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Aldhouse NVJ, Chan EKH, Al-Zubeidi T, McKee S, Oriol Mathieu V, El Khoury AC, Kitchen H. Perceptions and Acceptance of a Prophylactic Vaccine for Human Immunodeficiency Virus (HIV): A Qualitative Study. THE PATIENT 2024; 17:457-469. [PMID: 38581599 PMCID: PMC11189960 DOI: 10.1007/s40271-024-00686-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Despite advances in human immunodeficiency virus (HIV) prevention methods, such as the advent of pre-exposure prophylaxis (PrEP), the number of people with newly acquired HIV remains high, particularly in at-risk groups. A prophylactic HIV vaccine could contribute to reduced disease prevalence and future transmission and address limitations of existing options, such as suboptimal long-term adherence to PrEPs. METHODS This qualitative study aimed to capture perceptions towards and acceptance of prophylactic HIV vaccination in three adult populations in the United States: the general population, 'at-risk' individuals (e.g. men who have sex with men, transgender individuals, gender-nonconforming individuals, and individuals in a sexual relationship with a person living with HIV), and parents/caregivers of children aged 9-17 years. Interviews were conducted with 55 participants to explore key drivers and barriers to HIV vaccine uptake, and a conceptual model was developed. RESULTS The sample was diverse; participants were 51% female, aged 20-57 years (mean 37 years), 33% with high school diploma as highest education level, and identified as White (42%), Black or African American (35%), of Hispanic, Latino, or Spanish origin (22%), or other races/ethnicities (8%) [groupings are not mutually exclusive]. Perceptions were influenced by individual, interpersonal, community, institutional, and structural factors. Overall, 98% of participants thought vaccination would be beneficial in preventing HIV. Key considerations/barriers included perceived susceptibility, i.e. whether participants felt there was a risk of contracting HIV (discussed by 90%); the clinical profile of the vaccine (e.g. the adverse effect profile [98%], and vaccine efficacy [85%], cost [73%] and administration schedule [88%]); and concerns around potential vaccine-induced seropositivity (VISP; 62%). Stigma was not found to be an important barrier, with a general view that vaccination status was personal. Participants in the 'at-risk' group were the most likely to accept an HIV vaccine (70%). Unique concerns in the subgroups included how a potential vaccine's clinical profile compared with PrEP, voiced by those receiving/considering PrEP, and considerations of children's views on the topic, voiced by parents/caregivers. CONCLUSIONS Understanding these factors could help develop HIV vaccine research strategies and contribute toward public health messaging to support future HIV vaccination programs.
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Meskell P, Biesty LM, Dowling M, Roche K, Meehan E, Glenton C, Devane D, Shepperd S, Booth A, Cox R, Chan XHS, Houghton C. Factors that impact on recruitment to vaccine trials in the context of a pandemic or epidemic: a qualitative evidence synthesis. Cochrane Database Syst Rev 2023; 9:MR000065. [PMID: 37655964 PMCID: PMC10472890 DOI: 10.1002/14651858.mr000065.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND The World Health Organization declared the COVID-19 pandemic on 11 March 2020. Vaccine development and deployment were swiftly prioritised as a method to manage and control disease spread. The development of an effective vaccine relies on people's participation in randomised trials. Recruitment to vaccine trials is particularly challenging as it involves healthy volunteers who may have concerns around the potential risks and benefits associated with rapidly developed vaccines. OBJECTIVES To explore the factors that influence a person's decision to participate in a vaccine trial in the context of a pandemic or epidemic. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was June 2021. SELECTION CRITERIA We included qualitative studies and mixed-methods studies with an identifiable qualitative component. We included studies that explored the perspectives of adults aged 18 years or older who were invited to take part in vaccine trials in the context of a pandemic or epidemic. DATA COLLECTION AND ANALYSIS We assessed the title, abstracts and full texts identified by the search. We used a sampling frame to identify data-rich studies that represented a range of diseases and geographical spread. We used QSR NVivo to manage extracted data. We assessed methodological limitations using an adapted version of the Critical Skills Appraisal Programme (CASP) tool for qualitative studies. We used the 'best-fit framework approach' to analyse and synthesise the evidence from our included studies. We then used the Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) assessment to assess our confidence in each finding and develop implications for practice. MAIN RESULTS We included 34 studies in our review. Most studies related to HIV vaccine trials. The other studies related to Ebola virus, tuberculosis, Zika virus and COVID-19. We developed 20 key findings, under three broad themes (with seven subthemes), that described the factors that people consider when deciding whether to take part in a vaccine trial for a pandemic or epidemic disease. Our GRADE-CERQual confidence was high in nine of the key findings, moderate in 10 key findings and low in one key finding. The main reason for downgrading review findings were concerns regarding the relevance and adequacy of the underlying data. As a result of the over-representation of HIV studies, our GRADE-CERQual assessment of some findings was downgraded in terms of relevance because the views described may not reflect those of people regarding vaccine trials for other pandemic or epidemic diseases. Adequacy relates to the degree of richness and quantity of data supporting a review finding. Moderate concerns about adequacy resulted in a downgrading of some review findings. Some factors were considered to be under the control of the trial team. These included how trial information was communicated and the inclusion of people in the community to help with trial information dissemination. Aspects of trial design were also considered under control of the trial team and included convenience of participation, provision of financial incentives and access to additional support services for those taking part in the trial. Other factors influencing people's decision to take part could be personal, from family, friends or wider society. From a personal perceptive, people had concerns about vaccine side effects, vaccine efficacy and possible impact on their daily lives (carer responsibilities, work, etc.). People were also influenced by their families, and the impact participation may have on relationships. The fear of stigma from society influenced the decision to take part. Also, from a societal perspective, the level of trust in governments' involvement in research and trial may influence a person's decision. Finally, the perceived rewards, both personal and societal, were influencing factors on the decision to participate. Personal rewards included access to a vaccine, improved health and improved disease knowledge, and a return to normality in the context of a pandemic or epidemic. Potential societal rewards included helping the community and contributing to science, often motivated by the memories of family and friends who had died from the disease. AUTHORS' CONCLUSIONS This review identifies many of the factors that influence a person's decision to take part in a vaccine trial, and these reflect findings from reviews that examine trials more broadly. However, we also recognise some factors that become more important in connection with a vaccine trial in the context of a pandemic or epidemic. These factors include the potential stigma of taking part, the possible adverse effects of a vaccine, the added motivation for helping society, the role of community leaders in trial dissemination, and the level of trust placed in governments and companies developing vaccines. These specific influences need to be considered by trial teams when designing, and communicating about, vaccine trials in the context of a pandemic or epidemic.
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Affiliation(s)
- Pauline Meskell
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Linda M Biesty
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Maura Dowling
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | | | - Elaine Meehan
- Ageing Research Centre, School of Allied Health, University of Limerick, Limerick, Ireland
| | | | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, ScHARR, Sheffield, UK
| | - Rebecca Cox
- Department of Clinical Sciences, University of Bergen, Bergen, Norway
| | - Xin Hui S Chan
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Catherine Houghton
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
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Martínez AD, Ruelas-Thompson L. Acceptability, feasibility, and ethics of saliva collection in community-based research with Mexican-origin mixed-status families during high immigration enforcement. BMC Public Health 2022; 22:1685. [PMID: 36064334 PMCID: PMC9446519 DOI: 10.1186/s12889-022-13903-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/28/2022] [Indexed: 11/30/2022] Open
Abstract
Background There are concerns about the representation of vulnerable and underrepresented racial-ethnic minorities in biomedical and public health research, particularly when the research requires the collection of biospecimens. The current paper reports on the acceptability, feasibility, and ethics of saliva collection in a study examining the relationship between chronic stressors among mostly mixed-status, Latinx families (N = 30) during high immigration enforcement. Methods Data for this study included anthropometric measures and salivary biospecimens from each family member (N = 110) and a household survey. Data for this analysis are from ethnographic field notes, which were analyzed using a bricolage of critical ethnography and case study analysis techniques. Results We discuss the feasibility, aversions, acceptability, and ethical implications of integrating salivary biomarkers with Mexican-origin mixed-status families living in an area with restrictive immigration enforcement policies. We present the recruitment and data collection strategies used by the research team to gain participants’ trust, retain families, and maintain confidentiality. Conclusion We recommend that researchers who obtain biospecimens from Latinx, Mexican-origin, and/or immigrant populations answer the participants’ questions honestly and without fear that they will not understand the science to obtain voluntary assent and consent. We recommend that researchers be knowledgeable of the sociopolitical context that the Latinx, immigrant, and in particular, mixed-status families inhabit so that they are prepared to provide informational resources. Finally, we think it is imperative that the study team in the field be bilingual, multicultural Latinx persons who identify with the community.
