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Psaros C, Goodman GR, Lee JS, Rice W, Kelley CF, Oyedele T, Coelho LE, Phanuphak N, Singh Y, Middelkoop K, Griffith S, McCauley M, Rooney J, Rinehart AR, Clark J, Go V, Sugarman J, Fields SD, Adeyeye A, Grinsztejn B, Landovitz RJ, Safren SA. HPTN 083-02: factors influencing adherence to injectable PrEP and retention in an injectable PrEP study. J Int AIDS Soc 2024; 27:e26252. [PMID: 38783534 PMCID: PMC11116478 DOI: 10.1002/jia2.26252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 04/12/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION HPTN 083 demonstrated the superiority of long-acting cabotegravir (CAB-LA) versus daily oral emtricitabine/tenofovir disoproxil fumarate (TDF/FTC) as pre-exposure prophylaxis (PrEP) among cisgender men and transgender women who have sex with men (MSM/TGW). HPTN 083 provided the first opportunity to understand experiences with injectable PrEP in a clinical trial. METHODS Participants from two US sites (Chicago, IL and Atlanta, GA) and one international site (Rio de Janeiro, Brazil) were purposively sampled for individual qualitative interviews (N = 40), between November 2019 and March 2020, to explore trial experiences, barriers to adherence and other factors that may have impacted study implementation or outcomes. The blinded phase ended early due to efficacy; this analysis includes interviews conducted prior to unblinding with three groups defined by adherence (i.e. injection visit attendance): adherent (n = 27), non-adherent (n = 12) and early discontinuers (n = 1). Data were organized using NVivo software and analysed using content analysis. RESULTS Participants (mean age: 27) were primarily cisgender MSM (90%) and Black/African American (60%). Reasons for trial enrolment and PrEP use included a preference for using HIV prevention medication versus treatment in the event of HIV acquisition; the ability to enhance health via study-related education and services; access to a novel, convenient HIV prevention product at no cost; and contributing to MSM/TGW communities through research. Participants contrasted positive experiences with study staff with their routine clinical care, and emphasized increased scheduling flexibility, thorough communication, non-judgemental counselling and open, affirming environments (e.g. compassion, less stigma) as adherence facilitators. Injection experiences were positive overall; some described early injection-related anxiety, which abated with time and when given some measure of control (e.g. pre-injection countdown), and minimal injection site discomfort. Some concerns and misperceptions about injectable PrEP were reported. Barriers to adherence, across all adherence categories, included structural factors (e.g. financial constraints, travel) and competing demands (e.g. work schedules). CONCLUSIONS Respondents viewed injectable PrEP trial participation as a positive experience and a means of enhancing wellbeing. Study site flexibility and affirming clinic environments, inclusive of non-judgemental counselling, were key facilitators of adherence. To support injection persistence, interventions that address structural barriers and promote flexible means of injection delivery may be most effective.
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Affiliation(s)
- Christina Psaros
- Department of PsychiatryMassachusetts General HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Georgia R. Goodman
- Department of PsychiatryMassachusetts General HospitalBostonMassachusettsUSA
- Department of Emergency MedicineBrigham and Women's HospitalBostonMassachusettsUSA
| | - Jasper S. Lee
- Department of PsychiatryMassachusetts General HospitalBostonMassachusettsUSA
| | - Whitney Rice
- Department of BehavioralSocial and Health Education SciencesEmory University Rollins School of Public HealthAtlantaGeorgiaUSA
| | - Colleen F. Kelley
- Division of Infectious DiseasesDepartment of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | | | - Lara E. Coelho
- Instituto Nacional de Infectologia Evandro Chagas‐FiocruzRio de JaneiroBrazil
| | - Nittaya Phanuphak
- Institute of HIV Research and InnovationBangkokThailand
- Center of Excellence in Transgender HealthChulalongkorn UniversityBangkokThailand
| | - Yashna Singh
- Desmond Tutu HIV CentreUniversity of Cape TownCape TownSouth Africa
| | - Keren Middelkoop
- Desmond Tutu HIV CentreUniversity of Cape TownCape TownSouth Africa
- Department of MedicineUniversity of Cape TownCape TownSouth Africa
| | | | | | | | | | - Jesse Clark
- Division of Infectious DiseasesDepartment of MedicineDavid Geffen School of MedicineUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Vivian Go
- Department of Health BehaviorUniversity of North Carolina Gillings School of Global Public HealthChapel HillNorth CarolinaUSA
| | - Jeremy Sugarman
- Berman Institute of Bioethics and School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Sheldon D. Fields
- Ross and Carol Nese College of NursingThe Pennsylvania State UniversityUniversity ParkPennsylvaniaUSA
| | - Adeola Adeyeye
- Nigeria Country OfficeUS Centers for Disease Control and PreventionAbujaNigeria
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas‐FiocruzRio de JaneiroBrazil
| | - Raphael J. Landovitz
- Center for Clinical AIDS Research and EducationDavid Geffen School of MedicineUniversity of CaliforniaLos AngelesCaliforniaUSA
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Gómez W, Schustack A, Carrico AW, Ramirez-Forcier J, Batchelder A. In the Interest of Time: Assessing the Role of Resilience Across an Intergenerational Sample of People Living with HIV. Int J Behav Med 2024; 31:315-324. [PMID: 37438561 DOI: 10.1007/s12529-023-10198-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Biomedical advances have improved the quality of life of people living with HIV (PLWH); however, barriers to optimal well-being remain. A key feature in understanding the lived experiences of PLWH is resilience. The concept of resilience is quite complex in terms of its antecedents and expressions, suggesting the need for more nuanced understandings of how it could be harnessed to better support this population. METHOD The concept of resilience was explored in a qualitative study involving 22 PLWH, selectively sampled by era of diagnosis. Through interviews focused on context and experiences of living with HIV, the sample highlighted resilience processes corresponding to Positive reappraisal of life events, Positive reappraisal of self, and Community as resilience. RESULTS Participants who have lived with HIV longer more commonly described engaging in psychological processes of resilience, whereas those who were more recently diagnosed reported engaging in more social processes. However, these processes were not mutually exclusive and the ability to perform resilience through community seems to be key to optimizing outcomes, irrespective of era of diagnosis. CONCLUSION PLWH are a heterogeneous population where engagement in distinct processes of resilience may have important implications for optimal social and health outcomes. Better understanding of the distinct and diverse pathways through which PLWH engage in resilience may inform interventions promoting optimal well-being.
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Affiliation(s)
- Walter Gómez
- Jane Addams College of Social Work, University of Illinois Chicago, 1040 West Harrison Street (MC309), Chicago, IL, 60607-7134, USA.
| | | | - Adam W Carrico
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
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Dubé K, Ndukwe SO, Korolkova A, Dee L, Sugarman J, Sauceda JA. Participant experiences in a combination HIV cure-related trial with extended analytical treatment interruption in San Francisco, United States. HIV Res Clin Pract 2024; 25:2312318. [PMID: 38348830 PMCID: PMC10951555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
BACKGROUND There is limited systematic information available about the perspectives of participants enrolled in intensive combination HIV cure-related trials inclusive of an extended analytical treatment interruption (ATI). OBJECTIVE To assess and understand experiences of people with HIV involved in a combination HIV cure-related trial with an extended ATI. METHODS The trial included five interventions and was followed by an ATI lasting up to 52 wk. From 2022 - 2023, we conducted in-depth interviews with study participants following their extended ATIs. Interviews were audio-recorded, transcribed, and analyzed via conventional thematic analysis. RESULTS We interviewed seven participants. The majority were male, White, and non-Hispanic, with a median age of 37 years. Trust in the research team, scientific altruism and hope of becoming a post-intervention controller were key motivators for joining the trial. Interviewees reported being satisfied with their decision to participate in the trial and the extended ATI. Most recounted feelings of worry related to viral rebound during the ATI. Participants reported both defeat and relief with ART restart. Four faced challenges with protecting partners from HIV during their ATI, such as trying to find out if their partner(s) were using pre-exposure prophylaxis. CONCLUSIONS Our findings demonstrate potential improvements for future ATI trial participant experiences, such as more robust resources for psychosocial support and partner protections. Dedicating greater effort to understanding participant ATI experiences can inform the design of future participant-centered HIV cure trial protocols.
