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Lemey G, Larivière Y, Osang'ir BI, Zola T, Kimbulu P, Milolo S, Danoff E, Tchuma Y, Maketa V, Mitashi P, Ravinetto R, Van Damme P, Van Geertruyden JP, Muhindo-Mavoko H. An ancillary care policy in a vaccine trial conducted in a resource-constrained setting: evaluation and policy recommendations. BMJ Glob Health 2024; 9:e015259. [PMID: 38857947 PMCID: PMC11168174 DOI: 10.1136/bmjgh-2024-015259] [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: 02/02/2024] [Accepted: 05/22/2024] [Indexed: 06/12/2024] Open
Abstract
INTRODUCTION Clear guidelines to implement ancillary care (AC) in clinical trials conducted in resource-constrained settings are lacking. Here, we evaluate an AC policy developed for a vaccine trial in the Democratic Republic of the Congo and formulate policy recommendations. METHODS To evaluate the AC policy, we performed a longitudinal cohort study, nested in an open-label, single-centre, randomised Ebola vaccine trial conducted among healthcare personnel. Participants' demographic information, residence distance to the study site and details on the financial and/or medical support provided for any (serious) adverse events ((S)AE) were combined and analysed. To assess the feasibility of the AC policy, an expenditure analysis of the costs related to AC support outcomes was performed. RESULTS Enrolment in this evaluation study started on 29 November 2021. The study lasted 11 months and included 655 participants from the Ebola vaccine trial. In total, 393 participants used the AC policy, mostly for AE management (703 AE and 94 SAE) via medication provided by the study pharmacy (75.3%). Men had a 35.2% (95% CI 4.0% to 56.6%) lower likelihood of reporting AE compared with women. Likewise, this was 32.3% lower (95% CI 5.8% to 51.4%) for facility-based compared with community-based healthcare providers. The daily AE reporting was 78.8% lower during the passive vs the active trial stage, and 97.4% lower during unscheduled vs scheduled visits (p<0.001). Participants living further than 10 km from the trial site more frequently reported the travel distance as a reason for not using the policy (p<0.04). In practice, only 1.1% of the operational trial budget was used for AC policy support. CONCLUSION The trial design, study population and local health system impacted the use of the AC policy. Nonetheless, the AC policy implementation in this remote and resource-constrained setting was feasible, had negligible budgetary implications and contributed to participants' healthcare options and well-being.
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Affiliation(s)
- Gwen Lemey
- Global Health Institute, University of Antwerp, Antwerpen, Belgium
- Centre for the Evaluation of Vaccination, University of Antwerp, Antwerpen, Belgium
| | - Ynke Larivière
- Global Health Institute, University of Antwerp, Antwerpen, Belgium
- Centre for the Evaluation of Vaccination, University of Antwerp, Antwerpen, Belgium
| | - Bernard Isekah Osang'ir
- Global Health Institute, University of Antwerp, Antwerpen, Belgium
- Centre for the Evaluation of Vaccination, University of Antwerp, Antwerpen, Belgium
| | - Trésor Zola
- Global Health Institute, University of Antwerp, Antwerpen, Belgium
- Tropical Medicine Department, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
| | - Primo Kimbulu
- Tropical Medicine Department, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
| | - Solange Milolo
- Tropical Medicine Department, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
| | - Engbu Danoff
- Tropical Medicine Department, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
| | - Yves Tchuma
- Tropical Medicine Department, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
| | - Vivi Maketa
- Tropical Medicine Department, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
| | - Patrick Mitashi
- Tropical Medicine Department, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
| | - Raffaella Ravinetto
- Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, University of Antwerp, Antwerpen, Belgium
| | | | - Hypolite Muhindo-Mavoko
- Tropical Medicine Department, University of Kinshasa, Kinshasa, Congo (the Democratic Republic of the)
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Khan MMM, Munir MM, Woldesenbet S, Khalil M, Endo Y, Katayama E, Altaf A, Dillhoff M, Obeng-Gyasi S, Pawlik TM. Disparities in clinical trial enrollment among patients with gastrointestinal cancer relative to minority-serving and safety-netting hospitals. J Gastrointest Surg 2024; 28:896-902. [PMID: 38555017 DOI: 10.1016/j.gassur.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/06/2024] [Accepted: 03/24/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND For results to be generalizable to all patients with cancer, clinical trials need to include a diverse patient demographic that is representative of the general population. We sought to characterize the effect of receiving care at a minority-serving hospital (MSH) and/or safety-net hospital on clinical trial enrollment among patients with gastrointestinal (GI) malignancies. METHODS Adult patients with GI cancer who underwent oncologic surgery and were enrolled in institutional-/National Cancer Institute-funded clinical trials between 2012 and 2019 were identified in the National Cancer Database. Multivariable regression was used to assess the relationship between MSH and safety-net status relative to clinical trial enrollment. RESULTS Among 1,112,594 patients, 994,598 (89.4%) were treated at a non-MSH, whereas 117,996 (10.6%) were treated at an MSH. Only 1857 patients (0.2%) were enrolled in a clinical trial; most patients received care at a non-MSH (1794 [96.6%]). On multivariable analysis, the odds of enrollment in a clinical trial were markedly lower among patients treated at an MSH vs non-MSH (odds ratio [OR], 0.32; 95% CI, 0.22-0.46). In addition, even after controlling for receipt of care at MSH, Black patients remained at lower odds of enrollment in a clinical trial than White patients (OR, 0.57; 95% CI, 0.45-0.73; both P < .05). CONCLUSION Overall, clinical trial participation among patients with GI cancer was extremely low. Patients treated at an MSH and high safety-net burden hospitals and Black individuals were much less likely to be enrolled in a clinical trial. Efforts should be made to improve trial enrollment and address disparities in trial representation.