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Affiliation(s)
- Airín Denise Martínez
- School of Public Health and Health Sciences, Department of Health Promotion and Policy, University of Massachusetts-Amherst, 715 N. Pleasant Street, Arnold House 333, 01003, Amherst, MB, USA.
| | - Lillian Ruelas-Thompson
- College of Liberal Arts & Sciences, ASU Advance,, Knowledge Exchange for Resilience, Arizona State University, Box 5302, Tempe, AZ, 85281, USA
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Bass SB, D’Avanzo P, Alhajji M, Ventriglia N, Trainor A, Maurer L, Eisenberg R, Martinez O. Exploring the Engagement of Racial and Ethnic Minorities in HIV Treatment and Vaccine Clinical Trials: A Scoping Review of Literature and Implications for Future Research. AIDS Patient Care STDS 2020; 34:399-416. [PMID: 32931317 PMCID: PMC10722429 DOI: 10.1089/apc.2020.0008] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
HIV disproportionately impacts US racial and ethnic minorities but they participate in treatment and vaccine clinical trials at a lower rate than whites. To summarize barriers and facilitators to this participation we conducted a scoping review of the literature guided by the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Studies published from January 2007 and September 2019 were reviewed. Thirty-one articles were identified from an initial pool of 325 records using three coders. All records were then assessed for barriers and facilitators and summarized. Results indicate that while racial and ethnic minority participation in these trials has increased over the past 10 years, rates still do not proportionately reflect their burden of HIV infection. While many of the barriers mirror those found in other disease clinical trials (e.g., cancer), HIV stigma is a unique and important barrier to participating in HIV clinical trials. Recommendations to improve recruitment and retention of racial and ethnic minorities include training health care providers on the importance of recruiting diverse participants, creating interdisciplinary research teams that better represent who is being recruited, and providing culturally competent trial designs. Despite the knowledge of how to better recruit racial and ethnic minorities, few interventions have been documented using these strategies. Based on the findings of this review, we recommend that future clinical trials engage community stakeholders in all stages of the research process through community-based participatory research approaches and promote culturally and linguistically appropriate recruitment and retention strategies for marginalized populations overly impacted by HIV.
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Affiliation(s)
- Sarah Bauerle Bass
- Risk Communication Laboratory, Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
| | - Paul D’Avanzo
- Risk Communication Laboratory, Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
| | - Mohammed Alhajji
- Risk Communication Laboratory, Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
| | - Nicole Ventriglia
- Fox Chase Cancer Center, Risk Assessment Program, Philadelphia, Pennsylvania, USA
| | - Aurora Trainor
- Risk Communication Laboratory, Department of Social and Behavioral Sciences, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
| | - Laurie Maurer
- Tennessee Department of Health, HIV/STD/Viral Hepatitis Section, Nashville, Tennessee, USA
| | | | - Omar Martinez
- School of Social Work, Temple University College of Public Health, Philadelphia, Pennsylvania, USA
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DAY S, MATHEWS A, BLUMBERG M, VU T, MASON H, RENNIE S, KURUC JD, GAY CL, MARGOLIS DM, TUCKER JD. Expanding community engagement in HIV clinical trials: a pilot study using crowdsourcing. AIDS 2020; 34:1195-1204. [PMID: 32287062 PMCID: PMC8211407 DOI: 10.1097/qad.0000000000002534] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess the potential for crowdsourcing to complement and extend community advisory board (CAB) feedback on HIV clinical trials. Crowdsourcing involves community members attempting to solve a problem and then sharing solutions. METHODS CAB and crowdsourced approaches were implemented in the context of a phase 1 HIV antibody trial to collect feedback on informed consent, participation experiences, and fairness. CAB engagement was conducted through group discussions with members of an HIV CAB. Crowdsourcing involved open events intended to engage the local community, including interactive video modules, animated vignettes, and a creative idea contest. Open coding and analysis of emergent themes were conducted to compare CAB and crowdsourced feedback. RESULTS The crowdsourcing activities engaged 61 people across three events; nine people engaged in CAB feedback. Compared with CAB participants, crowdsourcing participants had lower levels of education and income, and higher levels of disability and unemployment. Overlap in CAB and crowdsourced feedback included recommendations for enhancing communication and additional support for trial participants. Crowdsourcing provided more detailed feedback on the impact of positive experiences and socio-economic factors on trial participation. CAB feedback included greater emphasis on institutional regulations and tailoring trial procedures. Crowdsourced feedback emphasized alternative methods for learning about trials and concerns with potential risks of trial participation. CONCLUSION Conducting crowdsourcing in addition to CAB engagement can yield a broader range of stakeholder feedback to inform the design and conduct of HIV clinical trials. VIDEO ABSTRACT:.
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Affiliation(s)
- Suzanne DAY
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Chapel Hill, NC, USA, 27599
| | - Allison MATHEWS
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Chapel Hill, NC, USA, 27599
| | - Meredith BLUMBERG
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Chapel Hill, NC, USA, 27599
- Department of Social Medicine, University of North Carolina at Chapel Hill, 333 South Columbia Street, Chapel Hill, NC, USA, 27516
| | - Thi VU
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Chapel Hill, NC, USA, 27599
| | - Hailey MASON
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Chapel Hill, NC, USA, 27599
| | - Stuart RENNIE
- Department of Social Medicine, University of North Carolina at Chapel Hill, 333 South Columbia Street, Chapel Hill, NC, USA, 27516
- Center for Bioethics, University of North Carolina at Chapel Hill, 333 South Columbia Street, Chapel Hill, NC, USA, 27516
| | - JoAnne D. KURUC
- Department of Medicine, University of North Carolina at Chapel Hill, 321 S Columbia St, Chapel Hill, NC, USA, 27516
- UNC HIV Cure Center, University of North Carolina at Chapel Hill, 120 Mason Farm Road, Chapel Hill, NC, USA, 27599
| | - Cynthia L. GAY
- Department of Medicine, University of North Carolina at Chapel Hill, 321 S Columbia St, Chapel Hill, NC, USA, 27516
- UNC HIV Cure Center, University of North Carolina at Chapel Hill, 120 Mason Farm Road, Chapel Hill, NC, USA, 27599
| | - David M. MARGOLIS
- Department of Medicine, University of North Carolina at Chapel Hill, 321 S Columbia St, Chapel Hill, NC, USA, 27516
- UNC HIV Cure Center, University of North Carolina at Chapel Hill, 120 Mason Farm Road, Chapel Hill, NC, USA, 27599
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, 125 Mason Farm Road, Chapel Hill, NC, USA, 27599
- Department of Epidemiology, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, USA, 27599
| | - Joseph D. TUCKER
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Road, Chapel Hill, NC, USA, 27599
- Department of Medicine, University of North Carolina at Chapel Hill, 321 S Columbia St, Chapel Hill, NC, USA, 27516
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK, WC1E 7HT
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Ortiz AP, Machin M, Soto-Salgado M, Centeno-Girona H, Rivera-Collazo D, González D, Chen MS, Colón-López V. Effect of an Educational Video to Increase Calls and Screening into an Anal Cancer Clinical Trial Among HIV+ Hispanics in PR: Results from a Randomized Controlled Behavioral Trial. AIDS Behav 2019; 23:1135-1146. [PMID: 30467711 PMCID: PMC10650566 DOI: 10.1007/s10461-018-2330-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Anal cancer incidence is higher in persons living with HIV/AIDS (PLWHA) than in the general population. Participation of PLWHA in anal cancer clinical trials (CTs) is essential; Hispanic PLWHA are underrepresented in CTs. We conducted a behavioral CT among 305 PLWHA in Puerto Rico to measure the efficacy of an educational video in increasing calls and screening into an anal cancer CT. Participants received printed educational materials on anal cancer and CTs; the intervention group also received an educational video. Outcome assessment based on follow-up interviews showed that printed materials increased awareness about CTs and high-resolution anoscopy (HRA), and willingness to participate in an anal cancer CT in both groups. However, the addition of the video increased the likelihood of participants to call the CT for orientation (RRadjusted = 1.66, 95% CI 1.00-2.76; p = 0.05) and pre-screening evaluation (RRadjusted = 1.70, 95% CI 0.95-3.03; p = 0.07). This intervention could help increase participation of Hispanics into anal cancer-related CTs.
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Affiliation(s)
- Ana P Ortiz
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico.