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Affiliation(s)
- Karine Dubé
- Division of Infectious Diseases and Global Public Health
(IDGPH), Department of Medicine, University of California San Diego (UCSD), La
Jolla, CA, USA
- Gillings School of Global Public Health, University of
North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Samuel O. Ndukwe
- Division of Infectious Diseases and Global Public Health
(IDGPH), Department of Medicine, University of California San Diego (UCSD), La
Jolla, CA, USA
| | - Ana Korolkova
- Division of Infectious Diseases and Global Public Health
(IDGPH), Department of Medicine, University of California San Diego (UCSD), La
Jolla, CA, USA
| | - Lynda Dee
- AIDS Action Baltimore, Baltimore, MD, USA
- Delaney AIDS Research Enterprise (DARE) Community
Engagement Coordinator, San Francisco, CA, USA
| | - Jeremy Sugarman
- Johns Hopkins Berman Institute for Bioethics, Baltimore,
MD, USA
| | - John A. Sauceda
- Division of Prevention Science, Center for AIDS Prevention
Studies (CAPS), San Francisco, CA, USA
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van Rijssel TI, van Thiel GJMW, Gardarsdottir H, van Delden JJM. Which Benefits Can Justify Risks in Research? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024:1-11. [PMID: 38181217 DOI: 10.1080/15265161.2023.2296404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
Research ethics committees (RECs) evaluate whether the risk-benefit ratio of a study is acceptable. Decentralized clinical trials (DCTs) are a novel approach for conducting clinical trials that potentially bring important benefits for research, including several collateral benefits. The position of collateral benefits in risk-benefit assessments is currently unclear. DCTs raise therefore questions about how these benefits should be assessed. This paper aims to reconsider the different types of research benefits, and their position in risk-benefit assessments. We first propose a categorization of research benefits, based on the types of benefits that can be distinguished from the literature and ethical guidelines. Secondly, we will reconsider the position of collateral benefits. We argue that these benefits are not fundamentally different from other benefits of research and can therefore be included in risk-benefit assessments of DCTs.
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Spahnie M, Matthews A, Kiss D, Ricks J, Miller W, Turner AN. Positive and Negative Social Consequences of Participating in a Sexual-Network Study. Ethics Hum Res 2024; 46:14-25. [PMID: 38240396 DOI: 10.1002/eahr.500196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Assessment of risks and benefits of study participation is standard practice preceding the initiation of human subjects research. Although tracking adverse events during research participation is routine, collecting information from participants about what they perceive as benefits is less common. We longitudinally tracked social risks and benefits of participation among a cohort of 241 men who have sex with men participating in a sexual health study to improve participants' experiences and enhance understanding of participant motivations to enroll and attend follow-up. Of the participants who returned for at least one follow-up visit (n = 217, 90%), most (n = 185, 85%) reported positive consequences resulting from participation. Reporting of negative social consequences was rare, and all concerned a stigmatized reaction from someone learning about the participant's involvement in a sexual health study. Better identification of both positive and negative consequences resulting from research participation may improve how researchers design, recruit, and conduct research.
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Affiliation(s)
- Morgan Spahnie
- Researcher at The Ohio State University Center for HOPES
| | | | - Dale Kiss
- Researcher at The Ohio State University Comprehensive Cancer Center
| | - JaNelle Ricks
- Assistant professor of health behavior and health promotion at The Ohio State University College of Public Health
| | - William Miller
- Professor of epidemiology at the University of North Carolina at Chapel Hill Gillings School of Public Health
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Mohtashemi N, Dubé K, Thio C, Song S, Patel S, Sugarman J, Bhattacharya D. Patient acceptability of, and attitudes towards, hepatitis B cure research - A scoping review and identification of knowledge gaps. J Virus Erad 2023; 9:100354. [PMID: 38161322 PMCID: PMC10755539 DOI: 10.1016/j.jve.2023.100354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
Functional cure, defined as durable loss of hepatitis B surface antigen (HBsAg) and hepatitis B virus (HBV) DNA suppression off therapy, is an increasingly important goal in the treatment of chronic hepatitis B. Although novel treatments aimed at achieving functional cure are being developed and tested in clinical trials, it is important to assess the perspectives of people living with HBV towards these potential treatments and their participation in HBV functional cure research. We have performed a scoping review that revealed that there is limited knowledge regarding patient perspectives of HBV functional cure research and then identified gaps in knowledge for further investigation. Our work highlights the need for further studies in patient perspectives in HBV functional cure research.
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Affiliation(s)
| | - Karine Dubé
- University of California, San Diego, San Diego, CA, USA
| | - Chloe Thio
- Johns Hopkins University, Baltimore, MD, USA
| | - Sihyeong Song
- University of California, Los Angeles, Los Angeles, CA, USA
| | - Shail Patel
- University of California, Los Angeles, Los Angeles, CA, USA
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Noorman MAJ, de Wit JBF, Marcos TA, Stutterheim SE, Jonas KJ, den Daas C. The Importance of Social Engagement in the Development of an HIV Cure: A Systematic Review of Stakeholder Perspectives. AIDS Behav 2023; 27:3789-3812. [PMID: 37329470 PMCID: PMC10589186 DOI: 10.1007/s10461-023-04095-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/19/2023]
Abstract
As research into the development of an HIV cure gains prominence, assessing the perspectives of stakeholders becomes imperative. It empowers stakeholders to determine priorities and influence research processes. We conducted a systematic review of the empirical literature on stakeholder perspectives. PubMed, Embase, Web of Science, and Scopus were searched for empirical, peer-reviewed articles, published before September 2022. Our analysis of 78 papers showed that stakeholders could be divided into three categories: people with HIV, key populations, and professionals. Following thematic synthesis, two main themes were distinguished: stakeholders' perspectives on HIV cure research and stakeholders' perspectives on HIV cure. Research on perspectives on HIV cure research showed that stakeholders' hypothetical willingness to participate (WTP) in HIV cure research was relatively high, while actual WTP was found to be lower. Studies also identified associated (individual) characteristics of hypothetical WTP, as well as facilitators and barriers to hypothetical participation. Additionally, we reported research on experiences of actual HIV cure research participation. Our analysis of stakeholder perceptions of HIV cure showed that most stakeholders preferred a cure that could eliminate HIV and outlined positive associated impacts. Furthermore, we observed that most included studies were conducted among PWHIV, and in the Global North. To empower stakeholders, we recommend that future research include an even greater diversity of stakeholders and incorporate theories of behavior to further explore how stakeholders decide to meaningfully engage in every stage of HIV cure research.
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Affiliation(s)
- Maaike A J Noorman
- Department of Interdisciplinary Social Science, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands.
| | - John B F de Wit
- Department of Interdisciplinary Social Science, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
| | - Tamika A Marcos
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Sarah E Stutterheim
- Department of Health Promotion and Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Kai J Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Chantal den Daas
- Institute of Applied Health Sciences, Health Psychology Group, University of Aberdeen, Aberdeen, UK
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Bilger A, Plenn E, Barg FK, Rendle KA, Carter WB, Lamour-Harrington A, Jones N, Peterson B, Sauceda JA, Tebas P, Mounzer K, Metzger D, Montaner LJ, Dubé K. Participant experiences in HIV cure-directed trial with an extended analytical treatment interruption in Philadelphia, United States. HIV Res Clin Pract 2023; 24:2267825. [PMID: 37837376 PMCID: PMC10634456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2023]
Abstract
BACKGROUND A feature of HIV cure trials is the need to interrupt treatment to test the efficacy of experimental interventions-a process known as analytical treatment interruptions (ATIs). OBJECTIVES We report the experiences of participants after they completed an extended ATI. METHODS From April to November 2022, we conducted post-ATI in-depth interviews with BEAT2 clinical trial (NCT03588715) participants who stopped ART while receiving an immunotherapy regimen. We used conventional content analysis to code the data. RESULTS We conducted interviews with 11 Black/African American and three White/Caucasian participants (11 males, two females, and one transgender woman). The mean ATI was 38 weeks. Participants noted several significant experiences surrounding the interventions' side effects, ATI, and returning to medication. Some participants had positive experiences with their ATI. Other participants were nervous during the ATI. Rising viral loads led some to feel a sense of failure. Although trial experiences were heterogeneous, participants unanimously had positive interactions with the clinical trial staff which facilitated their retention in the trial. Participants shared their experiences with the trial, including changes in expectations, experiences with experimental interventions and procedures, compensation as a measure of respect, effort, transportation, and effects of COVID-19 during the trial. Based on these results, we provide considerations for the conduct of future HIV cure-directed clinical trials involving ATIs. CONCLUSIONS Managing expectations, focusing on participants' contributions, and providing support to reduce feelings of having failed the research team and/or the HIV community following viral rebound should be part of HIV cure trial design. Discussing the mental health impact of rebound during consent, distinct from risk, is needed. Continued efforts to understand how people with HIV experience ATIs will improve future designs of HIV cure clinical trials.
