cure, most of which are early translational research and experimental medicine. As HIV cure research increases, it is critical to identify and address the ethical challenges posed by this research. METHODS We conducted a scoping review of the growing HIV cure research ethics literature, focusing on articles published in English peer-reviewed journals from 2013 to 2021. We extracted and summarized key developments in the ethics of HIV cure research. Twelve community advocates actively engaged in HIV cure research provided input on this summary and suggested areas warranting further ethical inquiry and foresight via email exchange and video conferencing. DISCUSSION Despite substantial scholarship related to the ethics of HIV cure research, additional attention should focus on emerging issues in six categories of ethical issues: (1) social value (ongoing and emerging biomedical research and scalability considerations); (2) scientific validity (study design issues, such as the use of analytical treatment interruptions and placebos); (3) fair selection of participants (equity and justice considerations); (4) favorable benefit/risk balance (early phase research, benefit-risk balance, risk perception, psychological risks, and pediatric research); (5) informed consent (attention to language, decision-making, informed consent processes and scientific uncertainty); and (6) respect for enrolled participants and community (perspectives of people living with HIV and affected communities and representation). CONCLUSION HIV cure research ethics has an unfinished agenda. Scientific research and bioethics should work in tandem to advance ethical HIV cure research. Because the science of HIV cure research will continue to rapidly advance, ethical considerations of the major themes we identified will need to be revisited and refined over time.
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Affiliation(s)
- Karine Dubé
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7469 USA
| | - John Kanazawa
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7469 USA
| | - Jeff Taylor
- HIV + Aging Research Project – Palm Springs (HARP–PS), Palm Springs, CA USA
- AntiViral Research Center (AVRC) Community Advisory Board (CAB), San Diego, CA USA
- Collaboratory of AIDS Researchers for Eradication (CARE) CAB, Chapel Hill, NC USA
| | - Lynda Dee
- AIDS Action Baltimore, Baltimore, MD USA
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board (CAB), San Francisco, CA USA
| | - Nora Jones
- BEAT-HIV Collaboratory CAB, Philadelphia, PA USA
| | | | | | | | - Jan Kosmyna
- AIDS Clinical Trials Group (ACTG) Community Scientific Subcommittee (CSS) Ethics Working Group, Nationwide, USA
| | - David Kelly
- AIDS Clinical Trials Group (ACTG) Community Scientific Subcommittee (CSS) Ethics Working Group, Nationwide, USA
| | - Orbit Clanton
- AIDS Clinical Trials Group Global CAB, Washington, D.C. USA
| | - David Palm
- Collaboratory of AIDS Researchers for Eradication (CARE) CAB, Chapel Hill, NC USA
- Institute of Global Health and Infectious Diseases HIV Treatment and Prevention CAB, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Danielle M. Campbell
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board (CAB), San Francisco, CA USA
- Charles R. Drew College of Medicine and Science, Los Angeles, CA USA
| | - Morénike Giwa Onaiwu
- AIDS Clinical Trials Group (ACTG) Community Scientific Subcommittee (CSS) Ethics Working Group, Nationwide, USA
- Center for the Study of Women, Gender, and Sexuality (School of Humanities), Rice University, Houston, TX USA
| | - Hursch Patel
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7469 USA
| | - Samuel Ndukwe
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7469 USA
| | - Laney Henley
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7469 USA
| | - Mallory O. Johnson
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA USA
| | - Parya Saberi
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA USA
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside, Riverside, CA USA
| | - John A. Sauceda
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA USA
| | - Jeremy Sugarman
- Johns Hopkins Berman Institute for Bioethics, Baltimore, MD USA
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Diepstra KL, Barr L, Palm D, Hogg E, Mollan KR, Henley L, Stover AM, Simoni JM, Sugarman J, Brown B, Sauceda JA, Deeks S, Fox L, Gandhi RT, Smith D, Li JZ, Dubé K. Participant Perspectives and Experiences Entering an Intensively Monitored Antiretroviral Pause: Results from the AIDS Clinical Trials Group A5345 Biomarker Study. AIDS Res Hum Retroviruses 2021; 37:489-501. [PMID: 33472545 DOI: 10.1089/aid.2020.0222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The AIDS Clinical Trials Group (ACTG) A5345 study included an intensively monitored antiretroviral pause (IMAP), during which a cohort of participants temporarily stopped antiretroviral treatment during chronic HIV infection. We surveyed participant perceptions and understanding of A5345 using a cross-sectional sociobehavioral questionnaire. Participants completed the baseline questionnaire either before or after initiating the study's IMAP. Questionnaire responses were linked to existing demographic data. Quantitative responses were analyzed overall and stratified by IMAP status. Open-ended responses were analyzed using conventional content analysis. Thirty-two participants completed the baseline sociobehavioral questionnaire. Half (n = 16) completed it before (i.e., pre-IMAP initiation group) and half (n = 16) after IMAP initiation (i.e., post-IMAP initiation group). Eight pre-IMAP initiation respondents (50%) and 11 post-IMAP respondents (69%) responded "yes" when asked if they perceived any direct benefits from participating in A5345. Perceived societal-level benefits included furthering HIV cure-related research and helping the HIV community. Perceived personal-level benefits included the opportunity to learn about the body's response to IMAP and financial compensation. The majority of respondents-13 from each group (81% of each)-reported risks from participation, for example, viral load becoming detectable. A5345 participants perceived both societal- and personal-level benefits of study participation. While the majority of survey respondents perceived participatory risks, nearly one in five did not. Key messages pertaining to study-related risks and benefits may need to be clarified or reiterated periodically throughout follow-up in HIV cure-related studies with IMAPs. Clinical Trail Registration Number: NCT03001128.