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico.
| | - Mark Machin
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
| | | | | | - Darilyn Rivera-Collazo
- Department of Biostatistics and Epidemiology, Graduate School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Daisy González
- University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
| | - Moon S Chen
- Cancer Control/Cancer Health Disparities, Division of Hematology and Oncology, University of California, Davis Comprehensive Cancer Center, Sacramento, CA, USA
| | - Vivian Colón-López
- Cancer Control and Population Sciences Program, University of Puerto Rico Comprehensive Cancer Center, San Juan, Puerto Rico
- Department of Health Services Administration, Graduate School of Public Health, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico
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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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Brooks RA, Allen VC, Regan R, Mutchler MG, Cervantes-Tadeo R, Lee SJ. HIV/AIDS conspiracy beliefs and intention to adopt preexposure prophylaxis among black men who have sex with men in Los Angeles. Int J STD AIDS 2018; 29:375-381. [PMID: 28853676 PMCID: PMC6221185 DOI: 10.1177/0956462417727691] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the United States, black men who have sex with men (MSM) are the group most affected by the HIV/AIDS epidemic. Pre-exposure prophylaxis (PrEP) is an important new HIV prevention strategy that may help reduce new HIV infections among black MSM. This analysis examined the association between HIV/AIDS conspiracy beliefs and intentions to adopt PrEP among 224 black MSM. The likelihood of adopting PrEP was assessed and more than half (60%) of the study population indicated a high intention to adopt PrEP. HIV/AIDS genocidal and treatment-related conspiracies were assessed using scales previously validated with black MSM. Almost two-thirds (63%) endorsed at least one of eight HIV/AIDS conspiracy beliefs presented. In multivariable analyses, black MSM who agreed with the genocidal or treatment-related conspiracy beliefs scales had a lower intention to adopt PrEP (Adjusted Odds Ratio [AOR] = 0.73, 95% CI = 0.54, 0.99 and AOR = 0.36, 95% CI = 0.23, 0.55, respectively). Our findings indicate that preexisting HIV/AIDS conspiracy beliefs may deter some black MSM from adopting PrEP. We suggest strategies PrEP implementers may want to employ to address the influence that HIV/AIDS conspiracy beliefs may have on the adoption of PrEP among black MSM, a population disproportionately affected by HIV/AIDS.
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Affiliation(s)
- Ronald A Brooks
- 1 Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Vincent C Allen
- 2 Georgia State University Counseling and Testing Center, Atlanta, GA, USA
| | - Rotrease Regan
- 3 Department of Medicine, Division of Infectious Diseases, 1371 Emory University , Atlanta, GA, USA
| | - Matt G Mutchler
- 4 Department of Sociology, California State University, Dominguez Hills, CA, USA
- 5 Community-Based Research, AIDS Project Los Angeles, CA, USA
| | - Ramon Cervantes-Tadeo
- 1 Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Sung-Jae Lee
- 6 Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Research altruism as motivation for participation in community-centered environmental health research. Soc Sci Med 2017; 196:175-181. [PMID: 29190538 DOI: 10.1016/j.socscimed.2017.11.028] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 10/28/2017] [Accepted: 11/16/2017] [Indexed: 11/22/2022]
Abstract
Protection of human subjects in research typically focuses on extrinsic rather than intrinsic motivations for participation in research. Recent sociological literature on altruism suggests that multiple kinds of altruism exist and are grounded in a sense of connection to common humanity. We interviewed participants in eight community-centered research studies that sampled for endocrine disrupting compounds and that shared research findings with participants. The results of our analysis of participation in these studies indicate that altruistic motivations were commonly held. We found that these sentiments were tied to feeling a sense of connection to society broadly, a sense of connection to science, or a sense of connection with the community partner organization. We develop a new concept of banal altruism to address mundane practices that work towards promoting social benefits. Further, we offer that research altruism is a specific type of banal altruism that is a multi-faceted and important reason for which individuals choose to participate in community-centered research.
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Chin LJ, Berenson JA, Klitzman RL. Typologies of Altruistic and Financial Motivations for Research Participation. J Empir Res Hum Res Ethics 2017; 11:299-310. [PMID: 28251864 DOI: 10.1177/1556264616679537] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Questions arise concerning participants' motives in risky studies, such as HIV vaccine trials (HVTs). We interviewed in-depth 20 gay/bisexual men. Participants described both altruistic and nonaltruistic motives. Altruistic motivations emerged primarily, with nine typologies: (a) cultural, (b) community related, (c) familial, (d) religious, (e) professional, (f) political (e.g., HIV activism), (g) moral (e.g., making up for past wrongs), (h) existential (e.g., providing sense of meaning), and (i) other psychological (e.g., emotional gratification). Views of compensation varied: not a factor (55%), added incentive (25%), main motivator, but in conjunction with altruism (15%), and primary motivator (5%). HVT participants thus often have both altruistic and financial motives, and related typologies emerged. These findings have critical implications for studies on HIV, other conditions, and research ethics.
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Affiliation(s)
- Lisa J Chin
- 1 State University of New York College at Old Westbury, USA
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Copeland RM, Wilson P, Betancourt G, Garcia D, Penner M, Abravanel R, Wong EY, Parisi LD. Disparities in HIV knowledge and attitudes toward biomedical interventions among the non-medical HIV workforce in the United States. AIDS Care 2017; 29:1576-1584. [PMID: 28449588 DOI: 10.1080/09540121.2017.1317323] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Non-medical, community-based workers play a critical role in supporting people living with (or at risk of acquiring) HIV along the care continuum. The biomedical nature of promising advances in HIV prevention, such as pre-exposure prophylaxis and treatment-as-prevention, requires frontline workers to be knowledgeable about HIV science and treatment. This study was developed to: measure knowledge of HIV science and treatment within the HIV non-medical workforce, evaluate workers' familiarity with and attitudes toward recent biomedical interventions, and identify factors that may affect HIV knowledge and attitudes. A 62-question, web-based survey was completed in English or Spanish between 2012 and 2014 by 3663 US-based employees, contractors, and volunteers working in AIDS service organizations, state/local health departments, and other community-based organizations in a non-medical capacity. Survey items captured the following: respondent demographics, HIV science and treatment knowledge, and familiarity with and attitudes toward biomedical interventions. An average of 61% of HIV knowledge questions were answered correctly. Higher knowledge scores were associated with higher education levels, work at organizations that serve people living with HIV/AIDS or who are at a high risk of acquiring HIV, and longer tenure in the field. Lower knowledge scores were associated with non-Hispanic Black or Black race/ethnicity and taking the survey in Spanish. Similarly, subgroup analyses showed that respondents who were non-Hispanic Black or Hispanic (versus non-Hispanic white), as well as those located in the South (versus other regions) scored significantly lower. These subpopulations were also less familiar with and had less positive attitudes toward newer biomedical prevention interventions. Respondents who took the survey in Spanish (versus English) had lower knowledge scores and higher familiarity with, but generally less positive attitudes toward, biomedical interventions. In summary, low knowledge scores suggest the need for additional capacity-building efforts and training for non-medical HIV workers, particularly those who provide services in the communities most affected by HIV.
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Affiliation(s)
| | | | | | - David Garcia
- b Latino Commission on AIDS , New York , NY , USA
| | - Murray Penner
- c National Alliance of State & Territorial AIDS Directors , Washington , DC , USA
| | | | - Eric Y Wong
- e Janssen Scientific Affairs, LLC , Titusville , NJ , USA
| | - Lori D Parisi
- e Janssen Scientific Affairs, LLC , Titusville , NJ , USA
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Tarimo EAM, Bakari M, Kakoko DCV, Kohi TW, Mhalu F, Sandstrom E, Kulane A. Motivations to participate in a Phase I/II HIV vaccine trial: A descriptive study from Dar es Salaam, Tanzania. BMC Public Health 2016; 16:182. [PMID: 26911203 PMCID: PMC4765221 DOI: 10.1186/s12889-016-2875-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 02/16/2016] [Indexed: 11/24/2022] Open
Abstract
Background The search for an efficacious HIV vaccine is a global priority. To date only one HIV vaccine trial (RV144) has shown modest efficacy in a phase III trial. With existing different HIV-1 subtypes and frequent mutations, multiple trials are needed from different geographical sites particularly in sub-Saharan Africa where most HIV infections occur. Thus, motivations to participate in HIV vaccine trials among Tanzanians need to be assessed. This paper describes the motives of Police Officers who showed great interest to volunteer in HIVIS-03 in Dar es Salaam, Tanzania. Methods A descriptive cross-sectional study was conducted among Police Officers who showed interest to participate in the HIVIS-03, a phase I/II HIV vaccine trial in Dar es Salaam. Prior to detailed training sessions about HIV vaccine trials, the potential participants narrated their individual motives to participate in the trial on a piece of paper. Descriptive analysis using content approach and frequency distributions were performed. Results Of the 265 respondents, 242 (91.3 %) provided their socio-demographic characteristics as well as reasons that would make them take part in the proposed trial. Majority, (39.7 %), cited altruism as the main motive. Women were more likely to volunteer due to altruism compared to men (P < 0.01). Researchers’ explanations about HIV/AIDS vaccine studies motivated 15.3 %. More men (19.6 %) than women (1.7 %) were motivated to volunteer due to researchers’ explanations (P < 0.001). Also, compared to other groups, those unmarried and educated up to secondary level of education were motivated to volunteer due to researchers’ explanation (P < 0.05). Other reasons were: desire to become a role model (18.6 %); to get knowledge for educating others (14.0 %); to cooperate with researchers in developing an HIV vaccine (9.5 %); to get protection against HIV infection (7.0 %), and severity of the disease within families (6.2 %). These results were supported by testimonies from both men and women. Conclusions Participation in an HIV vaccine trial in a Tanzanian context is likely to be influenced by altruism and comprehensive education about the trial. Gender differences, marital status and education level need to be considered to enhance participation in future HIV vaccine trials.