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Affiliation(s)
- Andrea Bilger
- Department of Family Medicine and Community Health, University of Pennsylvania, Pennsylvania, PA, USA
| | - Eion Plenn
- Department of Family Medicine and Community Health, University of Pennsylvania, Pennsylvania, PA, USA
| | - Frances K. Barg
- Department of Family Medicine and Community Health, University of Pennsylvania, Pennsylvania, PA, USA
| | - Katharine A. Rendle
- Department of Family Medicine and Community Health, University of Pennsylvania, Pennsylvania, PA, USA
| | - William B. Carter
- BEAT-HIV Delaney Collaboratory Community Advisory Board, Philadelphia, PA, USA
| | | | - Nora Jones
- BEAT-HIV Delaney Collaboratory Community Advisory Board, Philadelphia, PA, USA
| | | | - John A. Sauceda
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, CA, USA
| | - Pablo Tebas
- Hospital of the University of Philadelphia, University of Pennsylvania, Pennsylvania, PA, USA
| | - Karam Mounzer
- Philadelphia FIGHT Community Health Centers, Philadelphia, PA, USA
| | - David Metzger
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, USA
| | | | - Karine Dubé
- University of California San Diego School of Medicine, Division of Infectious Diseases and Global Public Health, Chapel Hill, NC, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Dubé K, Shelton B, Patel H, Ndukwe SO, Concha-Garcia S, Dullano C, Solso S, Hendrickx S, Kaytes A, Taylor J, Villa TJ, Little SJ, Riggs PK, Lessard D, Arora AK, Costiniuk CT, Eskaf S, Smith DM, Gianella S. Perceived risks and benefits of enrolling people with HIV at the end of life in cure research in Southern California, United States. J Virus Erad 2023; 9:100328. [PMID: 37440872 PMCID: PMC10334343 DOI: 10.1016/j.jve.2023.100328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/30/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction Although current antiretroviral therapy allows most people with HIV (PWH) to experience normal longevity with a good quality of life, an HIV cure remains elusive due to HIV reservoir formation within deep tissues. An HIV cure remains highly desirable to the community of PWH. This study reports on the perceived risks and benefits of participation in the Last Gift study, a study aimed at characterizing HIV reservoirs via post-mortem autopsy, among PWH at the end of life (EOL) and their next-of-kin (NOK)/loved ones. Methods Last Gift participants (PWH with a terminal illness and/or near the end of life) and their NOK/loved ones were surveyed for perceptions of risks, benefits, and meaning for participation in the Last Gift study. Results The average age of the 17 Last Gift participants was 66.6 years, 3 were females, 1 person identified as Hispanic, and 15 as Caucasian. The average age of the 17 NOK/loved ones was 56.7 years, and relationships to Last Gift participants included partner/spouse, sibling, friend, child, parent, grandparent, and nephew. The only perceived personal risk of the Last Gift among participants was the blood draws (3/17). NOK/loved ones perceived the following risks: blood draws (2/17), physical pain (3/17), worry that something bad will happen (2/17), and unpleasant side effects (1/17). Participants in Last Gift and NOK/loved ones indicated the study had various positive social effects. For both participants and NOK/loved ones, the most frequent perceived personal benefit of the Last Gift was the satisfaction of supporting HIV cure research. Discussion Participants perceived minimal personal and societal risks and valued the altruistic benefits of participating in the Last Gift study. Last Gift participants and NOK/loved ones were cautious about possible personal risks of EOL HIV cure research but still viewed that the emotional, psychological and societal benefits of participation outweighed potential risks.
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Affiliation(s)
- Karine Dubé
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, CA, USA
- UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Brittany Shelton
- Department of Public Health, College of Education, Health and Human Sciences, University of Tennessee Knoxville, TN, USA
| | - Hursch Patel
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, CA, USA
- UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Samuel O. Ndukwe
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, CA, USA
- UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Susanna Concha-Garcia
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
- HIV Neurobehavioral Research Center, University of California San Diego, San Diego, CA, USA
| | - Cheryl Dullano
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
| | - Stephanie Solso
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
| | - Steven Hendrickx
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
| | - Andy Kaytes
- AntiViral Research Center Community Advisory Board, San Diego, CA, USA
| | - Jeff Taylor
- AntiViral Research Center Community Advisory Board, San Diego, CA, USA
- HIV+Aging Research Project-Palm Springs (HARP-PS), Palm Springs, CA, USA
| | - Thomas J. Villa
- Reversing Immune Dysfunction (RID) Martin Delaney Collaboratory for HIV Cure Research Community Advisory Board, Rockville, MD, USA
| | - Susan J. Little
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, CA, USA
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
| | - Patricia K. Riggs
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, CA, USA
| | - David Lessard
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Center (MUCH), Montreal, QC, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Montreal, QC, Canada
- Center for Outcome Research and Evaluation, Research Institute of the McGill University Health Center, Montreal, QC, Canada
| | - Anish K. Arora
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Montreal, QC, Canada
- Center for Outcome Research and Evaluation, Research Institute of the McGill University Health Center, Montreal, QC, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Cecilia T. Costiniuk
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Center (MUCH), Montreal, QC, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, QC, Canada
- Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Shadi Eskaf
- Public Health Research Consultant, Chapel Hill, NC, USA
| | - Davey M. Smith
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, CA, USA
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
| | - Sara Gianella
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, CA, USA
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
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Dubé K, Eskaf S, Barr L, Palm D, Hogg E, Simoni JM, Sugarman J, Brown B, Sauceda JA, Henley L, Deeks S, Fox L, Gandhi RT, Smith D, Li JZ. Participant Perspectives and Experiences Following an Intensively Monitored Antiretroviral Pause in the United States: Results from the AIDS Clinical Trials Group A5345 Biomarker Study. AIDS Res Hum Retroviruses 2022; 38:510-517. [PMID: 35323030 PMCID: PMC9225827 DOI: 10.1089/aid.2021.0170] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The AIDS Clinical Trials Group A5345 study (NCT03001128) included an intensively monitored antiretroviral pause (IMAP), during which participants living with HIV temporarily stopped antiretroviral treatment (ART) in an effort to identify biomarkers that could predict HIV rebound. We evaluated the potential impact of the IMAP on A5345 study participants in the United States by questioning them immediately after the IMAP and at the end of the study. We administered longitudinal sociobehavioral questionnaires to participants following the IMAP when they resumed ART and at the end of the study. We summarized descriptive data from the post-IMAP and end-of-study questionnaires. Open-ended responses were analyzed using conventional content analysis. Reactions to pausing ART involved a mixture of curiosity and satisfaction from contributing to science. All participants indicated adherence with the ART interruption. About half (9/17) of post-IMAP questionnaire respondents reported having sexual partner(s) during the IMAP, and of those, nearly all (8/9) did not find it difficult to use measures to prevent HIV transmission to partners. The majority believed that they benefited from the study, yet some had elevated anxiety following the IMAP and at the end of the study. Most (24/29) respondents who completed the end-of-study questionnaire would recommend the study to other people living with HIV. Our findings underscore the relevance of the psychosocial aspects of participating in studies that involve interruptions of ART. Understanding how participants experience this research is invaluable for informing the design of future research aimed at sustained ART-free virologic suppression.
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Affiliation(s)
- Karine Dubé
- Public Health Leadership Program and Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA.,Address correspondence to: Karine Dubé, Public Health Leadership Program and Health Policy and Management, UNC Gillings School of Global Public Health, 4108 McGavran Greenberg Hall, Campus Box 7469, Chapel Hill, NC 27599-7469, USA
| | - Shadi Eskaf
- UNC School of Government, Chapel Hill, North Carolina, USA
| | - Liz Barr
- Community Scientific Sub-Committee, AIDS Clinical Trials Group (ACTG), Baltimore, Maryland, USA
| | - David Palm
- Community Scientific Sub-Committee, AIDS Clinical Trials Group (ACTG), Baltimore, Maryland, USA.,Institute of Global Health and Infectious Diseases (IGHID), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Evelyn Hogg
- Social and Scientific Systems, Inc., a DLH Holdings Company, Silver Spring, Maryland, USA
| | - Jane M. Simoni
- Department of Psychology, University of Washington, Seattle, Washington, USA.,Department of Global Health, and Women, and Sexuality Studies, University of Washington, Seattle, Washington, USA.,Department of Gender, Women, and Sexuality Studies, University of Washington, Seattle, Washington, USA
| | - Jeremy Sugarman
- Johns Hopkins Berman Institute for Bioethics, Baltimore, Maryland, USA
| | - Brandon Brown
- Center for Healthy Communities, Department of Social Medicine, Population and Public Health, University of California, Riverside School of Medicine, Riverside, California, USA
| | - John A. Sauceda
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Laney Henley
- Public Health Leadership Program and Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Steven Deeks
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, California, USA
| | - Lawrence Fox
- Division of AIDS (DAIDS), National Institute of Health (NIH), Bethesda, Maryland, USA
| | - Rajesh T. Gandhi
- Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Davey Smith
- Division of Infectious Diseases and Global Health, University of California, San Diego, California, USA
| | - Jonathan Z. Li
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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11
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Dubé K, Kanazawa J, Campbell C, Boone CA, Maragh-Bass AC, Campbell DM, Agosto-Rosario M, Stockman JK, Diallo DD, Poteat T, Johnson M, Saberi P, Sauceda JA. Considerations for Increasing Racial, Ethnic, Gender, and Sexual Diversity in HIV Cure-Related Research with Analytical Treatment Interruptions: A Qualitative Inquiry. AIDS Res Hum Retroviruses 2022; 38:50-63. [PMID: 33947268 PMCID: PMC8785755 DOI: 10.1089/aid.2021.0023] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Despite disproportionate incidence and prevalence of HIV among transgender individuals, cisgender women, and racial and ethnic minority groups, all remain underrepresented in HIV cure research. As HIV cure trials are scaled up, there is emerging research on ways to mitigate risks of HIV acquisition for sexual partners of analytical treatment interruption (ATI) trial participants. As such, it is imperative that HIV cure researchers consider the implications of implementing ATIs in populations that are disproportionately affected by HIV, but largely underrepresented in trials to date. In this qualitative study, we sought to derive triangulated perspectives on the social and ethical implications regarding ATIs and partner protection strategies during ATIs among under-represented populations. We conducted 21 in-depth interviews with 5 types of informants: bioethicists, community members [people living with HIV (PLWH) and their advocates], biomedical HIV cure researchers, sociobehavioral scientists, and HIV care providers. We analyzed the data using conventional content analysis and reduced the data to important considerations for implementing ATI trials in diverse communities and settings. Our study revealed the following key themes: (1) attention must be paid to gender and power dynamics in ATI trials; (2) ATI trials should be designed and implemented through the lenses of intersectionality and equity frameworks; (3) ATI trials may have both positive and negative effects on stigma for PLWH and their partners; and (4) partnership dynamics should be considered when designing ATI protocols. Our study generated actionable considerations that could be implemented in ATI trials to promote their acceptability to communities that have been underrepresented in HIV cure research to date. Research teams must invest in robust community and stakeholder engagement to define best practices. Paying attention to representation and equity will also promote better and more equitable implementation of HIV cure strategies once these become ready for rollout.