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Affiliation(s)
- Karen L. Diepstra
- UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Liz Barr
- AIDS Clinical Trials Group (ACTG) Community Scientific Sub-Committee, Baltimore, Maryland, USA
| | - David Palm
- Institute of Global Health and Infectious Diseases (IGHID), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Evelyn Hogg
- Social & Scientific Systems, a DLH Company, Silver Spring, Maryland, USA
| | - Katie R. Mollan
- Center for AIDS Research (CFAR), School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Laney Henley
- UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Angela M. Stover
- UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Jane M. Simoni
- Department of Psychology, University of Washington, Seattle, Washington, USA
- Department of Global Health and Gender, Women, and Sexuality Studies, University of Washington, Seattle, Washington, USA
| | - Jeremy Sugarman
- Johns Hopkins Berman Institute for Bioethics, Baltimore, Maryland, USA
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside School of Medicine, Riverside, California, USA
| | - John A. Sauceda
- Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, San Francisco, California, USA
| | - Steven Deeks
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Lawrence Fox
- National Institute of Health (NIH) Division of AIDS (DAIDS), Bethesda, Maryland, USA
| | | | - Davey Smith
- Division of Infectious Diseases and Global Health, University of California, San Diego, California, USA
| | - Jonathan Z. Li
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Karine Dubé
- UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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Anderson EE, Brown B. A Call for Radical Transparency regarding Research Payments. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:45-47. [PMID: 33616491 DOI: 10.1080/15265161.2020.1870763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
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10
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Brown B, Galea JT. The effect of incentives on HIV research must be studied. Lancet HIV 2019; 6:e142-e143. [PMID: 30660593 DOI: 10.1016/s2352-3018(18)30357-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Brandon Brown
- Center for Healthy Communities, Department of Social Medicine and Population Health, School of Medicine, University of California Riverside, Riverside, CA 92521, USA.
| | - Jerome T Galea
- School of Social Work, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
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Abadie R, Brown B, Fisher CB. "Money Helps": People who inject drugs and their perceptions of financial compensation and its ethical implications. ETHICS & BEHAVIOR 2018; 29:607-620. [PMID: 31579222 PMCID: PMC6774386 DOI: 10.1080/10508422.2018.1535976] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This study documents how people who inject drugs (PWID) in rural Puerto Rico perceive payments for participating in HIV epidemiological studies. In-depth interviews were conducted among a subset (n = 40) of active PWID older than 18 years of age who had been previously enrolled in a much larger study (N = 360). Findings suggest that financial compensation was the main motivation for initially enrolling in the parent study. Then, as trust in the researchers developed, participants came to perceive compensation as part of a reciprocal exchange in which they assisted researchers by providing a trustful account of their experiences and researchers reciprocated with financial support.
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Affiliation(s)
- Roberto Abadie
- Department of Sociology, University of Nebraska-Lincoln Brandon Brown
| | - Brandon Brown
- Center for Healthy Communities, University of California Riverside
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12
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Brown B, Galea JT, Dubé K, Davidson P, Khoshnood K, Holtzman L, Marg L, Taylor J. The Need to Track Payment Incentives to Participate in HIV Research. ACTA ACUST UNITED AC 2018. [DOI: 10.1002/eahr.404002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Brandon Brown
- University of California; Center for Healthy Communities in the Division of Clinical Sciences in the School of Medicine; Riverside
| | - Jerome T. Galea
- Harvard Medical School; Department of Global Health and Social Medicine
| | - Karine Dubé
- University of North Carolina; Gillings School of Global Public Health; Chapel Hill
| | - Peter Davidson
- University of California; Division of Global Public Health; Department of Medicine; San Diego
| | | | - Lisa Holtzman
- Harvard TH Chan School of Public Health; Department of Global Health and Population
| | - Logan Marg
- University of California; Center for Healthy Communities in the School of Medicine; Riverside
| | - Jeff Taylor
- Collaboratory of AIDS Researchers for Eradication; Palm Springs, CA
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13
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Brown B, Galea JT, Dubé K. Crucial but understudied: incentives in HIV research. THE LANCET HIV 2018; 5:e61-e62. [DOI: 10.1016/s2352-3018(17)30196-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 10/02/2017] [Indexed: 04/09/2023]
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14
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Dubé K, Sylla L, Dee L, Taylor J, Evans D, Bruton CD, Gilberston A, Gralinski L, Brown B, Skinner A, Weiner BJ, Greene SB, Corneli A, Adimora AA, Tucker JD, Rennie S. Research on HIV cure: Mapping the ethics landscape. PLoS Med 2017; 14:e1002470. [PMID: 29220353 PMCID: PMC5722280 DOI: 10.1371/journal.pmed.1002470] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In an essay, Karine Dubé and coauthors discuss the ethics of preclinical and clinical studies relevant to achieving an HIV cure.
