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Lefebvre S, Lelièvre JD, Rieux V, Weiss L, Ward D, Rachline A, Bureau-Stoltmann M, Ben Rayana R, Gaad N, Ben Mechlia M, Barbareschi G, Corbelli GM, Brodnicki E, Spire B, Mc Cormack S, Protière C. "They Have to Make an Effort Too": What Decliners Can Teach Us About HIV Cure/Remission-Related Clinical Trials? Results from a French Qualitative Study. AIDS Res Hum Retroviruses 2024. [PMID: 39437018 DOI: 10.1089/aid.2024.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2024] Open
Abstract
Only one study to date has focused on people living with HIV (PLWH) who refused to participate in a HIV cure/remission-related clinical trial (HCCT)-"decliners" hereafter-that included analytical treatment interruption (ATI). Exploring why these persons refuse may provide valuable information to ensure more ethical recruitment and support in HCCTs within the bigger picture of improving HIV cure research. The qualitative component of the AMEP-EHVA-T02/ANRS-95052 study, called AMEP-Decliners, documented the experiences of French PLWH who refused to participate in EHVA-T02/ANRS-VRI07, a phase II randomized, placebo-controlled HCCT with ATI. AMEP-Decliners comprised semi-structured individual interviews with six decliners in two HIV care sites in France between September 2022 and March 2023. The interviews documented their expectations regarding HCCTs, reasons for refusal, and perceived factors that might have led them to participate. Audio files were transcribed, and an inductive thematic analysis was performed. Surprisingly, the main reason for refusal was not ATI but the trial monitoring. Besides the frequency of appointments, respondents emphasized the incompatibility with their active life. One underlying reason for refusal was that participating would have meant "break[ing] the carefree attitude about the disease," reflecting the substantial psychological burden associated with participation. Finally, respondents perceived that the trial's clinical team did not sufficiently recognize their "normal life" and the level of commitment required to participate, leading them to call for greater involvement by the team: "they have to make an effort too." Results from decliners' discourses highlighted that two levels of commitment to participation must be considered when developing HCCTs: psychological burden and logistical constraints. We suggest allowing home examinations and flexible appointment times, prioritizing face-to-face invitations in order to address the psychological burden associated with HCCT participation, and explaining the reasons for monitoring constraints when they cannot be alleviated. Further studies are necessary to confirm our results.
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Affiliation(s)
- Sarah Lefebvre
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Jean-Daniel Lelièvre
- Vaccine Research Institute, Université Paris-Est, Créteil, France
- INSERM U955, Institut Mondor de Recherche Biomedicale, Team Lévy, Créteil, France
- Assistance Publique-Hôpitaux de Paris, Groupe Henri Mondor Albert-Chenevier, Service De Maladies Infectieuses & Immunologie Clinique, Créteil, France
| | | | - Laurence Weiss
- Service d'Immunologie Clinique, Hôtel Dieu, Paris, France
- Faculté de Santé, UFR de Médecine, Université Paris Cité, Paris, France
| | - Denise Ward
- MRC Clinical Trials Unit, UCL, London, United Kingdom
| | - Anne Rachline
- Service d'Immunologie Clinique, Hôtel Dieu, Paris, France
| | - Morgane Bureau-Stoltmann
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Raida Ben Rayana
- Assistance Publique-Hôpitaux de Paris, Groupe Henri Mondor Albert-Chenevier, Service De Maladies Infectieuses & Immunologie Clinique, Créteil, France
| | - Nadir Gaad
- Vaccine Research Institute, Université Paris-Est, Créteil, France
| | | | | | | | | | - Bruno Spire
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | | | - Christel Protière
- Aix Marseille Univ, Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
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Fridman I, Eyal N, Scherr KA, Currier JS, Freedberg KA, Halpern SD, Kuritzkes DR, Magalhaes M, Pollak KI, Ubel PA. Willingness to trade-off years of life for an HIV cure - an experimental exploration of affective forecasting. AIDS Res Ther 2024; 21:51. [PMID: 39107832 PMCID: PMC11304558 DOI: 10.1186/s12981-024-00640-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 07/24/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND In the US, 1.2 million people live with HIV (PWH). Despite having near-normal life expectancies due to antiretroviral therapy (ART), many PWH seek an HIV cure, even if it means risking their lives. This willingness to take risks for a cure raises questions about "affective forecasting biases," where people tend to overestimate the positive impact of future events on their well-being. We conducted a study to test two interventions to mitigate affective forecasting in the decisions of PWH about taking HIV cure medication. METHODS We recruited PWH to complete a 30-minute survey about their current quality of life (QoL) and the QoL they anticipate after being cured of HIV, and assigned them to either no additional intervention, to one of two interventions intended to reduce affective forecasting bias, or to both interventions: (1) a defocusing intervention designed to broaden the number of life domains people consider when imagining life changes associated with new circumstances (e.g. HIV cure); and (2) an adaptation intervention to help them gauge fading of strong emotions over time. The study design included a 2 × 2 design: defocusing (yes/no) x adaptation (yes/no) intervention. We assessed PWH's willingness to take hypothetical HIV sterilizing cure medication using the Time Trade-Off (TTO) and their quality of life predictions with WHOQOL-HIV. RESULTS 296 PWH participated. Counter to what we had hypothesized, neither intervention significantly reduced PWH's willingness to trade time for a cure. Instead, the defocusing intervention increased their willingness to trade time (IRR 1.77, p = 0.03). Exploratory analysis revealed that PWH with lower current quality of life who received the defocusing intervention were more willing to trade time for a cure. CONCLUSION These negative findings suggest that either these biases are difficult to overcome in the settings of HIV curative medication or other factors beyond affective forecasting biases influence willingness to participate in HIV curative studies, such as respondents' current quality of life.