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Affiliation(s)
- E A M Tarimo
- Department of Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - M Bakari
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - D C V Kakoko
- Department of Behavioural Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - T W Kohi
- Department of Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - F Mhalu
- Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - E Sandstrom
- Venhalsan, Karolinska Institutet, Sodersjukhuset, Venhalsan, Stockholm, Sweden.
| | - A Kulane
- Karolinska Institutet, Public Health, Stockholm, Sweden.
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Dhalla S, Poole G. Effect of race/ethnicity on participation in HIV vaccine trials and comparison to other trials of biomedical prevention. Hum Vaccin Immunother 2016; 10:1974-84. [PMID: 25424807 DOI: 10.4161/hv.28870] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Racial/ethnic minorities are underrepresented in actual HIV vaccine trials in North America, and willingness to participate (WTP) and retention in an HIV vaccine trial may differ from that in Whites. METHODS In this review, the authors identified HIV vaccine preparedness studies (VPS) in North America in high-risk populations that examined the relationship between race/ethnicity and WTP in a preventive phase 3 HIV vaccine trial, and the relationship to retention. Studies were categorized by risk group, and comparison group (Whites vs. non-Whites). Other types of trials of biomedical prevention were also identified, and WTP and retention rates were compared and contrasted to actual HIV vaccine trials. RESULTS In the studies identified, WTP in a hypothetical trial HIV vaccine trial did not differ by race/ethnicity. In contrast, actual HIV vaccine trials, an HIV acquisition trial, and a phase 2B preexposure prophylaxis (PrEP) trial have enrolled a large percentage of White men. Human papilloma virus (HPV) privately-funded trials have also enrolled a large number of Whites, due to convenience sampling. Retention in the HIV acquisition trial was lower in African-Americans compared with Whites. CONCLUSION Strategies to increase WTP and enhanced retention (ER) strategies may help in recruiting and retaining minority participants in actual HIV vaccine trials and other trials of biomedical prevention.
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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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Ellman TM, Hawkins K, Benitez J, Negron R, Chang S, Palmer S, Robertson V, Chiasson MA, Sobieszczyk ME. Representation of Latinos and Blacks in screening for and enrollment into preventive HIV vaccine trials in New York City. Vaccine 2015; 33:6809-15. [PMID: 26458799 PMCID: PMC5106036 DOI: 10.1016/j.vaccine.2015.09.091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/02/2015] [Accepted: 09/28/2015] [Indexed: 11/23/2022]
Abstract
INTRODUCTION In the United States, Latinos and Blacks are disproportionately affected by HIV/AIDS, but have been underrepresented in HIV vaccine trials. We assessed screening and enrollment of Blacks and Latinos for preventive HIV vaccine trials conducted in New York City, 2009-2012. METHODS A retrospective analysis was conducted among 18-50 year old men and transgender women screening for four preventive phase 1 and 2 HIV vaccine trials. Demographic, recruitment, and behavioral/medical eligibility data and outcome of screening were examined. To determine factors associated with enrollment, a multivariable logistic regression analysis was performed. RESULTS Among 6077 individuals who provided contact information, 2536 completed a phone pre-screen. 96 (1.6% of recruitment contacts) enrolled. Latinos were 35.7% of recruitment contacts, but 17.7% of those enrolled, whereas Blacks were 22.5% and 32.3%, respectively. Among all Latinos, nearly one third were excluded for being uncircumcised, an eligibility criterion for several studies. In multivariable analysis among potentially eligible potential participants, controlling for age and recruitment method, Latinos were less likely than Whites to enroll in a preventive HIV vaccine trial (aOR 0.52, 95% CI 0.28-0.95) whereas Blacks were as likely as Whites (aOR 0.99, 95% CI 0.59-1.67). Individuals recruited through print advertisements, social media/internet, referral, and other modes were more likely to enroll compared to those recruited through in-person outreach, controlling for age and race/ethnicity. CONCLUSIONS Targeted outreach has led to substantial inclusion of Latinos and Blacks, with Blacks comprising almost a third of those enrolled in these preventive HIV vaccine trials. Latinos, however, were less likely to enroll compared to Whites. Circumcision status as an eligibility criterion partly accounts for this, but further studies are warranted to address the reasons Latinos decide not to participate in preventive HIV vaccine trials.
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Affiliation(s)
- Tanya M Ellman
- Division of Infectious Diseases, Department of Medicine, Columbia University, College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA; ICAP, Columbia University, Mailman School of Public Health, 722 West 168th Street, Box 18, New York, NY 10032, USA.
| | - Kellie Hawkins
- Department of Medicine, Columbia University Medical Center, 630 West 168th Street, New York, NY 10032, USA; Division of Infectious Diseases, Department of Medicine, University of Colorado, 12700 E. 19th Avenue, Mail Stop B168, Aurora, CO 80045, USA.
| | - Jorge Benitez
- Division of Infectious Diseases, Department of Medicine, Columbia University, College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Ramon Negron
- Division of Infectious Diseases, Department of Medicine, Columbia University, College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Steven Chang
- Division of Infectious Diseases, Department of Medicine, Columbia University, College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Steven Palmer
- Division of Infectious Diseases, Department of Medicine, Columbia University, College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Verna Robertson
- Division of Infectious Diseases, Department of Medicine, Columbia University, College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
| | - Mary Ann Chiasson
- Public Health Solutions, 40 Worth Street, 5th Floor, New York, NY 10013, USA; Department of Epidemiology, Columbia University, Mailman School of Public Health, 722 West 168th Street, New York, NY 10032, USA
| | - Magdalena E Sobieszczyk
- Division of Infectious Diseases, Department of Medicine, Columbia University, College of Physicians and Surgeons, 630 West 168th Street, New York, NY 10032, USA
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Dhalla S, Poole G. Socioeconomic status and HIV vaccine preparedness studies in North America. Vaccine 2015; 33:2536-45. [PMID: 25820065 DOI: 10.1016/j.vaccine.2015.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 02/21/2015] [Accepted: 03/11/2015] [Indexed: 11/19/2022]
Abstract
Educational level, employment, and income are key components of socioeconomic status (SES). This article is a systematic review of SES variables in North American countries, and their relationship to willingness to participate (WTP) and retention in a hypothetical preventive phase 3 HIV vaccine trial and in actual HIV vaccine trials. Men who have sex with men (MSM) tended to have higher educational levels, be more employed, and had higher income levels than injection drug users (IDU) and women at heterosexual risk (WAHR). In large part, there was no relationship between educational level and WTP, as well as between educational level and retention. Similarly, there was no relationship between employment and WTP. In WAHR who were African-American, those employed were less likely than others to complete the study at 18 months. The exact occupations of participants analyzed have not been specified, and specification of these occupations may help determine whether enhanced retention (ER) strategies are required.
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Affiliation(s)
- Shayesta Dhalla
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
| | - Gary Poole
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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17
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Basta TB, Stambaugh T, Fisher CB. Efficacy of an Educational Intervention to Increase Consent for HIV Testing in Rural Appalachia. ETHICS & BEHAVIOR 2014; 25:125-149. [PMID: 27789935 DOI: 10.1080/10508422.2014.948958] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study sought to assess barriers and enhance readiness to consent to home and Planned Parenthood HIV testing among 60 out-patients from a mental health and substance abuse clinic in rural Appalachia. Testing barriers included not knowing where to get tested, lack of confidentiality, and loss of partners if one tested sero-positive. The intervention yielded lowered HIV stigma, increase in HIV knowledge, and agreement to take the HIV home test. These results are encouraging because they suggest that a brief educational intervention is a critical pathway to the success of the National Institutes on Drug Abuse's Seek, Test, Treat, and Retain initiative in poor rural counties.