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Affiliation(s)
- Karine Dubé
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.,Address correspondence to: Karine Dubé, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27516, USA
| | - John Kanazawa
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Chadwick Campbell
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), San Francisco, California, USA.,Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Cheriko A. Boone
- Department of Psychological and Brain Sciences, George Washington University, Washington, District of Columbia, USA
| | - Allysha C. Maragh-Bass
- Behavioral, Epidemiological, and Clinical Sciences, FHI 360, Durham, North Carolina, USA
| | - Danielle M. Campbell
- Charles R. Drew University of Medicine and Science, Los Angeles, California, USA
| | | | - Jamila K. Stockman
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, San Diego, California, USA
| | | | - Tonia Poteat
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mallory Johnson
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), San Francisco, California, USA
| | - Parya Saberi
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), San Francisco, California, USA
| | - John A. Sauceda
- Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco (UCSF), San Francisco, California, USA
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12
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Gilbertson A, Tucker JD, Dubé K, Dijkstra M, Rennie S. Ethical considerations for HIV remission clinical research involving participants diagnosed during acute HIV infection. BMC Med Ethics 2021; 22:169. [PMID: 34961509 PMCID: PMC8714439 DOI: 10.1186/s12910-021-00716-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/20/2021] [Indexed: 11/16/2022] Open
Abstract
HIV remission clinical researchers are increasingly seeking study participants who are diagnosed and treated during acute HIV infection—the brief period between infection and the point when the body creates detectable HIV antibodies. This earliest stage of infection is often marked by flu-like illness and may be an especially tumultuous period of confusion, guilt, anger, and uncertainty. Such experiences may present added ethical challenges for HIV research recruitment, participation, and retention. The purpose of this paper is to identify potential ethical challenges associated with involving acutely diagnosed people living with HIV in remission research and considerations for how to mitigate them. We identify three domains of potential ethical concern for clinicians, researchers, and ethics committee members to consider: 1) Recruitment and informed consent; (2) Transmission risks and partner protection; and (3) Ancillary and continuing care. We discuss each of these domains with the aim of inspiring further work to advance the ethical conduct of HIV remission research. For example, experiences of confusion and uncertainty regarding illness and diagnosis during acute HIV infection may complicate informed consent procedures in studies that seek to recruit directly after diagnosis. To address this, it may be appropriate to use staged re-consent procedures or comprehension assessment. Responsible conduct of research requires a broad understanding of acute HIV infection that encompasses its biomedical, psychological, social, and behavioral dimensions. We argue that the lived experience of acute HIV infection may introduce ethical concerns that researchers and reviewers should address during study design and ethical approval.
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Affiliation(s)
- Adam Gilbertson
- Pacific Institute for Research and Evaluation, Chapel Hill Center, 101 Conner Drive, Suite 200, Chapel Hill, NC, 27514-7038, USA. .,UNC Center for Bioethics, Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Joseph D Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.,Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WCE1, UK.,UNC Project-China, 2 Lujing Road, Guangzhou, China
| | - Karine Dubé
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Maartje Dijkstra
- Department of Infectious Diseases, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, The Netherlands
| | - Stuart Rennie
- UNC Center for Bioethics, Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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13
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Gilles I, Lesage S, Barbieux C, Alessandrini M, Jackson-Perry D, Vittoz L, Peytremann-Bridevaux I, Calmy A. Brief Report: Representations and Willingness of People Living With HIV in Switzerland to Participate in HIV Cure Trials: The Case of Gene-Modified Cell Therapies. J Acquir Immune Defic Syndr 2021; 87:1154-1160. [PMID: 34229328 DOI: 10.1097/qai.0000000000002693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent advances made in cell and gene therapies for cancer suggest that they represent plausible strategies to cure HIV. However, the health risks and constraints associated with these therapies require a deeper understanding of the expectations of such treatments among people living with HIV (PLWH). METHODS We conducted 15 semistructured in-depth interviews among patients from 2 HIV units in Switzerland. After a conversation about their perceptions of research on HIV therapies, participants were provided with a trial description using a gene-modified cell therapy as a potentially curative approach. They were invited to discuss how they might consider participation in the trial. Content analysis was performed to identify core themes. RESULTS Participants perceived the trial as burdensome and uncertain. Most were aware that cure was not guaranteed, and 6 of the 15 considered that they would participate. Two main concerns were expressed about potential participation: (1) the impact on the professional life and fear to be stigmatized because of this and (2) the fact that stopping antiretroviral treatment would challenge the balance currently achieved in their lives. The decision to participate would depend on their understanding of the trial, the availability of sufficient information, and the relationship with health care professionals. CONCLUSION Involving PLWH in early stages of research would be crucial to improve their understanding of gene-modified cell therapies. It could also help adapt trials to address key factors, including the anticipation of stigma, which may discourage PLWH from participating in treatment research.
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Affiliation(s)
- Ingrid Gilles
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Saphir Lesage
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Charlotte Barbieux
- HIV/AIDS Unit, Department of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Marco Alessandrini
- Department of Pathology and Immunology (PATIM), University of Geneva, Geneva, Switzerland; and
| | - David Jackson-Perry
- Department of Infectious Diseases, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Lucie Vittoz
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Department of Epidemiology and Health Systems, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Alexandra Calmy
- HIV/AIDS Unit, Department of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
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14
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Dubé K, Kanazawa J, Taylor J, Dee L, Jones N, Roebuck C, Sylla L, Louella M, Kosmyna J, Kelly D, Clanton O, Palm D, Campbell DM, Onaiwu MG, Patel H, Ndukwe S, Henley L, Johnson MO, Saberi P, Brown B, Sauceda JA, Sugarman J. Ethics of HIV cure research: an unfinished agenda. BMC Med Ethics 2021; 22:83. [PMID: 34193141 PMCID: PMC8243312 DOI: 10.1186/s12910-021-00651-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 06/23/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The pursuit of a cure for HIV is a high priority for researchers, funding agencies, governments and people living with HIV (PLWH). To date, over 250 biomedical studies worldwide are or have been related to discovering a safe, effective, and scalable HIV cure, most of which are early translational research and experimental medicine. As HIV cure research increases, it is critical to identify and address the ethical challenges posed by this research. METHODS We conducted a scoping review of the growing HIV cure research ethics literature, focusing on articles published in English peer-reviewed journals from 2013 to 2021. We extracted and summarized key developments in the ethics of HIV cure research. Twelve community advocates actively engaged in HIV cure research provided input on this summary and suggested areas warranting further ethical inquiry and foresight via email exchange and video conferencing. DISCUSSION Despite substantial scholarship related to the ethics of HIV cure research, additional attention should focus on emerging issues in six categories of ethical issues: (1) social value (ongoing and emerging biomedical research and scalability considerations); (2) scientific validity (study design issues, such as the use of analytical treatment interruptions and placebos); (3) fair selection of participants (equity and justice considerations); (4) favorable benefit/risk balance (early phase research, benefit-risk balance, risk perception, psychological risks, and pediatric research); (5) informed consent (attention to language, decision-making, informed consent processes and scientific uncertainty); and (6) respect for enrolled participants and community (perspectives of people living with HIV and affected communities and representation). CONCLUSION HIV cure research ethics has an unfinished agenda. Scientific research and bioethics should work in tandem to advance ethical HIV cure research. Because the science of HIV cure research will continue to rapidly advance, ethical considerations of the major themes we identified will need to be revisited and refined over time.