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Affiliation(s)
- Ilona Fridman
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, Chapel Hill, 450 West Dr, NC, 27599, USA.
| | - Nir Eyal
- School of Public Health, and Philosophy, Rutgers University Institute for Health, 112 Paterson St, NJ, 08901, USA
| | - Karen A Scherr
- Department of Family Medicine and Community Health, Duke School of Medicine, 2301 Erwin Rd, Durham, 27710, NC, USA
| | - Judith S Currier
- Department of Medicine, University of California Los Angeles, 911 Broxton Ave, Suite 30, Los Angeles, CA, 90095, USA
| | - Kenneth A Freedberg
- Medical Practice Evaluation Center, Divisions of General Internal Medicine and Infectious Diseases, Massachusetts General Hospital, 100 Cambridge St, Suite 1600, Boston, MA, 02115, USA
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Scott D Halpern
- Departments of Medicine, Medical Ethics and Health Policy, and Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - Daniel R Kuritzkes
- Division of Infectious Diseases Brigham and Women's Hospital, Harvard Medical School, 65 Landsdowne St, Rm 449, Cambridge, MA, 02139, USA
| | - Monica Magalhaes
- Rutgers University Institute for Health, 112 Paterson Street, New Brunswick, NJ, 08901, USA
| | - Kathryn I Pollak
- Cancer Control and Population Sciences in the Duke Cancer Institute, 2424 Erwin Road, Suite 602, Durham, NC, 27705, USA
- Department of Population Health Science, Duke University, 215 Morris St, Durham, NC, 27701, USA
| | - Peter A Ubel
- Department of Population Health Science, Fuqua School of Business, School of Medicine, Sanford School of Public Policy, Duke University, 100 Fuqua Drive., Durham, NC, 27708, USA
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3
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Ndukwe SO, Patel H, Shelton B, Concha-Garcia S, Dullano C, Solso S, Hendrickx S, Riggs PK, Villa TJ, Kaytes A, Taylor J, Little SJ, Lessard D, Arora AK, Costiniuk CT, Eskaf S, Smith DM, Gianella S, Dubé K. People with HIV at the end-of-life and their next-of-kin/loved ones are willing to participate in interventional HIV cure-related research. AIDS 2024; 38:235-243. [PMID: 37861674 PMCID: PMC10842373 DOI: 10.1097/qad.0000000000003754] [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: 10/21/2023]
Abstract
INTRODUCTION The Last Gift study at the University of California San Diego (UCSD), United States enrolls terminally ill people with HIV (PWH) in HIV cure research. METHODS From 2017 to 2022, we conducted surveys with Last Gift participants and their next-of-kin/loved ones to evaluate willingness to participate in different types of HIV cure research at the end of life (EOL). We analyzed willingness data descriptively. RESULTS We surveyed 17 Last Gift participants and 17 next-of-kin/loved ones. More than half of Last Gift participants ( n = 10; 58.8%) expressed willingness to participate in studies involving totally new treatments or approaches ('first-in-human' studies), a combination of different approaches, the use of unique antibodies, proteins or molecules, or therapeutic vaccines. Under one-quarter of Last Gift participants ( n = 4; 23.5%) expressed willingness to participate in research involving interventions that may shorten their life expectancy to benefit medical research. Most Last Gift participants and their next-of-kin/loved ones also expressed high acceptance for various types of donations and biopsies at the EOL (e.g. hair donations and skin, lymph node or gut biopsies). DISCUSSION Knowing whether people would be willing to participate in different types of EOL HIV cure research can help inform the design of future innovative studies. As a research community, we have a duty to design studies with adequate safeguards to preserve the public trust in research and honor PWH's important gift to humanity.