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Affiliation(s)
- Karine Dubé
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Laurie Sylla
- defeatHIV Community Advisory Board (CAB), Seattle, Washington, United States of America
| | - Lynda Dee
- amfAR Institute for HIV Cure Research CAB, San Francisco, California, United States of America
- Delaney AIDS Research Enterprise (DARE) CAB, San Francisco, California, United States of America
- AIDS Action Baltimore, Baltimore, Maryland, United States of America
| | - Jeff Taylor
- amfAR Institute for HIV Cure Research CAB, San Francisco, California, United States of America
- Collaboratory of AIDS Researchers for Eradication (CARE) CAB, Palm Springs, California, and Chapel Hill, North Carolina, United States of America
| | - David Evans
- Delaney AIDS Research Enterprise (DARE) CAB, San Francisco, California, United States of America
- Project Inform, San Francisco, California, United States of America
| | - Carl Dean Bruton
- Collaboratory of AIDS Researchers for Eradication (CARE) CAB, Palm Springs, California, and Chapel Hill, North Carolina, United States of America
- AIDS Clinical Trials Group (ACTG) CAB, Chapel Hill, North Carolina, United States of America
| | - Adam Gilberston
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Lisa Gralinski
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Brandon Brown
- University of California Riverside, Riverside, California, United States of America
| | - Asheley Skinner
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
- Duke Clinical Research Institute (DCRI), Durham, North Carolina, United States
| | - Bryan J. Weiner
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Sandra B. Greene
- University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - Amy Corneli
- Duke Clinical Research Institute (DCRI), Durham, North Carolina, United States
| | - Adaora A. Adimora
- UNC Institute of Global Health and Infectious Diseases (IGHID), Chapel Hill, North Carolina, United States of America
| | - Joseph D. Tucker
- UNC Institute of Global Health and Infectious Diseases (IGHID), Chapel Hill, North Carolina, United States of America
- UNC Project China, Guangzhou, China
| | - Stuart Rennie
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- UNC Center for Bioethics, Chapel Hill, North Carolina, United States of America
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15
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Largent EA, Fernandez Lynch H. Paying Research Participants: Regulatory Uncertainty, Conceptual Confusion, and a Path Forward. YALE JOURNAL OF HEALTH POLICY, LAW, AND ETHICS 2017; 17:61-141. [PMID: 29249912 PMCID: PMC5728432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The practice of offering payment to individuals in exchange for their participation in clinical research is widespread and longstanding. Nevertheless, such payment remains the source of substantial debate, in particular about whether or the extent to which offers of payment coerce and/or unduly induce individuals to participate. Yet, the various laws, regulations, and ethical guidelines that govern the conduct of human subjects research offer relatively little in the way of specific guidance regarding what makes a payment offer ethically acceptable-or not. Moreover, there is a lack of definitional agreement regarding what the terms coercion and undue inducement mean in the human subjects research context. It is, therefore, unsurprising that investigators and Institutional Review Boards (IRBs) experience confusion about how to evaluate offers of payment, and lean toward conservative approaches. These trends are exemplified by our pilot data regarding the ways in which some IRB members and investigators (mis)understand the concepts of coercion and undue inducement, as well as the ways in which certain research institutions oversee offers of payment at a local level. This article systematically examines the legal and ethical dimensions of offering payment to research participants. It argues that many concerns about offers of payment to research participants can be attributed to the misguided view that such offers ought to be treated differently than offers of payment in other contexts, a form of "research exceptionalism." We show that rejection of research exceptionalism with respect to payment helps settle open debates about both how best to define coercion and undue influence, and how to understand the relation between these concepts and offers of payment. We argue for adoption of our preferred definitions, ideally by regulatory authorities, and against the conventional conservatism toward payment of research participants. Instead, we draw attention to the rarely asked, even radical, question: are research participants paid enough? We conclude by arguing that we ought to change the default to favor, rather than encourage suspicion of, offers of payment to research participants.
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Affiliation(s)
- Emily A Largent
- Research Associate, Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard Law School
| | - Holly Fernandez Lynch
- Executive Director, Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics, Harvard Law School
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