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Affiliation(s)
- Karine Dubé
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7469 USA
| | - John Kanazawa
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7469 USA
| | - Jeff Taylor
- HIV + Aging Research Project – Palm Springs (HARP–PS), Palm Springs, CA USA
- AntiViral Research Center (AVRC) Community Advisory Board (CAB), San Diego, CA USA
- Collaboratory of AIDS Researchers for Eradication (CARE) CAB, Chapel Hill, NC USA
| | - Lynda Dee
- AIDS Action Baltimore, Baltimore, MD USA
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board (CAB), San Francisco, CA USA
| | - Nora Jones
- BEAT-HIV Collaboratory CAB, Philadelphia, PA USA
| | | | | | | | - Jan Kosmyna
- AIDS Clinical Trials Group (ACTG) Community Scientific Subcommittee (CSS) Ethics Working Group, Nationwide, USA
| | - David Kelly
- AIDS Clinical Trials Group (ACTG) Community Scientific Subcommittee (CSS) Ethics Working Group, Nationwide, USA
| | - Orbit Clanton
- AIDS Clinical Trials Group Global CAB, Washington, D.C. USA
| | - David Palm
- Collaboratory of AIDS Researchers for Eradication (CARE) CAB, Chapel Hill, NC USA
- Institute of Global Health and Infectious Diseases HIV Treatment and Prevention CAB, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Danielle M. Campbell
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board (CAB), San Francisco, CA USA
- Charles R. Drew College of Medicine and Science, Los Angeles, CA USA
| | - Morénike Giwa Onaiwu
- AIDS Clinical Trials Group (ACTG) Community Scientific Subcommittee (CSS) Ethics Working Group, Nationwide, USA
- Center for the Study of Women, Gender, and Sexuality (School of Humanities), Rice University, Houston, TX USA
| | - Hursch Patel
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7469 USA
| | - Samuel Ndukwe
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7469 USA
| | - Laney Henley
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC 27599-7469 USA
| | - Mallory O. Johnson
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA USA
| | - Parya Saberi
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA USA
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside, Riverside, CA USA
| | - John A. Sauceda
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA USA
| | - Jeremy Sugarman
- Johns Hopkins Berman Institute for Bioethics, Baltimore, MD USA
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15
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Diepstra KL, Barr L, Palm D, Hogg E, Mollan KR, Henley L, Stover AM, Simoni JM, Sugarman J, Brown B, Sauceda JA, Deeks S, Fox L, Gandhi RT, Smith D, Li JZ, Dubé K. Participant Perspectives and Experiences Entering an Intensively Monitored Antiretroviral Pause: Results from the AIDS Clinical Trials Group A5345 Biomarker Study. AIDS Res Hum Retroviruses 2021; 37:489-501. [PMID: 33472545 DOI: 10.1089/aid.2020.0222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The AIDS Clinical Trials Group (ACTG) A5345 study included an intensively monitored antiretroviral pause (IMAP), during which a cohort of participants temporarily stopped antiretroviral treatment during chronic HIV infection. We surveyed participant perceptions and understanding of A5345 using a cross-sectional sociobehavioral questionnaire. Participants completed the baseline questionnaire either before or after initiating the study's IMAP. Questionnaire responses were linked to existing demographic data. Quantitative responses were analyzed overall and stratified by IMAP status. Open-ended responses were analyzed using conventional content analysis. Thirty-two participants completed the baseline sociobehavioral questionnaire. Half (n = 16) completed it before (i.e., pre-IMAP initiation group) and half (n = 16) after IMAP initiation (i.e., post-IMAP initiation group). Eight pre-IMAP initiation respondents (50%) and 11 post-IMAP respondents (69%) responded "yes" when asked if they perceived any direct benefits from participating in A5345. Perceived societal-level benefits included furthering HIV cure-related research and helping the HIV community. Perceived personal-level benefits included the opportunity to learn about the body's response to IMAP and financial compensation. The majority of respondents-13 from each group (81% of each)-reported risks from participation, for example, viral load becoming detectable. A5345 participants perceived both societal- and personal-level benefits of study participation. While the majority of survey respondents perceived participatory risks, nearly one in five did not. Key messages pertaining to study-related risks and benefits may need to be clarified or reiterated periodically throughout follow-up in HIV cure-related studies with IMAPs. Clinical Trail Registration Number: NCT03001128.
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Affiliation(s)
- Karen L. Diepstra
- UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Liz Barr
- AIDS Clinical Trials Group (ACTG) Community Scientific Sub-Committee, Baltimore, Maryland, USA
| | - David Palm
- Institute of Global Health and Infectious Diseases (IGHID), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Evelyn Hogg
- Social & Scientific Systems, a DLH Company, Silver Spring, Maryland, USA
| | - Katie R. Mollan
- Center for AIDS Research (CFAR), School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Laney Henley
- UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Angela M. Stover
- UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Jane M. Simoni
- Department of Psychology, University of Washington, Seattle, Washington, USA
- Department of Global Health and Gender, Women, and Sexuality Studies, University of Washington, Seattle, Washington, USA
| | - Jeremy Sugarman
- Johns Hopkins Berman Institute for Bioethics, Baltimore, Maryland, USA
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside School of Medicine, Riverside, California, USA
| | - John A. Sauceda
- Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, San Francisco, California, USA
| | - Steven Deeks
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Lawrence Fox
- National Institute of Health (NIH) Division of AIDS (DAIDS), Bethesda, Maryland, USA
| | | | - Davey Smith
- Division of Infectious Diseases and Global Health, University of California, San Diego, California, USA
| | - Jonathan Z. Li
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Karine Dubé
- UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
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16
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Ethical considerations of COVID-19-related adjustments to clinical research. Nat Med 2021; 27:191-193. [PMID: 33495603 DOI: 10.1038/s41591-020-01216-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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17
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Poteat T, Aqil A, Corbett D, Evans D, Dubé K. "I would really want to know that they had my back": Transgender women's perceptions of HIV cure-related research in the United States. PLoS One 2020; 15:e0244490. [PMID: 33382760 PMCID: PMC7774946 DOI: 10.1371/journal.pone.0244490] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 12/10/2020] [Indexed: 11/18/2022] Open
Abstract
Forty-four percent of Black transgender women are living with HIV, and many face challenges with HIV care engagement. An HIV cure has much to offer this population, however little HIV cure-related research has included them. We conducted 19 face-to-face in-depth interviews with 10 Black transgender women living with HIV. Interviews were audio recorded, transcribed verbatim, coded, and analyzed using content analysis. Our interview guide contained three categories: 1) perceptions of HIV cure-related research and participation, 2) perceptions of HIV treatment and treatment interruptions, and 3) considerations for transgender women and HIV cure-related research. Salient themes included skepticism about HIV cure strategies and limited benefits compared with an undetectable viral load. Willingness to interrupt HIV treatment for research was low and linked to being able to go back on the same HIV treatment without consequence when the study ended. Concerns about being a test subject and perceptions of risks versus benefits of various strategies also affected willingness to take part in HIV cure-related research. Centering the dignity and autonomy of research participants as well as building upon and supporting existing social networks were identified as important facilitators for engaging Black transgender women in HIV cure-related research. Specific to Black transgender women, other concerns included the desire for gender-affirming research staff, community-building among transgender women, and safety issues associated with risk of transphobic violence when traveling to study visits. Participants stressed the importance of HIV cure-related researchers providing accessible and complete information and expressing genuine care and concern for transgender communities.
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Affiliation(s)
- Tonia Poteat
- Department of Social Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Anushka Aqil
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Dana Corbett
- Public Health Leadership Program, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - David Evans
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board, New York City, New York, United States of America
| | - Karine Dubé
- Public Health Leadership Program, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
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18
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Sauceda JA, Dubé K, Brown B, Pérez AE, Rivas CE, Evans D, Fisher CB. Framing a Consent Form to Improve Consent Understanding and Determine How This Affects Willingness to Participate in HIV Cure Research: An Experimental Survey Study. J Empir Res Hum Res Ethics 2020; 16:78-87. [PMID: 33307932 DOI: 10.1177/1556264620981205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
HIV cure research carries serious risks and negligible benefits. We investigated how participants understand these risks and what influences their willingness to participate. Through internet-based and in-person convenience sampling, 86 HIV+ participants completed an experimental survey. Participants were randomized to read a standard consent form describing a hypothetical HIV cure study or one adapted using Fuzzy Trace Theory-a decision-making model to facilitate complex information processing. We measured consent understanding and cognitive (e.g., safe/harmful) and affective (e.g., concerning, satisfying) evaluations of HIV cure research. Participants who read the adapted consent form had improved consent understanding, but only positive affective evaluations were associated with a willingness to participate. Consent processes can use decision-making theories to facilitate comprehension of study information.