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Affiliation(s)
- Muhammad Muntazir Mehdi Khan
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Muhammad Musaab Munir
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Selamawit Woldesenbet
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Mujtaba Khalil
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Yutaka Endo
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Erryk Katayama
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Abdullah Altaf
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Mary Dillhoff
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States
| | - Timothy M Pawlik
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, United States.
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Davidson N, Hammarberg K, Fisher J. Ethical Considerations in Research With People From Refugee and Asylum Seeker Backgrounds: A Systematic Review of National and International Ethics Guidelines. JOURNAL OF BIOETHICAL INQUIRY 2024; 21:261-284. [PMID: 37889418 PMCID: PMC11289226 DOI: 10.1007/s11673-023-10297-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 08/03/2023] [Indexed: 10/28/2023]
Abstract
Refugees and asylum seekers may experience challenges related to pre-arrival experiences, structural disadvantage after migration and during resettlement requiring the need for special protection when participating in research. The aim was to review if and how people with refugee and asylum seeker backgrounds have had their need for special protection addressed in national and international research ethics guidelines. A systematic search of grey literature was undertaken. The search yielded 2187 documents of which fourteen met the inclusion criteria. Few guidelines addressed specific ethical considerations for vulnerable groups much less people with refugee and asylum seeker backgrounds. One guideline explicitly addressed vulnerability for refugees and asylums seekers. To ensure members of ethics committees and researchers consider the potential challenges of conducting research with these groups, guidelines may need to be supplemented with a refugee and asylum seeker specific research ethics framework. Such a framework may be necessary to optimally protect people with refugee and asylum seeker backgrounds in research.
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Affiliation(s)
- Natasha Davidson
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia.
| | - Karin Hammarberg
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
| | - Jane Fisher
- Global and Women's Health, School of Public Health and Preventive Medicine, Monash University Faculty of Medicine Nursing and Health Sciences, 553 St Kilda Road, Melbourne, Victoria, 3004, Australia
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Dabira ED, Fehr A, Beloum N, Van Geertruyden JP, Achan J, Erhart A, Martinez-Alvarez M, D'Alessandro U. Perceptions and acceptability of the controlled human malaria infection (CHMI) model in The Gambia: a qualitative study. Sci Rep 2023; 13:8708. [PMID: 37248260 DOI: 10.1038/s41598-023-35752-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 05/23/2023] [Indexed: 05/31/2023] Open
Abstract
Controlled human malaria infection (CHMI) studies, i.e. the deliberate infection of healthy volunteers with malaria parasites to study immune response and/or test drug or vaccine efficacy, are increasingly being conducted in malaria endemic countries, including in sub-Saharan Africa. However, there have been few studies on the perceptions and acceptability of CHMI by the local communities. This qualitative study assessed the perception and acceptability of such studies in The Gambia following the first CHMI study conducted in the country in March-May 2018. Data were collected through non-participant observation, in-depth interviews and focus group discussions and analyzed using NVivo 12 software with an inductive-deductive approach. Sixty-seven participants were involved, including volunteers enrolled in the CHMI, community stakeholders and members of the Gambian Ethics Committee. Respondents expressed a positive view about CHMI. Key motivating factors for participation were the financial compensation, comprehensive health checks, and willingness to support malaria research. Risks associated with participation were considered low. Concerns raised included the frequency of bleeding and the blood volume collected.
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Affiliation(s)
- Edgard Diniba Dabira
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Fajara, The Gambia.
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
| | - Alexandra Fehr
- London School of Hygiene and Tropical Medicine, London, UK
| | - Nathalie Beloum
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Fajara, The Gambia
| | | | | | - Annette Erhart
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Fajara, The Gambia
| | - Melisa Martinez-Alvarez
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Fajara, The Gambia
| | - Umberto D'Alessandro
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine (MRCG at LSHTM), Fajara, The Gambia
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Maketa V, Luzolo F, Muhindo Mavoko H, Claeys Y, Munday F, Yemesi Benge R, Bongo Pasi W, Mankindu D, Mampunza S, Lukanu P, Kasongo M, Ntabe Namegabe E, Kambale Karafuli L, Phanzu Mavinga D, Milandu Massamba E, Muaka Khoso C, Ravinetto R. Boosting ethics review capacity in public health emergency situations: Co-creation of a training model for French-speaking research ethics committees. Trop Med Int Health 2022; 27:934-940. [PMID: 36053926 PMCID: PMC9826200 DOI: 10.1111/tmi.13815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Ethics review preparedness is a major foundation for national effective response to public health emergencies, because it promotes pertinent research and enhances the protection of research participants and communities. In low-income countries, it can also promote equitable research partnership. However, most relevant literature is in English and not easily accessible for the members of research ethics committees in French-speaking African countries. METHODS A training module in French, addressing the issue of research ethics review during outbreaks and other public health emergencies, was designed based on a non-systematic literature review, and in order to be complementary to the Democratic Republic of Congo (DRC) national guidelines for ethics review. The module was administered to 42 members of the five ethics committees in DRC that expressed their interest for the training. RESULT This training, co-designed with local stakeholders, in the local working language and taking into account local circumstances and regulation, provided participants with up-to-date insights of research ethics (and research ethics preparedness) in public health emergencies. It resulted in rich reflection and knowledge-sharing on good practices across the ethics committees. CONCLUSION As most participating ethics committees do not have yet explicit standard operating procedures for expedited review of protocols submitted in emergency situations, this would be a next important step to facilitate emergency reviews in the most efficient way.