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Affiliation(s)
- Tania B Basta
- Department of Social and Public Health, Ohio University
| | | | - Celia B Fisher
- Center for Ethics Education, Department of Psychology, Fordham University
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18
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Castillo-Mancilla JR, Cohn SE, Krishnan S, Cespedes M, Floris-Moore M, Schulte G, Pavlov G, Mildvan D, Smith KY. Minorities remain underrepresented in HIV/AIDS research despite access to clinical trials. HIV CLINICAL TRIALS 2014; 15:14-26. [PMID: 24518211 DOI: 10.1310/hct1501-14] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVE The reasons for minority underrepresentation in HIV/AIDS clinical trials remain unclear. We aimed to evaluate the knowledge, experience, and factors that influence minority participation in HIV/AIDS studies in the United States. METHODS An anonymous, bilingual, self-administered survey on study participation was given to HIV-infected adults attending AIDS Clinical Trials Group-affiliated clinics in the United States and Puerto Rico. Chi-square tests were used to evaluate differences by race, first language, and level of education. Logistic regression was used to estimate odds ratio (OR) and 95% confidence interval (CI) for factors associated with being talked to about participation in a study. RESULTS We analyzed 2,175 complete surveys (221 in Spanish). Among respondents, 31% were White, 40% were Black/African American (AA), and 21% were Hispanic. The overall rate of previous participation in any HIV/AIDS study was 48%. Hispanics were less likely to know about studies compared to Whites and AAs (67% vs 74% and 76%, respectively; P < .001). Compared to Whites, AAs and Hispanics were less likely to have been talked to about participating in a study (76% vs 67% and 67%, respectively; P < .001). The OR for being talked to about participating in a study was 0.65 (95% CI, 0.52-0.81) for AAs and 0.65 (95% CI, 0.49-0.85) for Hispanics, compared to Whites. AAs and Hispanics were more likely to state that studies were not friendly to their race (17% and 10% vs 4%; P < .001). CONCLUSIONS Minorities continue to face barriers for HIV/AIDS trial participation, even when clinical research is available. Enrollment strategies should better target minorities to improve recruitment in HIV/AIDS research.
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Affiliation(s)
| | - Susan E Cohn
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Supriya Krishnan
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, Massachusetts
| | | | | | - Gail Schulte
- Social and Scientific Systems, Silver Spring, Maryland
| | - Gregory Pavlov
- Frontier Science & Technology Research Foundation, Inc, Amherst, New York
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George S, Duran N, Norris K. A systematic review of barriers and facilitators to minority research participation among African Americans, Latinos, Asian Americans, and Pacific Islanders. Am J Public Health 2014; 104:e16-31. [PMID: 24328648 PMCID: PMC3935672 DOI: 10.2105/ajph.2013.301706] [Citation(s) in RCA: 945] [Impact Index Per Article: 94.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2013] [Indexed: 11/04/2022]
Abstract
To assess the experienced or perceived barriers and facilitators to health research participation for major US racial/ethnic minority populations, we conducted a systematic review of qualitative and quantitative studies from a search on PubMed and Web of Science from January 2000 to December 2011. With 44 articles included in the review, we found distinct and shared barriers and facilitators. Despite different expressions of mistrust, all groups represented in these studies were willing to participate for altruistic reasons embedded in cultural and community priorities. Greater comparative understanding of barriers and facilitators to racial/ethnic minorities' research participation can improve population-specific recruitment and retention strategies and could better inform future large-scale prospective quantitative and in-depth ethnographic studies.
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Affiliation(s)
- Sheba George
- Sheba George is with the Center for Biomedical Informatics, Charles R. Drew University of Medicine and Science, and the Department of Community Health Sciences, University of California Los Angeles (UCLA) Fielding School of Public Health, Los Angeles. Nelida Duran is with the Department of Community Health Sciences, UCLA Fielding School of Public Health. Keith Norris is with the Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles
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20
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Lee S, Kapogiannis BG, Flynn PM, Rudy BJ, Bethel J, Ahmad S, Tucker D, Abdalian SE, Hoffman D, Wilson CM, Cunningham CK. Comprehension of a simplified assent form in a vaccine trial for adolescents. JOURNAL OF MEDICAL ETHICS 2013; 39:410-2. [PMID: 23349510 PMCID: PMC3655100 DOI: 10.1136/medethics-2012-101286] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Future HIV vaccine efficacy trials with adolescents will need to ensure that participants comprehend study concepts in order to confer true informed assent. A Hepatitis B vaccine trial with adolescents offers valuable opportunity to test youth understanding of vaccine trial requirements in general. METHODS Youth reviewed a simplified assent form with study investigators and then completed a comprehension questionnaire. Once enrolled, all youth were tested for HIV and confirmed to be HIV-negative. RESULTS 123 youth completed the questionnaire (mean age=15 years; 63% male; 70% Hispanic). Overall, only 69 (56%) youth answered all six questions correctly. CONCLUSIONS Youth enrolled in a Hepatitis B vaccine trial demonstrated variable comprehension of the study design and various methodological concepts, such as treatment group masking.
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Affiliation(s)
- Sonia Lee
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Maternal Pediatric Infectious Disease Branch, Bethesda, Maryland, USA.
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Pérez-Guerra CL, Rodríguez-Acosta RL, Soto-Gómez E, Zielinski-Gutierrez E, Peña-Orellana M, Santiago LM, Rivera R, Cruz RR, Ramírez V, Tomashek KM, Dayan G. Assessing the interest to participate in a dengue vaccine efficacy trial among residents of Puerto Rico. Hum Vaccin Immunother 2012; 8:905-15. [PMID: 22832259 DOI: 10.4161/hv.20056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Dengue, endemic in Puerto Rico, is a major public health problem. Vaccines are thought the best means to prevent dengue because vector control alone has been largely ineffective. We implemented qualitative studies in 2006 and 2010 to determine the acceptability of conducting placebo-controlled dengue vaccine efficacy trials in Puerto Rican children. Key informant interviews and focus groups with parents and children were conducted in municipalities with high dengue incidence. We used structured open-ended questions to determine motivators and attitudes regarding vaccine trial participation. Knowledge about dengue risk and prevention, and knowledge, attitudes, and beliefs regarding vaccines and vaccine trials were assessed. Using grounded theory, we conducted content analysis and established categories and sub-categories of participant responses. All participants were knowledgeable about dengue prevention and perceived children as most affected age groups. Participants were aware of vaccines benefits and they thought a vaccine could prevent dengue. However, most would not allow their children to participate in a placebo-controlled vaccine trial. Barriers included lack of trust in new vaccines and vaccine trial procedures; fear of developing dengue or side effects from the vaccine and lack of information about candidate dengue vaccines. Participants thought information, including results of previous trials might overcome barriers to participation. Motivators for participation were altruism, protection from dengue, free medical attention, and compensation for transportation and participation. Parents would consider children participation if accurate vaccine trial information is provided.
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Affiliation(s)
- Carmen L Pérez-Guerra
- Dengue Branch, Division of Vector Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, San Juan, Puerto Rico.
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Park JN, White B, Bates A, Enriquez J, Liao L, Maher L. Motivators and barriers influencing willingness to participate in candidate HCV vaccine trials: perspectives of people who inject drugs. Drug Alcohol Depend 2012; 123:35-40. [PMID: 22071117 DOI: 10.1016/j.drugalcdep.2011.10.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 10/13/2011] [Accepted: 10/13/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND A safe and efficacious vaccine may be the most efficient and cost-effective strategy for controlling the hepatitis C virus (HCV) epidemic among people who inject drugs (PWID) and several candidates are in development. However, little is known about the factors that influence willingness to participate (WTP) in candidate HCV vaccine trials among this group. METHODS HCV seronegative PWID recruited between 2008 and 2010 as part of a prospective observational cohort study in Sydney, Australia were asked whether they would be willing to participate in a future candidate hepatitis C vaccine trial and to provide reasons to explain their decision. RESULTS Of 113 participants, 74% indicated WTP, 15% were unwilling to participate and 11% reported WTP that was contingent on vaccine characteristics and trial design issues. The most commonly reported motivator for hypothetical trial participation was altruism, followed by potential health benefits, financial remuneration, and knowledge gain. Barriers to hypothetical participation included fears about possible harms to health, such as concerns about vaccine safety, side effects, and acquiring HCV from the vaccine; other barriers included mistrust of biomedical research and time constraints. CONCLUSIONS These results may be useful in designing strategies to enhance HCV vaccine trial recruitment and retention and have ethical implications for developing informed consent processes and standards of care.