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Affiliation(s)
| | - Karine Dubé
- 2331University of North Carolina Chapel Hill, USA
| | | | | | | | - David Evans
- 455669Delaney AIDS Research Enterprise Martin Delaney Collaboratory Community Advisory Board, San Francisco, CA, USA
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19
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Perry KE, Dubé K, Concha-Garcia S, Patel H, Kaytes A, Taylor J, Javadi SS, Mathur K, Lo M, Brown B, Sauceda JA, Wohl DA, Little S, Hendrickx S, Rawlings SA, Smith DM, Gianella S. "My Death Will Not [Be] in Vain": Testimonials from Last Gift Rapid Research Autopsy Study Participants Living with HIV at the End of Life. AIDS Res Hum Retroviruses 2020; 36:1071-1082. [PMID: 32449625 PMCID: PMC7703253 DOI: 10.1089/aid.2020.0020] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
End-of-life (EOL) HIV cure-related research provides a novel approach to studying HIV reservoirs. The Last Gift is a rapid autopsy research study at the University of California San Diego that enrolls terminally ill people living with HIV (PLWHIV) with a desire to contribute to HIV cure-related research. We conducted in-depth baseline and follow-up interviews with Last Gift study participants. We analyzed interview data applying conventional content analysis. Since summer 2017, 13 participants have been enrolled (n = 11 males and 2 females; aged 45-89 years) and 8 participants interviewed. Terminal illnesses included cancers, heart diseases, and neurodegenerative illnesses. Our analysis revealed five key themes: (1) The Last Gift study has tremendous meaning for participants at the end of their life. (2) HIV-specific altruism was a primary motivator to join the Last Gift study, nested within the context of community, scientific advancement, and moral obligation. (3) Participants did not expect physical benefits yet they perceived emotional/psychological, financial, and societal/scientific benefits. (4) There were minimal participant-perceived risks and concerns. (5) Last Gift participants expressed immense gratitude toward study staff. The Last Gift study provides a framework for ethical HIV cure-related research at EOL and highlighted participants' perspectives, motivations, and experiences. Knowing how PLWHIV understand and experience such studies will remain critical to designing ethical, fully informed HIV cure research protocols that are acceptable to PLWHIV.
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Affiliation(s)
- Kelly E. Perry
- Public Health Leadership Program, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Karine Dubé
- Public Health Leadership Program, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Susanna Concha-Garcia
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
| | - Hursch Patel
- Public Health Leadership Program, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Andy Kaytes
- Community Advisory Board, AntiViral Research Center, San Diego, California, USA
| | - Jeff Taylor
- Community Advisory Board, AntiViral Research Center, San Diego, California, USA
- HIV+Aging Research Project–Palm Springs (HARP-PS), Palm Springs, California, USA
| | - Sogol Stephanie Javadi
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Kushagra Mathur
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Megan Lo
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside, Riverside, California, USA
| | - John A. Sauceda
- Department of Medicine, Division of Prevention Sciences, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - David A. Wohl
- Department of Medicine, Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Susan Little
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Steven Hendrickx
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Stephen A. Rawlings
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Davey M. Smith
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Sara Gianella
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
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Dubé K, Patel H, Concha-Garcia S, Perry KE, Mathur K, Javadi SS, Taylor J, Kaytes A, Brown B, Sauceda JA, Little S, Hendrickx S, Rawlings SA, Smith DM, Gianella S. Perceptions of Next-of-Kin/Loved Ones About Last Gift Rapid Research Autopsy Study Enrolling People with HIV/AIDS at the End of Life: A Qualitative Interview Study. AIDS Res Hum Retroviruses 2020; 36:1033-1046. [PMID: 32449624 PMCID: PMC7703245 DOI: 10.1089/aid.2020.0025] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A growing number of people living with HIV/AIDS are participating in HIV cure-related research at the end of life (EOL). Due to the novelty of EOL HIV cure-related research, there is a need to understand how their next-of-kin (NOK) perceive such research. We conducted in-depth interviews with NOK of the Last Gift study participants at the University of California, San Diego. The Last Gift study occurs in the context of the EOL and involves a full body donation. NOK completed two interviews: (1) shortly after the participants' enrollment in the study and (2) following death. We applied thematic analysis to analyze qualitative data. NOK included seven individuals (five males and two females), including two spouses, one ex-partner, one sister, a grandmother/grandfather, and a close friend. Thematic analysis revealed five key themes: (1) NOK viewed the Last Gift program in a positive light and had an accurate overall understanding of the study; (2) NOK identified factors that motivated participants to donate their body to science; (3) NOK identified benefits of the Last Gift program for both the donors and themselves; (4) NOK did not perceive any physical risks or decisional regrets of study but wanted to minimize psychosocial impacts and ensure the dignity of participants at all times; and (5) NOK noted elements that remained essential to the successful implementation of EOL HIV cure-related research, such as early involvement and clear communication. Our study uniquely contributes to increased understanding and knowledge of what is important from the point of view of supportive NOK to ensure successful implementation of EOL HIV cure-related research. More research will be needed to understand perspectives of less supportive NOK.
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Affiliation(s)
- Karine Dubé
- Public Health Leadership Program, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Hursch Patel
- Public Health Leadership Program, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Susan Concha-Garcia
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
- HIV Neurobehavioral Research Center, University of California San Diego, San Diego, California, USA
| | - Kelly E. Perry
- Public Health Leadership Program, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Kushagra Mathur
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Sogol Stephanie Javadi
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Jeff Taylor
- AntiViral Research Center Community Advisory Board, San Diego, California, USA
- HIV+Aging Research Project–Palm Springs (HARP-PS), Palm Springs, California, USA
| | - Andy Kaytes
- AntiViral Research Center Community Advisory Board, San Diego, California, USA
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside, Riverside, California, USA
| | - John A. Sauceda
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, University of California, San Francisco, California, USA
| | - Susan Little
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Steven Hendrickx
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Stephen A. Rawlings
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Davey M. Smith
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Sara Gianella
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
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21
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Perry KE, Taylor J, Patel H, Javadi SS, Mathur K, Kaytes A, Concha-Garcia S, Little S, Smith D, Gianella S, Dubé K. "[It] is now my responsibility to fulfill that wish:" Clinical and rapid autopsy staff members' experiences and perceptions of HIV reservoir research at the end of life. PLoS One 2020; 15:e0242420. [PMID: 33206710 PMCID: PMC7673534 DOI: 10.1371/journal.pone.0242420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 11/03/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Little is known about the effects of HIV reservoir research at the end of life on staff members involved. Staff members' perceptions and experiences were assessed related to their involvement in the Last Gift, a rapid autopsy study at the University of California San Diego enrolling people living with HIV who are terminally ill and have a desire to contribute to HIV cure-related research. METHODS Two focus group discussions consisting of clinical (n = 7) and rapid research autopsy (n = 8) staff members were conducted to understand the perspectives of staff members and the impact the Last Gift rapid autopsy study had on them. The total sample consisted of 66.7% females and 33.3% males and was ethnically diverse (66.7% Caucasian, 6.7% African American, 20.0% Asian descent, 6.7% Hispanic descent and American Indian) with a range of experience in the HIV field from 1 year to 30 years. RESULTS Qualitative focus group data revealed five major themes underlying study staff members' multilayered mental and practical involvement: 1) positive perceptions of the Last Gift study, with sub-themes including Last Gift study participants' altruism, fulfillment, and control at the end of life, 2) perceptions of staff members' close involvement in the Last Gift study, with sub-themes related to staff members' cognitive processing, self-actualization and fulfillment, stress management and resilience, coping mechanisms, and gratitude toward Last Gift participants and toward the study itself, 3) considerations for successful and sustainable study implementation, such as ethical awareness and sustained community and patient engagement, 4) collaborative learning and organizational processes and the value of interdependence between staff members, and 5) considerations for potential study scale-up at other clinical research sites. DISCUSSION Understanding staff members' nuanced emotional and procedural experiences is crucial to the Last Gift study's sustainability and will inform similar cure research studies conducted with people living with HIV at the end of life. The study's potential reproducibility depends on a robust research infrastructure with established, interdependent clinical and rapid autopsy teams, continuous community engagement, and an ethical and well-informed engagement process with people living with HIV.