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Affiliation(s)
- Vivi Maketa
- University of KinshasaKinshasaDemocratic Republic of Congo
| | - Flory Luzolo
- University of KinshasaKinshasaDemocratic Republic of Congo
| | | | - Yves Claeys
- Institute of Tropical MedicineAntwerpBelgium
| | - Felicien Munday
- Comité National d'Ethique de la SantéKinshasaDemocratic Republic of Congo
| | | | - Willy Bongo Pasi
- Comité d'Ethique de l'Ecole de Santé Publique de KinshasaKinshasaDemocratic Republic of Congo
| | - Darius Mankindu
- Comité d'Ethique de l'Ecole de Santé Publique de KinshasaKinshasaDemocratic Republic of Congo
| | - Samuel Mampunza
- Comité d'Ethique de l'Université Protestante au CongoKinshasaDemocratic Republic of Congo
| | - Philippe Lukanu
- Comité d'Ethique de l'Université Protestante au CongoKinshasaDemocratic Republic of Congo
| | - Muteho Kasongo
- Comité d'Ethique de l'Université Libre des Pays des Grands LacsGomaDemocratic Republic of Congo
| | - Edmond Ntabe Namegabe
- Comité d'Ethique de l'Université Libre des Pays des Grands LacsGomaDemocratic Republic of Congo
| | | | - Delphin Phanzu Mavinga
- Comité d'Ethique du Centre de Recherche en Santé de KimpeseKimpeseDemocratic Republic of Congo
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Lemey G, Larivière Y, Zola TM, Maketa V, Matangila J, Mitashi P, Vermeiren P, Thys S, De Bie J, Muhindo HM, Ravinetto R, Van Damme P, Van Geertruyden JP. Algorithm for the support of non-related (serious) adverse events in an Ebola vaccine trial in the Democratic Republic of the Congo. BMJ Glob Health 2021; 6:bmjgh-2021-005726. [PMID: 34183329 PMCID: PMC8240587 DOI: 10.1136/bmjgh-2021-005726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/13/2021] [Indexed: 01/10/2023] Open
Abstract
Implementing an Ebola vaccine trial in a remote area in the Democratic Republic of the Congo (DRC), and being confronted with a dysfunctional health care system and acute unmet health needs of participants, ethical considerations were made regarding the ancillary care obligations of the sponsor and researchers. Spurred by the occurrence of non-related (serious) adverse events (NR-SAEs), the Universities of Antwerp and Kinshasa jointly developed an algorithm, accompanied by an algorithm policy. The algorithm consists of a set of consecutive questions with binary response options, leading to structured, non-arbitrary and consistent support and management for each NR-SAE. It is the result of dialogue and collaboration between the sponsor (University of Antwerp) and the principal investigator (University of Kinshasa), consultation of literature, and input of research ethics and social sciences experts. The characteristics of the project and its budgetary framework were taken into account, as well as the local socioeconomic and healthcare situation. The algorithm and related policy have been approved by the relevant ethics committee (EC), so field implementation will begin when the study activities resume in November 2021. Lessons learnt will be shared with the relevant stakeholders within and outside DRC. If NR-SAEs are not covered by a functioning social welfare system, sponsors and researchers should develop a feasible, standardised and transparent approach to the provision of ancillary care. National legislation and contextualised requirements are therefore needed, particularly in low/middle-income countries, to guide researchers and sponsors in this process. Protocols, particularly of clinical trials conducted in areas with ‘access to care’ constraints, should include adequate ancillary care arrangements. Furthermore, it is essential that local ECs systematically require ancillary care provisions to enhance the well-being and protection of the rights of research participants. This project was funded by the European Union’s Horizon 2020 research and innovation programme, European Federation of Pharmaceutical Industries and Associations, and the Coalition for Epidemic Preparedness Innovations.