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Affiliation(s)
- Ju Nyeong Park
- The Kirby Institute, University of New South Wales, Centre for Immunology, Cnr Boundary and West Streets, Darlinghurst, NSW 2010, Australia
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Magyar MS, Edens JF, Epstein M, Stiles PG, Poythress NG. Examining attitudes about and influences on research participation among forensic psychiatric inpatients. BEHAVIORAL SCIENCES & THE LAW 2012; 30:69-86. [PMID: 22259125 DOI: 10.1002/bsl.1997] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Revised: 11/12/2011] [Accepted: 11/28/2011] [Indexed: 05/31/2023]
Abstract
Although a growing body of research has examined various types of coercive practices that may occur among psychiatric patients over the years, almost no attention has been given to coercive influences that may occur specifically in the context of recruitment into research projects. Particularly for those who are institutionalized (e.g., in-patient insanity acquittees), there are significant concerns that their autonomous decision-making to consent or not may be significantly impaired due to the highly restrictive and controlled environment in which they live. This exploratory study sought to examine patients' perceptions of coercive influences by presenting them with hypothetical research vignettes regarding possible recruitment into either a biomedical or social-behavioral research project. Among 148 multi-ethnic male and female participants across two facilities, participants reported relatively minimal perceptions that their autonomous decision-making would be impacted or that various potentially coercive factors (e.g., pressures from staff) would impair their free choice to participate (or not) in such research. To the extent that such perceptions of coercion did occur, they were moderately associated with patients' more general personality traits and attitudinal variables, such as alienation and external locus of control. Limitations of this study and their implications for future research are discussed.
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Affiliation(s)
- Melissa S Magyar
- Department of Psychology, Texas A&M University, College Station, TX, USA
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Vissman AT, Hergenrather KC, Rojas G, Langdon SE, Wilkin AM, Rhodes SD. Applying the theory of planned behavior to explore HAART adherence among HIV-positive immigrant Latinos: elicitation interview results. PATIENT EDUCATION AND COUNSELING 2011; 85:454-460. [PMID: 21208772 DOI: 10.1016/j.pec.2010.12.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 11/14/2010] [Accepted: 12/06/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE This study explored influences on intention to adhere to highly active antiretroviral therapy (HAART) among immigrant Latinos living with HIV/AIDS in the southeastern USA. METHODS Our community-based participatory research (CBPR) partnership completed individual in-depth interviews with 25 immigrant Latinos, based on the theory of planned behavior (TPB), to explore beliefs toward HAART adherence and HIV testing. RESULTS Participants identified (a) seven outcomes of treatment adherence (e.g., "feeling good" and "controlling the virus"), (b) six groups of persons influencing adherence (e.g., family, partner/spouse), and (c) nine impediments to adherence (e.g., appointment scheduling, side effects of treatment). Fear of deportation, perceived costs of services, and barriers to communication emerged as impediments to both HAART adherence and HIV testing. CONCLUSION The findings suggest the utility of TPB in identifying factors to enhance HAART adherence among immigrant Latinos. Future research should explore the extent to which these identified TPB components quantitatively influence adherence intention and immunological and virological outcomes. PRACTICE IMPLICATIONS Culturally congruent interventions for immigrant Latinos may need to focus on facilitators of adherence, influential referent groups, and destigmatizing HIV/AIDS.
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Affiliation(s)
- Aaron T Vissman
- Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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Nyblade L, Singh S, Ashburn K, Brady L, Olenja J. "Once I begin to participate, people will run away from me": understanding stigma as a barrier to HIV vaccine research participation in Kenya. Vaccine 2011; 29:8924-8. [PMID: 21964057 DOI: 10.1016/j.vaccine.2011.09.067] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 09/02/2011] [Accepted: 09/14/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE Participation of volunteers in clinical research is essential to the development of effective HIV prevention methods, including an HIV vaccine. This study expands current knowledge of stigma and discrimination related to participation in HIV vaccine research in sub-Saharan Africa by exploring the perception of stigma and discrimination as a barrier to participation in HIV vaccine research in Kenya. METHODS Eighteen focus groups with a total of 133 participants and 82 individual interviews were conducted with a range of respondents at two centers in Nairobi, Kenya: a preventive AIDS vaccine trial center; and a preparatory clinical and epidemiological study center. Respondents included peer leaders, community advisory board members, former and current volunteers in clinical research, study staff, community leaders and community members. Data were analyzed using an iterative coding process. RESULTS Four prominent stigma-related barriers to participation emerged among all respondent groups, across both centers: (1) volunteers are often assumed by family and community members to be HIV positive because of their participation in vaccine research; (2) HIV-related stigma is perceived as pervasive and damaging in the communities where volunteers live, thus they fear consequent stigma if people believe them to be HIV positive; (3) potential volunteers fear being tested for HIV, a prerequisite for participation, because of possible disclosure of HIV status in communities with high perceived HIV-related stigma; and (4) volunteers must carefully manage information about their participation because of misperceptions and assumptions about vaccine research volunteers. CONCLUSIONS HIV-related stigma and discrimination influence people's decisions to join HIV-vaccine related research. Findings underscore a need for integration of stigma-reduction programming into education and outreach activities for volunteers, and the communities in which they live. This is particularly critical for trials recruiting individuals with higher HIV risk, who are often already highly stigmatized.
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Affiliation(s)
- Laura Nyblade
- Research Triangle Institute International, 805 15th St, NW, Suite 601, Washington, DC 20005, USA.
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Polanco FR, Dominguez DC, Grady C, Stoll P, Ramos C, Mican JM, Miranda-Acevedo R, Morgan M, Aizvera J, Purdie L, Koziol D, Rivera-Goba MV. Conducting HIV research in racial and ethnic minority communities: building a successful interdisciplinary research team. J Assoc Nurses AIDS Care 2011; 22:388-96. [PMID: 21277228 PMCID: PMC3097304 DOI: 10.1016/j.jana.2010.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Accepted: 10/24/2010] [Indexed: 11/28/2022]
Abstract
HIV infection occurs in disproportionately high rates among racial and ethnic minorities in the United States, making it imperative that individuals from these groups be included in research studies. However, it is often difficult to recruit HIV-infected Hispanics and African Americans in clinical trials, but a skilled interdisciplinary team that includes researchers with racial and ethnic diversity can help. This article describes a successful approach for building an interdisciplinary team that values the participation of racial and ethnic minorities in clinical trials and has the skills to work with these groups. The success of the Adelante (a Spanish word meaning forward) Team can be attributed to team members who actively participate in decision-making, are empowered, and function in a cohesive manner. Successful research teams build relationships with research participants to increase the probability that racial and ethnic minorities will enroll and participate fully in research.
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Affiliation(s)
- Frinny R Polanco
- Nursing and Patient Care Services, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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Barriers of enrolment in HIV vaccine trials: a review of HIV vaccine preparedness studies. Vaccine 2011; 29:5850-9. [PMID: 21740947 DOI: 10.1016/j.vaccine.2011.06.055] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 05/31/2011] [Accepted: 06/14/2011] [Indexed: 11/22/2022]
Abstract
Barriers to participation in an HIV vaccine trial have been examined in many HIV vaccine preparedness studies (VPS). These barriers can be understood in terms of the locus of the barrier (personal vs. social) and the nature of the barrier (risk vs. cost). Another type of barrier is perceived misconceptions. In this systematic review, we categorize barriers, and compare these barriers between the Organization for Economic Co-operation and Development (OECD) countries and the non-OECD countries. In the OECD countries, we retrieved 25 studies reporting personal risks (PR), 9 studies reporting social risks (SR), 10 studies reporting personal costs (PC), and 16 studies reporting misconceptions. In the non-OECD countries, we retrieved 27 studies reporting PR, 19 studies reporting SR, 18 studies reporting PC, 1 study reporting social costs (SC), and 13 studies reporting misconceptions. Important PR were "adverse effects" and "vaccine-induced seropositivity", "distrust of institutions", and "temptation to have unsafe sex" in men who have sex with men (MSM). "Discrimination" was a common SR. "Time commitment" was an important PC, and "family commitments" were a SC in one non-OECD country. "HIV infection from the vaccine" was a common misconception. Both the OECD and the non-OECD countries have similar barriers, and people's decisions to participate in a clinical trial involve multiple barriers. However, these barriers apply to hypothetical HIV vaccine trials, and barriers for actual vaccine trials need further assessment.
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Balfour L, Corace K, Tasca GA, Tremblay C, Routy JP, Angel JB. Altruism motivates participation in a therapeutic HIV vaccine trial (CTN 173). AIDS Care 2011; 22:1403-9. [PMID: 20936540 DOI: 10.1080/09540121003693522] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This is the first study examining motivation to participate in an HIV therapeutic vaccine trial of Remune and ALVAC. Trial participants (N=49) completed psychological measures at baseline. While 69% reported some personal risk in participating, 100% felt hopeful for societal benefits. Trial participants also reported high levels of existential well-being (e.g., "I believe there is some real purpose for my life"). Results suggest that HIV therapeutic vaccine trial participants are highly motivated by altruism and that participating in research may contribute meaning to living with HIV. Fostering altruism and responsibly promoting the societal benefits of research may facilitate trial participation.