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Affiliation(s)
- Kelly E. Perry
- UNC Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| | - Jeff Taylor
- AntiViral Research Center Community Advisory Board, San Diego, CA, United States of America
- HIV + Aging Research Project–Palm Springs (HARP-PS), Palm Springs, CA, United States of America
| | - Hursch Patel
- UNC Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| | - Sogol Stephanie Javadi
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, United States of America
| | - Kushagra Mathur
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, United States of America
| | - Andy Kaytes
- AntiViral Research Center Community Advisory Board, San Diego, CA, United States of America
| | - Susanna Concha-Garcia
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, United States of America
- HIV Neurobehavioral Research Center, University of California San Diego, San Diego, CA, United States of America
| | - Susan Little
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, United States of America
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, United States of America
| | - Davey Smith
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, United States of America
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, United States of America
| | - Sara Gianella
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, United States of America
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, United States of America
| | - Karine Dubé
- UNC Gillings School of Global Public Health, Chapel Hill, NC, United States of America
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Dubé K, Perry KE, Mathur K, Lo M, Javadi SS, Patel H, Concha-Garcia S, Taylor J, Kaytes A, Dee L, Campbell D, Kanazawa J, Smith D, Gianella S, Auerbach JD, Saberi P, Sauceda JA. Altruism: Scoping review of the literature and future directions for HIV cure-related research. J Virus Erad 2020; 6:100008. [PMID: 33294210 PMCID: PMC7695811 DOI: 10.1016/j.jve.2020.100008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/27/2020] [Accepted: 08/20/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The question of what motivates people to participate in research is particularly salient in the HIV field. While participation in HIV research was driven by survival in the 1980's and early 1990's, access to novel therapies became the primary motivator with the advent of combination antiretroviral therapy (cART) in the late 1990s. In the HIV cure-related research context, the concept of altruism has remained insufficiently studied. METHODS We conducted a scoping review to better contextualize and understand how altruism is or could be operationalized in HIV cure-related research. We drew from the fields of altruism in general, clinical research, cancer, and HIV clinical research-including the HIV prevention, treatment, and cure-related research fields. DISCUSSION Altruism as a key motivating factor for participation in clinical research has often been intertwined with the desire for personal benefit. The cancer field informs us that reasons for participation usually are multi-faceted and complex. The HIV prevention field offers ways to organize altruism-either by the types of benefits achieved (e.g., societal versus personal), or the origin of the values that motivate research participation. The HIV treatment literature reveals the critical role of clinical interactions in fostering altruism. There remains a dearth of in-depth knowledge regarding reasons surrounding research participation and the types of altruism displayed in HIV cure-related clinical research. CONCLUSION Lessons learned from various research fields can guide questions which will inform the assessment of altruism in future HIV cure-related research.
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Affiliation(s)
- Karine Dubé
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Kelly E. Perry
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Kushagra Mathur
- University of California San Diego (UCSD) School of Medicine, San Diego, CA, USA
| | - Megan Lo
- University of California San Diego (UCSD) School of Medicine, San Diego, CA, USA
| | - Sogol S. Javadi
- University of California San Diego (UCSD) School of Medicine, San Diego, CA, USA
| | - Hursch Patel
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Susanna Concha-Garcia
- AntiViral Research Center (AVRC), USA, San Diego, CA, USA
- HIV Neurobehavioral Research Program, UCSD, San Diego, CA, USA
| | - Jeff Taylor
- AVRC Community Advisory Board (CAB), San Diego, CA, USA
- amfAR Institute for HIV Cure Research CAB, San Francisco, CA, USA
- HIV + Aging Research Project – Palm Springs (HARP – PS), Palm Springs, CA, USA
| | - Andy Kaytes
- AVRC Community Advisory Board (CAB), San Diego, CA, USA
| | - Lynda Dee
- amfAR Institute for HIV Cure Research CAB, San Francisco, CA, USA
- AIDS Action Baltimore, Baltimore, MD, CA, USA
- Delaney AIDS Research Enterprise (DARE), CAB, San Francisco, CA, USA
| | - Danielle Campbell
- Delaney AIDS Research Enterprise (DARE), CAB, San Francisco, CA, USA
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - John Kanazawa
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - David Smith
- AntiViral Research Center (AVRC), USA, San Diego, CA, USA
- Division of Infectious Diseases and Global Public Health, UCSD, San Diego, CA, USA
| | - Sara Gianella
- AntiViral Research Center (AVRC), USA, San Diego, CA, USA
- Division of Infectious Diseases and Global Public Health, UCSD, San Diego, CA, USA
| | - Judith D. Auerbach
- School of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Parya Saberi
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA, USA
| | - John A. Sauceda
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA, USA
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Abstract
Human challenge trials to test the efficacy of vaccine candidates against SARS-CoV-2, the novel coronavirus behind Covid-19, could save considerable time and many lives. But they may initially seem unethical because they expose healthy volunteers to a live virus that is killing many people and for which no cure exists. This article argues that this is not the correct test of their ethics. The correct test is comparative. And in the special circumstances of the Covid-19 pandemic, human challenge trials meet the correct test better than standard efficacy testing would.
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Affiliation(s)
- Nir Eyal
- Directs the Center for Population-Level Bioethics at Rutgers University and is the Henry Rutgers professor of bioethics in the Department of Health Behavior, Society and Policy at Rutgers School of Public Health and in the Department of Philosophy at Rutgers's School of Arts and Sciences
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Dubé K, Dee L. Willingness to risk death endpoint in HIV cure-related research with otherwise healthy volunteers is misleading. J Virus Erad 2020; 6:81-84. [PMID: 32405426 PMCID: PMC7213068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This viewpoint article critiques two recent articles examining 'willingness to risk death' to advance HIV cure-related research. The 'willingness to risk death' endpoint sends the wrong signal to the HIV cure-related research community about ongoing research in otherwise healthy volunteers living with HIV. Socio-behavioural scientists have examined the acceptability of a 99% risk of death scenario, which is unrealistic and would not be acceptable by current regulatory and ethical standards. We believe that the field needs robust and relevant socio-behavioural research reflecting ongoing biomedical HIV cure-related trials. These studies will need to withstand regulatory and ethical scrutiny if cure or remission regimens are to proceed to the licensing stage. The HIV cure-related research community must continue to protect the public trust in the HIV cure-related research field and sustain societal value generated by such research. We call for the utmost prudence in designing biomedical HIV cure trials as well as in setting up socio-behavioural research experiments related to these complex trials.
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Affiliation(s)
- Karine Dubé
- Public Health Leadership Program,
UNC Gillings School of Global Public Health,
Chapel Hill,
NC,
USA
| | - Lynda Dee
- Delaney AIDS Research Enterprise Community Advisory Board (CAB),
Baltimore,
MD,
USA
- amfAR Institute for HIV Cure Research CAB,
Baltimore,
MD,
USA
- AIDS Action Baltimore,
MD,
USA
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25
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Dubé K, Eskaf S, Evans D, Sauceda J, Saberi P, Brown B, Averitt D, Martel K, Meija M, Campbell D, Barr L, Kanazawa J, Perry K, Patel H, Luter S, Poteat T, Auerbach JD, Wohl DA. The Dose Response: Perceptions of People Living with HIV in the United States on Alternatives to Oral Daily Antiretroviral Therapy. AIDS Res Hum Retroviruses 2020; 36:324-348. [PMID: 31608651 PMCID: PMC7185332 DOI: 10.1089/aid.2019.0175] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
There are two concurrent and novel major research pathways toward strategies for HIV control: (1) long-acting antiretroviral therapy (ART) formulations and (2) research aimed at conferring sustained ART-free HIV remission, considered a step toward an HIV cure. The importance of perspectives from people living with HIV on the development of new modalities is high, but data are lacking. We administered an online survey in which respondents selected their likelihood of participation or nonparticipation in HIV cure/remission research based on potential risks and perceived benefits of these new modalities. We also tested the correlation between perceptions of potential risks and benefits with preferences of virologic control strategies and/or responses to scenario choices, while controlling for respondent characteristics. Of the 282 eligible respondents, 42% would be willing to switch from oral daily ART to long-acting ART injectables or implantables taken at 6-month intervals, and 24% to a hypothetical ART-free remission strategy. We found statistically significant gender differences in perceptions of risk and preferences of HIV control strategies, and possible psychosocial factors that could mediate willingness to switch to novel HIV treatment or remission options. Our study yielded data on possible desirable product characteristics for future HIV treatment and remission options. Findings also revealed differences in motivations and preferences across gender and other sociodemographic characteristics that may be actionable as part of research recruitment efforts. The diversity of participant perspectives reveals the need to provide a variety of therapeutic options to people living with HIV and to acknowledge their diverse experiential expertise when developing novel HIV therapies.