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Affiliation(s)
- Gwen Lemey
- Global Health Institute, University of Antwerp, Antwerpen, Belgium .,Centre for the Evaluation of Vaccination, University of Antwerp, Antwerpen, Belgium
| | - Ynke Larivière
- Global Health Institute, University of Antwerp, Antwerpen, Belgium.,Centre for the Evaluation of Vaccination, University of Antwerp, Antwerpen, Belgium
| | - Trésor Matuvanga Zola
- Tropical Medicine Department, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Vivi Maketa
- Tropical Medicine Department, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Junior Matangila
- Tropical Medicine Department, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Patrick Mitashi
- Tropical Medicine Department, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Peter Vermeiren
- Global Health Institute, University of Antwerp, Antwerpen, Belgium.,Centre for the Evaluation of Vaccination, University of Antwerp, Antwerpen, Belgium
| | - Séverine Thys
- Global Health Institute, University of Antwerp, Antwerpen, Belgium.,Centre for the Evaluation of Vaccination, University of Antwerp, Antwerpen, Belgium
| | - Jessie De Bie
- Global Health Institute, University of Antwerp, Antwerpen, Belgium.,Centre for the Evaluation of Vaccination, University of Antwerp, Antwerpen, Belgium
| | - Hypolite Mavoko Muhindo
- Tropical Medicine Department, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Raffaella Ravinetto
- Department of Public Health, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Pierre Van Damme
- Centre for the Evaluation of Vaccination, University of Antwerp, Antwerpen, Belgium
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Kapumba BM, Desmond N, Seeley J. What do we know about ancillary care practices in East and Southern Africa? A systematic review and meta-synthesis. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16858.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Despite growing calls for the provision of ancillary care to study participants during medical research, there remains a noticeable gap in ethical guidelines for medical researchers in resource-constrained settings (RCS). We reviewed recent studies to determine the extent to which ancillary care is provided in East and Southern Africa and to examine the ethical justifications researchers provide to support their views on ancillary care obligations. Methods: A systematic search for qualitative and mixed methods studies on ancillary care was conducted across MEDLINE, Embase, African Wide Information, PubMed, CINAHL Plus, and Scopus. The National Institutes of Health (NIH) Department of Bioethics and H3 Africa websites and Google Scholar were further searched. Studies conducted in East and Southern Africa between 2004 and 2020, as well as those that reported on ancillary care provided to study participants were included. All studies included in this review were evaluated for methodological quality as well as bias risk. NVivo version 12 was used for thematic analysis. Results: Overall, 4,710 articles were identified by the initial search. After the data extraction and quality assessment, 24 articles were included. Key areas presented include ancillary care approaches and the themes of researcher motivation for providing ancillary care and expectations of participants in medical research. The review shows that while some international researchers do provide ancillary care to their study participants, approaches are not standardised without consistent guidelines for ethical practice for ancillary care. We found limited empirical studies in RCS that report on ancillary care, hence findings in this review are based on single studies rather than a collection of multiple studies. Conclusions: This paper emphasizes the value of establishing ethics guidelines for medical researchers in RCS who consider provision of ancillary care to their participants, and the need to account for these ethical guidelines in medical research.
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Nyirenda D, Sariola S, Kingori P, Squire B, Bandawe C, Parker M, Desmond N. Structural coercion in the context of community engagement in global health research conducted in a low resource setting in Africa. BMC Med Ethics 2020; 21:90. [PMID: 32957967 PMCID: PMC7504839 DOI: 10.1186/s12910-020-00530-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/26/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND While community engagement is increasingly promoted in global health research to improve ethical research practice, it can sometimes coerce participation and thereby compromise ethical research. This paper seeks to discuss some of the ethical issues arising from community engagement in a low resource setting. METHODS A qualitative study design focusing on the engagement activities of three biomedical research projects as ethnographic case studies was used to gain in-depth understanding of community engagement as experienced by multiple stakeholders in Malawi. Data was collected through participant observation, 43 In-depth interviews and 17 focus group discussions with community leaders, research staff, community members and research participants. Thematic analysis was used to analyse and interpret the findings. RESULTS The results showed that structural coercion arose due to an interplay of factors pertaining to social-economic context, study design and power relations among research stakeholders. The involvement of community leaders, government stakeholders, and power inequalities among research stakeholders affected some participants' ability to make autonomous decisions about research participation. These results have been presented under the themes of perception of research as development, research participants' motivation to access individual benefits, the power of vernacular translations to influence research participation, and coercive power of leaders. CONCLUSION The study identified ethical issues in community engagement practices pertaining to structural coercion. We conclude that community engagement alone did not address underlying structural inequalities to ensure adequate protection of communities. These results raise important questions on how to balance between engaging communities to improve research participation and ensure that informed consent is voluntarily given.
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Affiliation(s)
- Deborah Nyirenda
- Malawi Liverpool Wellcome Trust Clinical Research Programme, PO Box 30096, Chichiri, Blantyre 3, Malawi.