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Affiliation(s)
- Samuel O. Ndukwe
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego (UCSD), CA, USA
- UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Hursch Patel
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego (UCSD), 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
| | - 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
| | - Patricia K. Riggs
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego (UCSD), CA, USA
| | - Thomas J. Villa
- HIV Obstruction by Programmed Epigenetics (HOPE) Collaboratory Community Advisory Board, Rockville, MD, USA
| | - Andy Kaytes
- UCSD Antiviral Research Center Community Advisory Board, San Diego, CA, USA
| | - Jeff Taylor
- UCSD Antiviral Research Center Community Advisory Board, San Diego, CA, USA
- HIV + Aging Research Project Palm Springs (HARP-PS), Palm Springs, CA, USA
| | - Susan J. Little
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego (UCSD), CA, USA
- Antiviral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
| | - David Lessard
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, Division of Infectious Diseases, 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, Division of Infectious Diseases, McGill University Health Center (MUCH), Montreal, QC, Canada
- Department of Medicine, Division of Infectious Diseases and 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 (UCSD), 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 (UCSD), CA, USA
- Antiviral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
| | - Karine Dubé
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego (UCSD), CA, USA
- UNC Gillings School of Global Public Health, Chapel Hill, NC, 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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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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Neergaard R, Jones NL, Roebuck C, Rendle KA, Barbati Z, Peterson B, Tebas P, Mounzer K, Metzger D, Montaner LJ, Dube K, Barg FK. "I Know That I Was a Part of Making a Difference": Participant Motivations for Joining a Cure-Directed HIV Trial with an Analytical Treatment Interruption. AIDS Res Hum Retroviruses 2023; 39:414-421. [PMID: 35979886 PMCID: PMC10389247 DOI: 10.1089/aid.2022.0040] [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: 11/12/2022] Open
Abstract
Analytical treatment interruption (ATI), defined as a closely monitored clinical pause in antiretroviral therapy (ART), is a core component of many HIV cure-directed clinical studies. ATIs may cause significant physical and psychosocial risks for people living with HIV and, as a result, integrating participant and community perspectives into clinical trial designs that include an ATI is crucial to ensuring a successful and person-centered trial. We conducted semi-structured interviews with participants enrolling in the BEAT-2 cure-directed trial (NCT03588715). Interviews elicited participant motivations and decision-making processes for trial participation along with participants' perceptions of the ATI. Interviews were recorded, transcribed, and analyzed using a directed content analysis. Fourteen of 15 trial participants completed interviews. The majority were Black (79%) cisgender male (79%). Participants noted several significant motivating factors contributing to their desire to enroll in the HIV cure-directed clinical trial, the most prominent being a desire to find a cure for HIV and help others in the HIV community. HIV care teams were the most commonly identified resource for patients when making the decision to enroll in the trial, and family, friends, and romantic partners also played a significant role. Altruism was a primary motivation for participation, although participants also shared interest in learning about HIV science and research. Participants had a strong understanding of trial procedures and displayed significant trust in the study team to keep them informed and healthy during their participation. The ATI was a significant source of anxiety for participants. Their primary worry was that their prior antiretroviral therapy (ART) regimen would no longer be effective once they resumed ART. Despite these concerns, participants shared considerable excitement for continued participation in the trial and being a part of the search toward an HIV cure.
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Affiliation(s)
- Rebecca Neergaard
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nora L. Jones
- Center for Urban Bioethics, Temple University Ringgold Standard Institution, Philadelphia, Pennsylvania, USA
- BEAT-HIV Collaboratory Community Advisory Board (CAB), Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Christopher Roebuck
- BEAT-HIV Collaboratory Community Advisory Board (CAB), Wistar Institute, Philadelphia, Pennsylvania, USA
- Department of Anthropology, University of California Berkeley, Berkeley, California, USA
| | - Katharine A. Rendle
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Zoe Barbati
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Beth Peterson
- BEAT-HIV Collaboratory Community Advisory Board (CAB), Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Pablo Tebas
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Karam Mounzer
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - David Metzger
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Luis J. Montaner
- BEAT-HIV Collaboratory Community Advisory Board (CAB), Wistar Institute, Philadelphia, Pennsylvania, USA
| | - Karine Dube
- UNC Gillings School of Global Health, Chapel Hill, North Carolina, USA
| | - Frances K. Barg
- Family Medicine and Community Health, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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7
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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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8
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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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