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Affiliation(s)
- Karine Dubé
- Public Health Leadership Program (PHLP), UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
- Women's Research Initiative on HIV/AIDS (WRI), Chapel Hill, North Carolina
| | - Shadi Eskaf
- Environmental Finance Center, UNC School of Government, Chapel Hill, North Carolina
| | - David Evans
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board, Los Angeles, California
| | - John Sauceda
- Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, San Francisco, California
| | - Parya Saberi
- Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, San Francisco, California
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside School of Medicine, Riverside, California
| | - Dawn Averitt
- Women's Research Initiative on HIV/AIDS (WRI), Chapel Hill, North Carolina
- The Well Project, Norwich, Vermont
| | - Krista Martel
- Women's Research Initiative on HIV/AIDS (WRI), Chapel Hill, North Carolina
- The Well Project, Norwich, Vermont
| | - Maria Meija
- The Well Project Community Advisory Board, Tamarac, Florida
| | - Danielle Campbell
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board, Los Angeles, California
| | - Liz Barr
- AIDS Clinical Trials Group (ACTG) Community Scientific Subcommittee Representative, Baltimore, Maryland
| | - John Kanazawa
- Public Health Leadership Program (PHLP), UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Kelly Perry
- Public Health Leadership Program (PHLP), UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Hursch Patel
- Public Health Leadership Program (PHLP), UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Stuart Luter
- Public Health Leadership Program (PHLP), UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Tonia Poteat
- Women's Research Initiative on HIV/AIDS (WRI), Chapel Hill, North Carolina
- UNC Department of Social Medicine, School of Medicine, Chapel Hill, North Carolina
| | - Judith D. Auerbach
- Women's Research Initiative on HIV/AIDS (WRI), Chapel Hill, North Carolina
- The Well Project, Norwich, Vermont
- School of Medicine, University of California, San Francisco, San Francisco, California
| | - David A. Wohl
- Institute of Global Health and Infectious Diseases (IGHID), University of North Carolina, Chapel Hill, North Carolina
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Dubé K, Dee L. Willingness to risk death endpoint in HIV cure-related research with otherwise healthy volunteers is misleading. J Virus Erad 2020. [DOI: 10.1016/s2055-6640(20)30021-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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27
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Dubé K, Hosey L, Starr K, Barr L, Evans D, Hoffman E, Campbell DM, Simoni J, Sugarman J, Sauceda J, Brown B, Diepstra KL, Godfrey C, Kuritzkes DR, Wohl DA, Gandhi R, Scully E. Participant Perspectives in an HIV Cure-Related Trial Conducted Exclusively in Women in the United States: Results from AIDS Clinical Trials Group 5366. AIDS Res Hum Retroviruses 2020; 36:268-282. [PMID: 32160755 DOI: 10.1089/aid.2019.0284] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Women remain underrepresented in HIV research. The AIDS Clinical Trials Group (ACTG) 5366 study was the first HIV cure-related trial conducted exclusively in women. Our multidisciplinary team integrated participant-centered reports into the ACTG 5366 protocol to elicit their perspectives. We nested mixed-methods surveys at the enrollment and final study visits to assess ACTG 5366 participants' perceptions and experiences. Of 31 participants enrolled in the ACTG 5366, 29 study agreed to complete the entry questionnaire and 27 completed the exit survey. The majority of study participants were nonwhite. We identified societal and personal motivators for participation, understanding of risks and benefits, and minor misconceptions among some trial participants. Stigma was pervasive for several women who joined the study, and served as a motivator for study participation. Reimbursements to defray costs of study participation were reported to facilitate involvement in the trial by about one-third of participants. Almost all respondents reported positive experiences participating in the ACTG 5366 trial. The ACTG 5366 study showed that it is possible to recruit and retain women in HIV cure-related research and to embed participant-centered outcomes at strategic time points during the study. The findings could help in the design, implementation, recruitment, and retention of women in HIV cure-related research and highlight the value of assessing psychosocial factors in HIV cure-related research participation.
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Affiliation(s)
- Karine Dubé
- UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Lara Hosey
- Social and Scientific Systems (S-3), Silver Spring, Maryland
| | - Kate Starr
- ACTG Community Scientific Sub-Committee, Columbus, Ohio and Baltimore, Maryland
| | - Liz Barr
- ACTG Community Scientific Sub-Committee, Columbus, Ohio and Baltimore, Maryland
- Department of Gender, Women's and Sexuality Studies, University of Maryland Baltimore County (UMBC), Baltimore, Maryland
| | - David Evans
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board (CAB), New York City, New York
| | - Erin Hoffman
- Institute of Global Health and Infectious Diseases (IGHID), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Jane Simoni
- Department of Global Health and University of Washington, Seattle, Washington
- Department of Psychology, University of Washington, Seattle, Washington
| | - Jeremy Sugarman
- Johns Hopkins Berman Institute for Bioethics, Baltimore, Maryland
| | - John Sauceda
- Division of Prevention Sciences, Center for AIDS Prevention Studies (CAPS), University of California, San Francisco, San Francisco, California
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside School of Medicine, Riverside, California
| | - Karen L. Diepstra
- UNC Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Catherine Godfrey
- HIV Research Branch, National Institute of Allergies and Infectious Diseases (NIAID), National Institutes of Health, Bethesda, Maryland
| | | | - David A. Wohl
- Institute of Global Health and Infectious Diseases (IGHID), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Rajesh Gandhi
- Massachusetts General Hospital, Boston, Massachusetts
| | - Eileen Scully
- John Hopkins University School of Medicine, Baltimore, Maryland
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28
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Rennie S, Day S, Mathews A, Gilbertson A, Luseno WK, Tucker JD, Henderson GE. The Role of Inclusion Benefits in Ethics Committee Assessment of Research Studies. Ethics Hum Res 2019; 41:13-22. [PMID: 31108576 DOI: 10.1002/eahr.500015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The relationship between risks and benefits is central to the ethics of research involving human participants. Traditionally, to be ethically justifiable, risks should be reasonable in relation to anticipated benefits (if any) to subjects and to the potential social benefits resulting from research. This calculus is being further complicated by findings from an increasing number of social science studies that reveal that prospective and actual research participants frequently describe various types of inclusion benefits (for example, personal benefits such as access to or improved health care, increased knowledge about their disease or condition, and greater solidarity with the local community) as important to them. What is the ethical significance of such inclusion benefits, particularly those nonmedical in nature, for research ethics committees' risk-benefit assessment of research studies? We argue that, unless participants are clearly mistaken in their perceptions, ethics committees should take these types of inclusion benefits into account, and we suggest a few ways this might look in practice.
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Affiliation(s)
- Stuart Rennie
- Associate professor in the Department of Social Medicine and the Center for Bioethics at the University of North Carolina at Chapel Hill
| | - Suzanne Day
- Postdoctoral researcher in the Department of Social Medicine and the Institute for Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill
| | - Allison Mathews
- Postdoctoral researcher in the Department of Social Medicine and Institute for Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill
| | - Adam Gilbertson
- Postdoctoral researcher in the Department of Social Medicine and the Institute for Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill and an associate research scientist at Pacific Institute for Research and Evaluation
| | - Winfred K Luseno
- Research scientist at the Pacific Institute for Research and Evaluation
| | - Joseph D Tucker
- Associate professor at the Institute for Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill
| | - Gail E Henderson
- Professor in the Department of Social Medicine at the University of North Carolina at Chapel Hill
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29
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Dubé K, Auerbach JD, Stirratt MJ, Gaist P. Applying the Behavioural and Social Sciences Research (BSSR) Functional Framework to HIV Cure Research. J Int AIDS Soc 2019; 22:e25404. [PMID: 31665568 PMCID: PMC6820877 DOI: 10.1002/jia2.25404] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/30/2019] [Accepted: 09/25/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The search for an HIV cure involves important behavioural and social processes that complement the domains of biomedicine. However, the field has yet to tap into the full potential of behavioural and social sciences research (BSSR). In this article, we apply Gaist and Stirratt's BSSR Functional Framework to the field of HIV cure research. DISCUSSION The BSSR Functional Framework describes four key research domains: (1) basic BSSR (understanding basic behavioural and social factors), (2) elemental BSSR (advancing behavioural and social interventions), (3) supportive BSSR (strengthening biomedically focused clinical trials), and (4) integrative BSSR (building multi-disciplinary combination approaches for real-world implementation). In revisiting and applying the BSSR Functional Framework, we clarify the importance of BSSR in HIV cure research by drawing attention to such things as: how language and communication affect the meaning of "cure" to people living with HIV (PLHIV) and broader communities; how cure affects the identity and social position of PLHIV; counselling and support interventions to address the psychosocial needs and concerns of study participants related to analytical treatment interruptions (ATIs); risk reduction in the course of ATI study participation; motivation, acceptability, and decision-making processes of potential study participants related to different cure strategies; HIV care providers' perceptions and attitudes about their patients' participation in cure research; potential social harms or adverse social events associated with cure research participation; and the scalability of a proven cure strategy in the context of further advances in HIV prevention and treatment. We also discuss the BSSR Functional Framework in the context of ATIs, which involve processes at the confluence of the BSSR domains. CONCLUSIONS To move HIV cure regimens through the translational research pathway, attention will need to be paid to both biomedical and socio-behavioural elements. BSSR can contribute an improved understanding of the human and social dimensions related to HIV cure research and the eventual application of HIV cure regimens. The BSSR Functional Framework provides a way to identify advances, gaps and opportunities to craft an integrated, multi-disciplinary approach at all stages of cure research to ensure the real-world applicability of any strategy that shows promise.
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Affiliation(s)
- Karine Dubé
- UNC Gillings School of Global Public HealthUniversity of North CarolinaChapel HillNCUSA
| | - Judith D Auerbach
- School of MedicineUniversity of California San FranciscoSan FranciscoCAUSA
| | - Michael J Stirratt
- Division of AIDS Research (DAR)National Institute of Mental HealthNational Institutes of HealthBethesdaMDUSA
| | - Paul Gaist
- Office of AIDS ResearchDivision of Program Coordination, Planning, and Strategic InitiativesOffice of the DirectorNational Institutes of HealthBethesdaMDUSA
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