| | - Salla Sariola
- Department of Social Sciences, University of Helsinki, P.O 18 (Unioninkatu 35), 00014, Helsinki, Finland
| | - Patricia Kingori
- The Ethox Centre/ Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Bertie Squire
- Malawi Liverpool Wellcome Trust Clinical Research Programme, PO Box 30096, Chichiri, Blantyre 3, Malawi
- Department of Social Sciences, University of Helsinki, P.O 18 (Unioninkatu 35), 00014, Helsinki, Finland
| | - Chiwoza Bandawe
- University of Malawi College of Medicine, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Michael Parker
- The Ethox Centre/ Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Nicola Desmond
- Malawi Liverpool Wellcome Trust Clinical Research Programme, PO Box 30096, Chichiri, Blantyre 3, Malawi
- Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
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Van Nuil JI, Nguyen TTT, Le Nguyen TN, Nguyen VVC, Chambers M, Ta TDN, Merson L, Nguyen TPD, Hoang MTV, Parker M, Bull S, Kestelyn E. Researcher and study participants' perspectives of consent in clinical studies in four referral hospitals in Vietnam. BMC Med Ethics 2020; 21:4. [PMID: 31924199 PMCID: PMC6954581 DOI: 10.1186/s12910-020-0445-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 12/31/2019] [Indexed: 02/01/2023] Open
Abstract
Background Within the research community, it is generally accepted that consent processes for research should be culturally appropriate and tailored to the context, yet researchers continue to grapple with what valid consent means within specific stakeholder groups. In this study, we explored the consent practices and attitudes regarding essential information required for the consent process within hospital-based trial communities from four referral hospitals in Vietnam. Methods We collected surveys from and conducted semi-structured interviews with study physicians, study nurses, ethics committee members, and study participants and family members regarding their experiences of participating in research, their perspectives toward research, and their views about various elements of the consent process. Results In our findings, we describe three interrelated themes related to the consent process: (1) words and regulation; (2) reimbursement, suspicions, and joining; and (3) responsibilities. In general, stakeholders had highly varied perspectives of nghiên cứu (Eng.: research) and researchers used varying levels of detail regarding all aspects of the study in the consent process to build trust with and/or promote potential research participants’ choices about taking part in research. Findings additionally highlight how researchers felt that offering financial reimbursements in a hospital setting, where payment for services was routine, would be unfamiliar to participants and could raise suspicions about the research. Participants, however, focused their discussions on reimbursement or alternative reasons for joining the study, such as health related benefits or altruism. Finally, participants often relied on their physician to help them decide about joining a study or not. Conclusion Further research is needed to understand how researchers and participants make sense of and practice consent, and how that impacts participants’ decision-making about research participation. To promote valid consent within this context, it is important to engage with hospital-based trial communities as a whole. The data from this study will inform future research on consent, guide the revisions of consent related policies within our research sites and point to several larger issues surrounding researcher-participant expectations, communication, and trust.
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Affiliation(s)
- Jennifer Ilo Van Nuil
- Oxford University Clinical Research Unit, Hospital for Tropical Disease, 764 Vo Van Kiet Street, District 5, Ho Chi Minh City, Vietnam. .,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
| | - Thi Thanh Thuy Nguyen
- Oxford University Clinical Research Unit, Hospital for Tropical Disease, 764 Vo Van Kiet Street, District 5, Ho Chi Minh City, Vietnam
| | | | | | - Mary Chambers
- Oxford University Clinical Research Unit, Hospital for Tropical Disease, 764 Vo Van Kiet Street, District 5, Ho Chi Minh City, Vietnam.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | | | - Laura Merson
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.,Infectious Diseases Data Observatory, Oxford, UK
| | - Thi Phuong Dung Nguyen
- Oxford University Clinical Research Unit, Hospital for Tropical Disease, 764 Vo Van Kiet Street, District 5, Ho Chi Minh City, Vietnam
| | | | | | - Susan Bull
- Ethox Centre, University of Oxford, Oxford, UK
| | - Evelyne Kestelyn
- Oxford University Clinical Research Unit, Hospital for Tropical Disease, 764 Vo Van Kiet Street, District 5, Ho Chi Minh City, Vietnam.,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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Compaoré A, Dierickx S, Jaiteh F, Nahum A, Bohissou TFE, Tinto H, Scott S, D'Alessandro U, Schallig H, Grietens KP. Fear and rumours regarding placental biopsies in a malaria-in-pregnancy trial in Benin. Malar J 2018; 17:425. [PMID: 30442132 PMCID: PMC6238265 DOI: 10.1186/s12936-018-2578-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/09/2018] [Indexed: 05/30/2023] Open
Abstract
Background A multi-country, community-based trial on scheduled screening and treatment for malaria in pregnancy was conducted in Benin, The Gambia and Burkina Faso. Despite standardized procedures and outcomes, the study became subject to rumours and accusations of placenta being sold for mystical and financial gain by trial staff, leading to drop-out rates of 30% and the consequent halting of placental biopsy sampling in Benin. This paper explores the role of socio-cultural beliefs related to placenta and identified additional factors contributing these rumours. Methods A qualitative comparative emergent-theory design was used to assess social factors related to trial implementation and uptake in the three countries. Data from participant observation, informal conversations, group discussions and interviews were triangulated and analysed with NVivo Qualitative Analysis software. Results Despite similar sociocultural beliefs about the sacred nature of the placenta in all three study countries, these beliefs did not affect participation rates in Burkina Faso and The Gambia and placenta-related rumours only emerged in Benin. Therefore, the presence of beliefs is not a sufficient condition to have generated placenta-selling fears. The rumours in Benin reflected the confluence of placenta-related beliefs and factors related to the implementation of the trial (including a catalysing adverse event and miscommunication during the informed consent procedure). Furthermore, distinct socio-political factors contributed to the emergence of rumours, including the historical distrust in governmental organizations and the tense relationship between some of the actors involved in the trial. Conclusion Transdisciplinary social science research designs should accompany the implementation of the trial. The integration of multiple stakeholders’ knowledge and involvement is required to define and solve upcoming barriers.