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So different, yet so similar: meta-analysis and policy modeling of willingness to participate in clinical trials among Brazilians and Indians. PLoS One 2010; 5:e14368. [PMID: 21179556 PMCID: PMC3002940 DOI: 10.1371/journal.pone.0014368] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Accepted: 09/08/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND With the global expansion of clinical trials and the expectations of the rise of the emerging economies known as BRICs (Brazil, Russia, India and China), the understanding of factors that affect the willingness to participate in clinical trials of patients from those countries assumes a central role in the future of health research. METHODS We conducted a systematic review and meta-analysis (SRMA) of willingness to participate in clinical trials among Brazilian patients and then we compared it with Indian patients (with results of another SRMA previously conducted by our group) through a system dynamics model. RESULTS Five studies were included in the SRMA of Brazilian patients. Our main findings are 1) the major motivation for Brazilian patients to participate in clinical trials is altruism, 2) monetary reimbursement is the least important factor motivating Brazilian patients, 3) the major barrier for Brazilian patients to not participate in clinical trials is the fear of side effects, and 4) Brazilian patients are more likely willing to participate in clinical trials than Indians. CONCLUSION Our study provides important insights for investigators and sponsors for planning trials in Brazil (and India) in the future. Ignoring these results may lead to unnecessary fund/time spending. More studies are needed to validate our results and for better understanding of this poorly studied theme.
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Candidate hepatitis C vaccine trials and people who inject drugs: challenges and opportunities. Vaccine 2010; 28:7273-8. [PMID: 20831914 DOI: 10.1016/j.vaccine.2010.08.085] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Revised: 08/17/2010] [Accepted: 08/24/2010] [Indexed: 12/23/2022]
Abstract
People who inject drugs (PWID) are at high risk of HCV. Limited evidence of the effectiveness of prevention interventions and low uptake of treatment in this group highlight the need for increased investment in biomedical interventions, notably safe and efficacious vaccines. While several candidates are currently in development, field trials in PWID present challenges, including ethical issues associated with trial literacy, informed consent and standards of care. Significant biological and social factors and differences between HIV and HCV suggest that HCV warrants targeted vaccine preparedness research to lay the groundwork for successful implementation of future trials.
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Abstract
This research used open-ended and true-false questions to assess the preparedness of 96 ethnically diverse, economically and socially marginalized adult street drug users to consent to participate in HIV vaccine trials (HVT). Specific areas of consent vulnerability included misconceptions about: (1) the recuperative value and risk of vaccines in general; (2) the presence of the HIV virus within the vaccine and the possibility of contracting or transmitting HIV as a consequence of participation; (3) inclusion criteria and experimental blinds; and (4) distrust in the medical and research establishments. A brief HVT lesson administered to 30 participants was effective in correcting specific HVT knowledge misperceptions and increasing certain, but not all areas of HVT trust. Assessment of post-lesson responses to ethics-relevant questions provides information on respondents' attitudes toward AIDS safe behavior, research risks and benefits, monetary compensation, and willingness to participate. Implications for enhancing informed consent for HVT involving active drug users are discussed.
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Affiliation(s)
- Celia B Fisher
- Center for Ethics Education and Department of Psychology, Fordham University, Dealy Hall, 441 East Fordham Road, Bronx, NY 10458, USA.
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Abstract
OBJECTIVE To conduct a systematic review of the literature to examine HIV vaccine acceptability and factors impacting acceptability of future HIV vaccines. DESIGN Systematic review and meta-analysis of peer-reviewed articles that assessed HIV vaccine acceptability. METHODS We used a comprehensive search strategy across multiple electronic databases to locate original quantitative or qualitative studies that examined rates or correlates of HIV vaccine acceptability. We conducted meta-analysis on studies reporting correlates or predictors of HIV vaccine acceptability. RESULTS Twenty studies (n=7576) reported HIV vaccine acceptability ranging from 37.2 to 94.0 on a 100-point scale; weighted mean acceptability =65.6 (SD=21.1). Eleven studies compared HIV vaccine acceptability at high (80-95%) efficacy (mean =73.8; SD=9.2) versus moderate (50%) efficacy (mean =40.4; SD=20.2). Among 13 studies (n=5023) included in meta-analysis, efficacy and non 'risk group' membership had medium effect sizes, and pragmatic obstacles, cost, perceived susceptibility to HIV infection, side effects/safety concerns, fear of vaccines, perceived vaccine benefits, duration of protection, and ethnicity had small effect sizes on HIV vaccine acceptability. CONCLUSION Public health strategies to promote the benefits of partial efficacy HIV vaccines and accurate HIV risk perceptions, and to dispel vaccine fears, along with structural interventions to subsidize vaccine costs and facilitate access, may increase future HIV vaccine uptake and, in turn, the effectiveness of HIV vaccines in controlling the epidemic.
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Tarimo EAM, Thorson A, Kohi TW, Mwami J, Bakari M, Sandström E, Kulane A. Balancing collective responsibility, individual opportunities and risks: a qualitative study on how police officers reason around volunteering in an HIV vaccine trial in Dar es Salaam, Tanzania. BMC Public Health 2010; 10:292. [PMID: 20509908 PMCID: PMC2888745 DOI: 10.1186/1471-2458-10-292] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 05/28/2010] [Indexed: 11/21/2022] Open
Abstract
Background Results from HIV vaccine trials on potential volunteers will contribute to global efforts to develop an HIV vaccine. The purpose of this study among police officers in Dar es Salaam, Tanzania, was to explore the underlying reasons that induce people to enrol in an HIV vaccine trial. Methods We conducted discussions with eight focus groups, containing a total of 66 police officers. The information collected was analyzed using interpretive description. Results The results showed that participants were motivated to participate in the trial by altruism, and that the participants experienced some concerns about their participation. They stated that altruism in the fight against HIV infection was the main reason for enrolling in the trial. However, young participants were seriously concerned about a possible loss of close relationships if they enrolled in the HIV vaccine trial. Both men and women feared the effect of the trial on their reproductive biology, and they feared interference with pregnancy norms. They were unsure about risks such as the risks of acquiring HIV infection and of suffering physical harm, and they were unsure of the intentions of the researchers conducting the trial. Further, enrolling in the trial required medical examination, and this led some participants to fear that unknown diseases would be revealed. Other participants, however, saw an opportunity to obtain free health services. Conclusions We have shown that specific fears are important concerns when recruiting volunteers to an HIV vaccine trial. More knowledge is needed to determine participants' views and to ensure that they understand the conduct of the trial and the reasons it is being carried out.
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Affiliation(s)
- Edith A M Tarimo
- Division of Global Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
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Langford A, Resnicow K, An L. Clinical trial awareness among racial/ethnic minorities in HINTS 2007: sociodemographic, attitudinal, and knowledge correlates. JOURNAL OF HEALTH COMMUNICATION 2010; 15 Suppl 3:92-101. [PMID: 21154086 PMCID: PMC4013828 DOI: 10.1080/10810730.2010.525296] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The purpose of this study was (1) to examine the association of race/ethnicity on clinical trial awareness, controlling for several sociodemographic, attitudinal, and knowledge variables, and (2) to inform future communication campaigns to increase clinical trial awareness and participation. Secondary analysis was conducted among 6,754 Hispanic, Black, and White adult respondents to the National Cancer Institute's 2007 Health Information National Trends Survey (HINTS). The dependent variable was awareness of clinical trials. Logistic regression was used to examine possible correlates of clinical trial awareness including sociodemographics, trust of sources of health information, beliefs about safety of health information, family/personal history of cancer, health seeking information, and awareness of three health agencies. Compared with Whites, Blacks and Hispanics were significantly less likely to have heard of a clinical trial. Other significant correlates of clinical trial awareness included education, income, belief that health information is safely guarded, family history of cancer, awareness of the Centers for Disease control, trust of health information from the Internet and charitable organizations, and distrust of health information from religious institutions. Blacks and Hispanics are significantly less aware of clinical trials. Campaigns that exploit unique beliefs and delivery channels for racial/ethnic subgroups should be considered.
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Affiliation(s)
- Aisha Langford
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 109 South Observatory, Ann Arbor, MI 48109, USA.
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Engaging members of African American and Latino communities in preventive HIV vaccine trials. J Acquir Immune Defic Syndr 2009; 51:194-201. [PMID: 19504752 DOI: 10.1097/qai.0b013e3181990605] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND African Americans (AAs) and Latinos in United States bear a disproportionate burden of HIV infection, yet remain underrepresented in HIV vaccine trials. The success in engaging and enrolling AAs and Latinos in phase 1 and phase 2 vaccine trials at 2 research sites in New York City is described. METHODS A retrospective analysis of 1683 HIV-uninfected individuals who completed > or = 1 stage of the screening process from 2002 to 2006. Data on sociodemographic, behavioral characteristics, medical eligibility, and enrollment in National Institutes of Health-sponsored vaccine trials were collected. RESULTS 7.5% of screening participants completed enrollment; 33% were AAs, 24% Latinos. The proportion of enrollees did not differ significantly by race/ethnicity. Low-risk vs. high-risk AAs (49% vs. 23%, P = 0.006) and high-risk vs. low-risk Latinos (31% vs. 13%, P = 0.006) were more likely to enroll. Among them, loss to follow-up was the most common reason for not completing screening. In multivariate analysis, older participants, high-risk men, and high-risk women were more likely to complete enrollment. CONCLUSIONS Once potential minority participants are identified and engaged in the screening process, it is possible to enroll them at rates comparable to white participants. Experience at these sites suggests that the challenge in achieving high rates of minority participation is in increasing the initial pool of candidates prescreening for HIV vaccine studies.