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Affiliation(s)
- Adélaïde Compaoré
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso.
| | - Susan Dierickx
- Medical Anthropology Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Centre of Expertise on Gender, Diversity and Intersectionality (RHEA), Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.,Centre for Research on Culture and Gender, Ghent University, Rozier 44, 9000, Ghent, Belgium
| | - Fatou Jaiteh
- Medical Anthropology Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Amsterdam Institute of Social Science Research, Amsterdam, The Netherlands.,Medical Research Council Unit The Gambia at London, School of Tropical Medicine and Hygiene, Fajara, The Gambia
| | - Alain Nahum
- Centre de Recherches Entomologiques de Cotonou, Cotonou, Benin
| | | | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de la Santé, Nanoro, Burkina Faso
| | - Susana Scott
- Medical Research Council Unit The Gambia at London, School of Tropical Medicine and Hygiene, Fajara, The Gambia.,London School of Tropical Medicine and Hygiene, London, UK
| | - Umberto D'Alessandro
- Medical Research Council Unit The Gambia at London, School of Tropical Medicine and Hygiene, Fajara, The Gambia
| | - Henk Schallig
- Department of Medical Microbiology-Parasitology Unit, Academic Medical Centre, Amsterdam, 1105, AZ, The Netherlands
| | - Koen Peeters Grietens
- Medical Anthropology Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.,Amsterdam Institute of Social Science Research, Amsterdam, The Netherlands.,Partners for Applied Social Sciences (PASS) International, Tessenderlo, Belgium.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Ronse M, Marí Sáez A, Gryseels C, Bannister-Tyrrell M, Delamou A, Guillard A, Briki M, Bigey F, Haba N, van Griensven J, Peeters Grietens K. What motivates Ebola survivors to donate plasma during an emergency clinical trial? The case of Ebola-Tx in Guinea. PLoS Negl Trop Dis 2018; 12:e0006885. [PMID: 30332421 PMCID: PMC6219816 DOI: 10.1371/journal.pntd.0006885] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 11/06/2018] [Accepted: 09/29/2018] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION During the 2014 Ebola Virus Disease (EVD) epidemic, the Ebola-Tx trial evaluated the use of convalescent plasma (CP) in Guinea. The effectiveness of plasmapheresis trials depends on the recruitment of plasma donors. This paper describes what motivated or deterred EVD survivors to donate CP, providing insights for future plasmapheresis trials and epidemic preparedness. METHODS This qualitative study, part of Ebola-Tx, researched and addressed emergent trial difficulties through interviewing, participant observation and focus group discussions. Sampling was theoretical and retroductive analysis was done in NVivo 10. RESULTS Willingness or hesitance to participate in plasma donation depended on factors at the interface of pre-existing social dynamics; the impact of the disease and the consequent emergency response including the trial set-up. For volunteers, motivation to donate was mainly related to the feeling of social responsibility inspired by having survived EVD and to positive perceptions of plasmapheresis technology despite still unknown trial outcomes. Conversely, confidentiality concerns when volunteering due to stigmatization of survivors and perceived decrease in vital strength and in antibodies when donating, leading to fears of loss in protection against EVD, were main deterrents. The dynamic (dis)trust in Ebola Response Actors and in other survivors further determined willingness to participate and lead to the emergence/decline of rumours related to blood stealing and treatment effectiveness. Historic inter-ethnic relations in the health care setting further defined volunteering along socio-economic and ethnic lines. Finally, lack of follow-up and of dedicated care further impacted on motivation to volunteer. CONCLUSIONS Ebola-Tx was the first trial to solicit and evaluate blood-product donation as an experimental treatment on a large scale in Sub-Saharan Africa. An effective donation system requires directly engaging with emergent social barriers and providing an effective ethical response, including improved and transparent communication, effective follow-up after donation, assuring confidentiality and determining ethical incentives.
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Affiliation(s)
- Maya Ronse
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Almudena Marí Sáez
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Global Health and Biosecurity, Robert Koch Institut, Berlin, Germany
| | - Charlotte Gryseels
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | - Alexandre Delamou
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Centre National de Formation et Recherche de Maferinyah, Forécariah, Guinea
| | - Alain Guillard
- Collecte et Production des PSL, Établissement Français Du Sang Bretagne, Rennes, France
| | - Mustapha Briki
- Établissement Français Du Sang Alpes-Méditerranée, Marseille, France
| | - Frédéric Bigey
- Direction, Établissement Français du Sang Grand-Est, Strasbourg, France
| | - Nyankoye Haba
- Centre National de Transfusion Sanguine (National Blood Transfusion Centre), Conakry, Guinea
| | - Johan van Griensven
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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Gooding K, Phiri M, Peterson I, Parker M, Desmond N. Six dimensions of research trial acceptability: how much, what, when, in what circumstances, to whom and why? Soc Sci Med 2018; 213:190-198. [PMID: 30142500 PMCID: PMC7614255 DOI: 10.1016/j.socscimed.2018.07.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 07/21/2018] [Accepted: 07/24/2018] [Indexed: 11/16/2022]
Abstract
Ethics guidelines emphasise that research should be acceptable to the people invited to take part. However, acceptability is subjective and dependent on context, complicating its assessment and use as an ethical standard. This paper examines the concept of acceptability in relation to parents' perspectives on a paediatric vaccine trial in Malawi. We examined decisions on participation and experiences of the trial through interviews with parents in 41 households invited to enrol their children and participant observation of trial processes. Fieldwork took place in Chikwawa, Southern Malawi from February-October 2016. Parents were not neatly split between those who saw the trial as acceptable and those who did not; instead there were mixed and changing feelings among parents who enrolled their children, and among those who withdrew or did not take part. Some parents agreed to participate but had concerns about the trial, while others expressed satisfaction with the trial but still did not take part. These experiences indicate substantial variation in the nature of acceptance. We describe these variations in relation to six dimensions of acceptability: how acceptable the trial is, what aspects are acceptable, changes over time, circumstances affecting acceptability, variations between people, and reasons for participation or non-participation. The findings illustrate the difficulty of determining whether a trial is sufficiently acceptable to potential participants. We suggest that clarifying definitions of acceptability and examining how acceptability varies in degree, between trial components, over time, and between people and contexts may help researchers generate more nuanced descriptions of acceptability that support responsive and ethical trial design.
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Affiliation(s)
- Kate Gooding
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi; Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Mackwellings Phiri
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi.
| | - Ingrid Peterson
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi; Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
| | - Michael Parker
- Nuffield Department of Population Health, University of Oxford, Big Data Institute Building, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Nicola Desmond
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, College of Medicine, P.O. Box 30096, Chichiri, Blantyre 3, Malawi; Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK.
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Murdoch B, Caulfield T. Doing Research with Vulnerable Populations: The Case of Intravenous Drug Users. BIOÉTHIQUEONLINE 2018. [DOI: 10.7202/1044290ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This review article considers ethical concerns when doing research on potentially vulnerable people who inject drugs (PWID) in a Canadian context. The Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans broadly addresses many of the traditional ethical principles of research on vulnerable persons, but does so at the cost of clarity and precision. Vulnerability is contextual rather than absolute. When doing research with vulnerable persons, informed consent should be obtained from an independent person, and comprehension should be checked using questioning. Participants can be vulnerable due to many factors, including addiction, chronic disease, socioeconomic and racial status, and lack of education. The ability of PWID to give informed consent can be compromised by undue influence or intoxication, but existing research shows that neither the mode nor the magnitude of compensation has a significant effect on new rates of drug use. Compensation can also help dispel the therapeutic misconception. Intoxication rather than undue influence is the main concern when obtaining informed consent from PWID. The stigmatization of PWID as incapable of consent should be avoided. Paternalistic exclusion from research can harm PWID and exacerbate their vulnerability by reducing our knowledge of and ability to specifically treat them. As such, we must collect better data about the effects of research ethics policies. Studies to this effect should focus on experiences, perspectives and needs of potentially vulnerable research participants. Research ethics boards in Canada should adopt an evidence-based approach when applying discretionary power to proposals for clinical research.
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Affiliation(s)
- Blake Murdoch
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, Canada
| | - Timothy Caulfield
- Health Law Institute, Faculty of Law, University of Alberta, Edmonton, Canada
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Abstract
Children of minor parents are under-represented in clinical trials. This is largely because of the ethical, legal, and regulatory complexities in the enrolment, consent, and appropriate access of children of minor parents to clinical research. Using a case-based approach, we examine appropriate access of children of minor parents in an international vaccine trial. We first consider the scientific justification for inclusion of children of minor parents in a vaccine trial. Laws and regulations governing consent generally do not address the issue of minor parents. In their absence, local community and cultural contexts may influence consent processes. Rights of the minor parent include dignity in their role as a parent and respect for their decision-making capacity in that role. Rights of the child include the right to have decisions made in their best interest and the right to the highest attainable standard of health. Children of minor parents may have vulnerabilities related to the age of their parent, such as increased rates of poverty, that have implications for consent. Neuroscience research suggests that, by age 12-14 years, minors have adult-level capacity to make research decisions in situations with low emotion and low distraction. We conclude with a set of recommendations based on these findings to facilitate appropriate access and equity related to the participation of children of minor parents in clinical research.
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Ward CL, Shaw D, Anane-Sarpong E, Sankoh O, Tanner M, Elger B. The Ethics of Health Care Delivery in a Pediatric Malaria Vaccine Trial: The Perspectives of Stakeholders From Ghana and Tanzania. J Empir Res Hum Res Ethics 2017; 13:26-41. [PMID: 29179625 DOI: 10.1177/1556264617742236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study explores ethical issues raised in providing medical care to participants and communities of low-resource settings involved in a Phase II/III pediatric malaria vaccine trial (PMVT). We conducted 52 key informant interviews with major stakeholders of an international multi-center PMVT (GSK/PATH-MVI RTS,S) (NCT00866619) in Ghana and Tanzania. Based on their stakeholder experiences, the responses fell into three main themes: (a) undue inducement, (b) community disparities, and (c) broad therapeutic misconceptions. The study identified the critical ethical aspects, from the perspectives of stakeholders, of delivering health care during a PMVT. The study showed that integrating research into health care services needs to be addressed in a manner that upholds the favorable risk-benefit ratio of research and attends to the health needs of local populations. The implementation of research should aim to improve local standards of care through building a collaborative agenda with local institutions and systems of health.