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Lau CY, Stansbury JP, Gust DA, Kafaar Z. Social and behavioral science in HIV vaccine trials: a gap assessment of the literature. Expert Rev Vaccines 2009; 8:179-90. [PMID: 19196198 DOI: 10.1586/14760584.8.2.179] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Social and behavioral science research is integral to the conduct of HIV vaccine trials, especially because the vaccine targets an infection laden with sensitive human issues. Although social and behavioral sciences have played a larger role in HIV vaccine clinical trials than other vaccine clinical trials to date, this role should be expanded. Fortunately, related publications, conference coverage and research proposals are on the rise; community engagement is receiving more attention during the earlier stages of product development; and collaboration between HIV vaccine scientists and social and behavioral scientists is being fostered. Greater attention to social and behavioral science issues could not only facilitate accrual, but also improve research efficiency and relevance. In this review, gaps in the literature on social and behavioral science issues in HIV vaccine clinical research, including barriers and facilitators to trial participation, enhancing feasibility of trial success, health systems, policy and monitoring social and behavioral issues, are identified and directions are suggested for filling those gaps. Development of a safe, efficacious and acceptable HIV vaccine will be nurtured by addressing the gaps through interdisciplinary collaborations.
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Affiliation(s)
- Chuen-Yen Lau
- Vaccine Clinical Research Branch, Vaccine Research Program, National Institute of Allergy and Infectious Disease, National Institutes of Health, 6700 B Rockledge, Room 5126, Bethesda, MD 20817, USA.
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Lee SJ, Brooks RA, Newman PA, Seiden D, Sangthong R, Duan N. HIV vaccine acceptability among immigrant Thai residents in Los Angeles: a mixed-method approach. AIDS Care 2009; 20:1161-8. [PMID: 18608068 DOI: 10.1080/09540120701855375] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study examined HIV vaccine acceptability among immigrant Thai residents in Los Angeles, California. We combined a qualitative research method (focus groups) with an innovative market research method (conjoint analysis). Focus groups explored social issues, concerns, barriers and motivators associated with HIV vaccine acceptability. Conjoint analysis was used to assess preferences among eight hypothetical HIV vaccines with varying attribute profiles and the impact of various attributes on acceptability. Five main themes were identified in the focus groups regarding acceptance and utilization of preventive HIV vaccines: (1) vaccine characteristics, such as efficacy, physical side-effects and cost, (2) fear of a vaccine, (3) vaccine acceptability and optimism, (4) social and family responses and (5) behavioral disinhibition. Conjoint analysis revealed HIV vaccine acceptability ranging from 7.4 (SD = 19.4) to 85.2 (SD = 24.3) across eight hypothetical vaccines. The vaccine with the highest acceptability had the following attributes: 99% efficacy, no side-effects, 10 years of protection, protects against one sub-type, free, one dose and given by injection. Vaccine efficacy had the greatest impact on acceptability (51.4, p=.005), followed by side-effects (11.1, p=.005) and duration of protection (8.3, p=.005). Despite some apprehensions and concerns, Thai residents perceived an HIV vaccine as making an important contribution to society and to protecting oneself and one's family from HIV infection. Nevertheless, acceptability of a partially efficacious vaccine may be low, suggesting the need for tailored social marketing interventions that might emphasize a collectivistic rather than an individualistic focus. Assessing HIV vaccine acceptability using a mixed-method approach is feasible with Thai residents and should lend itself to HIV vaccine research with other Asian Pacific Islander populations in the US.
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Affiliation(s)
- Sung-Jae Lee
- Center for HIV Identification, Prevention, and Treatment Services, Semel Institute Center for Community Health, University of California, Los Angeles, CA, USA.
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Mahajan AP, Sayles JN, Patel VA, Remien RH, Sawires SR, Ortiz DJ, Szekeres G, Coates TJ. Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward. AIDS 2008; 22 Suppl 2:S67-79. [PMID: 18641472 PMCID: PMC2835402 DOI: 10.1097/01.aids.0000327438.13291.62] [Citation(s) in RCA: 803] [Impact Index Per Article: 50.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although stigma is considered a major barrier to effective responses to the HIV/AIDS epidemic, stigma reduction efforts are relegated to the bottom of AIDS programme priorities. The complexity of HIV/AIDS-related stigma is often cited as a primary reason for the limited response to this pervasive phenomenon. In this paper, we systematically review the scientific literature on HIV/AIDS-related stigma to document the current state of research, identify gaps in the available evidence and highlight promising strategies to address stigma. We focus on the following key challenges: defining, measuring and reducing HIV/AIDS-related stigma as well as assessing the impact of stigma on the effectiveness of HIV prevention and treatment programmes. Based on the literature, we conclude by offering a set of recommendations that may represent important next steps in a multifaceted response to stigma in the HIV/AIDS epidemic.
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Affiliation(s)
- Anish P Mahajan
- UCLA Program in Global Health, University of California, Los Angeles, California 90024, USA.
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Newman PA, Duan N, Kakinami L, Roberts K. What can HIV vaccine trials teach us about future HIV vaccine dissemination? Vaccine 2008; 26:2528-36. [PMID: 18420313 PMCID: PMC2715699 DOI: 10.1016/j.vaccine.2008.03.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2007] [Revised: 03/06/2008] [Accepted: 03/09/2008] [Indexed: 10/22/2022]
Abstract
This investigation explored commonalities and differences in barriers and motivators to HIV vaccine trial participation and acceptability of future U.S. Food and Drug Administration (FDA)-approved HIV vaccines in order to identify implications of clinical trials for future HIV vaccine dissemination. Fifteen focus groups were conducted with 157 predominately ethnic minority and low income participants recruited using venue-based sampling in Los Angeles. Data were analyzed using narrative thematic analysis. Barriers and motivators in common across willingness to participate (WTP) in HIV vaccine trials and future HIV vaccine acceptability (e.g., concerns about vaccine-induced infection, false-positives, side effects, efficacy, mistrust and stigma) suggest clinical trials present significant opportunities to develop and evaluate empirically based interventions to support future HIV vaccine dissemination. Barriers specific to HIV vaccine acceptability (e.g., concerns about duration of protection, cross-clade protection, cost and access) also indicate the need for formative research focused specifically on future dissemination. Protection motivation, common to WTP and acceptability, highlights the need to provide and evaluate prevention counseling and education in clinical trials, which may form the basis of evidence-informed preventive interventions to be launched in tandem with dissemination of partial efficacy HIV vaccines.
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Affiliation(s)
- Peter A Newman
- University of Toronto, Centre for Applied Social Research, Faculty of Social Work, 246 Bloor Street West, Toronto, Ontario, Canada M5S 1A1.
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Gray K, Legg K, Sharp A, Mackie N, Olarinde F, De Souza C, Weber J, Peters B. Participation in two phase II prophylactic HIV vaccine trials in the UK. Vaccine 2008; 26:2919-24. [PMID: 18450339 DOI: 10.1016/j.vaccine.2008.03.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2007] [Revised: 03/14/2008] [Accepted: 03/19/2008] [Indexed: 10/22/2022]
Abstract
There will be a continued imperative to recruit large numbers of healthy volunteers to early phase prophylactic HIV vaccine (PHV) trials. We studied mechanisms associated with participation in two related phase II PHV trials. The most cited reasons for volunteering were altruism and a personal connection to HIV. The most successful recruiting strategies targeted organisations dealing with HIV, health or social issues, or were directed to large audiences through the mass media. However, circulated emails and word of mouth were the most resource-effective approaches. Group discussions and the collection of a pool of potential volunteers were much less effective than one-to-one discussions and immediate screening after recruitment. We utilised our findings to devise key recommendations to assist PHV trial teams who are planning future studies.
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Affiliation(s)
- Kimberly Gray
- King's College London, Guy's and St. Thomas' Hospitals, UK.
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Rolling up our sleeves now to reap the benefits later: preparing the community for an adolescent HIV vaccine. Curr Opin HIV AIDS 2007; 2:375-84. [DOI: 10.1097/coh.0b013e3282cecf0a] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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