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Ravinetto R, Tinto H, Diro E, Okebe J, Mahendradhata Y, Rijal S, Gotuzzo E, Lutumba P, Nahum A, De Nys K, Casteels M, Boelaert M. It is time to revise the international Good Clinical Practices guidelines: recommendations from non-commercial North-South collaborative trials. BMJ Glob Health 2016; 1:e000122. [PMID: 28588969 PMCID: PMC5321366 DOI: 10.1136/bmjgh-2016-000122] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 09/23/2016] [Accepted: 09/26/2016] [Indexed: 11/04/2022] Open
Abstract
The Good Clinical Practices (GCP) codes of the WHO and the International Conference of Harmonization set international standards for clinical research. But critics argue that they were written without consideration for the challenges faced in low and middle income countries (LMICs). Based on our field experience in LMICs, we developed a non-exhaustive set of recommendations for the improvement of GCP. These cover 3 domains: ethical, legal and operational, and 8 specific issues: the double ethical review of 'externally sponsored' trials; the informed consent procedure in minors and in illiterate people; post-trial access to newly-developed products for the trial communities; the role of communities as key research actors; the definition of sponsor; and the guidance for contractual agreements, laboratory quality management systems, and quality assurance of investigational medicinal products. Issues not covered in our analysis include among others biobanking, standard of care, and study designs. The international GCP codes de facto guide national legislators and funding agencies, so the current shortcomings may weaken the regulatory oversight of international research. In addition, activities neglected by GCP are less likely to be implemented or funded. If GCP are meant to serve the interests of global society, a comprehensive revision is needed. The revised guidelines should be strongly rooted in ethics, sensitive to different sociocultural perspectives, and allow consideration for trial-specific and context-specific challenges. This can be only achieved if all stakeholders, including researchers, sponsors, regulators, ethical reviewers and patients' representatives from LMICs, as well as non-commercial researchers and sponsors from affluent countries, are transparently involved in the revision process. We hope that our limited analysis would foster advocacy for a broad and inclusive revision of the international GCP codes, to make them at the same time 'global', 'context centred' and 'patient centred'.
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Affiliation(s)
- Raffaella Ravinetto
- Public Health Department, Institute Tropical Medicine, Antwerp, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | | | - Ermias Diro
- Department of Internal Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Joseph Okebe
- Medical Research Council Unit, The Gambia, Fajara, Gambia
| | - Yodi Mahendradhata
- Faculty of Medicine, Center for Tropical Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Suman Rijal
- B.P. Koirala Institute of Health Science, Dharan, Nepal
| | - Eduardo Gotuzzo
- Department of Medicine, Alexander von Humboldt Institute of Tropical Medicine and Infectious Diseases, Lima, Peru
| | - Pascal Lutumba
- University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Alain Nahum
- Centre des Recherches Entomologiques de Cotonou, Cotonou, Benin
| | - Katelijne De Nys
- Clinical Trial Center, Leuven University Hospital, KU Leuven, Leuven, Belgium
| | - Minne Casteels
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Marleen Boelaert
- Public Health Department, Institute Tropical Medicine, Antwerp, Belgium
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Clinical Research in Neglected Tropical Diseases: The Challenge of Implementing Good Clinical (Laboratory) Practices. PLoS Negl Trop Dis 2016; 10:e0004654. [PMID: 27812089 PMCID: PMC5094655 DOI: 10.1371/journal.pntd.0004654] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Baiden F, Akazili J, Chatio S, Achana FS, Oduro AR, Ravinetto R, Hodgson A. Should consent forms used in clinical trials be translated into the local dialects? A survey among past participants in rural Ghana. Clin Trials 2015; 13:234-9. [PMID: 26452387 DOI: 10.1177/1740774515609290] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Obtaining informed consent is part of the expression of the principle of participant autonomy during clinical trials. It is critical that participants understand the content of informed consent forms and remain in a position to seek independent advice on its content. We conducted a survey among past participants of a clinical trial in the Kassena-Nankana Districts of rural northern Ghana about the usefulness of informed consent forms that are written in the local dialects. The written forms of local dialects are largely undeveloped. METHOD We contacted a randomly selected sample of caregivers whose children were enrolled in a completed clinical trial and interviewed them using a structured questionnaire. Analysis sought to determine participants' preference and whether or not they were likely to find confidants who will be able to read, understand and give advice on the content of the informed consent form to them when they take the informed consent forms home. RESULTS We interviewed 394 caregivers, 88.6% of whom were women. About half (54%) of the respondents wanted the informed consent forms to be in the English language. Caregivers with higher than primary level education were more likely to prefer the informed consent form to be in English than those with no formal education (74% versus 26%, p = 0.04). The majority (85%) indicated that they would be able to find close confidants who would be able to read and explain it to them if it is in English. In contrast, only 8% thought they would be able to do the same if the informed consent form was written in the local language. Respondents were more likely to find close confidants to read and explain the informed consent form if it were written in English than if it were written in the local language (94% versus 19%, p value < 0.01). CONCLUSION The practice of translating informed consent forms into undeveloped local dialects and giving such copies to trial participants to send home needs to be re-evaluated. In populations where the written forms of local dialects are undeveloped and literacy is low, the use of local dialect versions of informed consent forms could ironically enhance the vulnerability of trial participants.
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Affiliation(s)
| | | | | | | | | | - Raffaella Ravinetto
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Abraham Hodgson
- Health Research and Development Division, Ghana Health Service, Accra, Ghana
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