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Koricha ZB, Abraha YG, Ababulgu SA, Abraham G, Morankar S. Community engagement in research addressing infectious diseases of poverty in sub-Saharan Africa: A qualitative systematic review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003167. [PMID: 39008476 PMCID: PMC11249264 DOI: 10.1371/journal.pgph.0003167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 04/05/2024] [Indexed: 07/17/2024]
Abstract
Though engaging communities in research processes has several advantages and implications, research efforts are poorly embedded in and linked with communities, especially in low- and middle-income countries (LMICs). There is also a need for more empirical evidence on effectively engaging communities in research in LMICs, specifically in Sub-Saharan Africa (SSA). Thus, there is an urgent need to synthesize existing evidence on community engagement experiences in research in SSA. Therefore, this review aimed to synthesize the existing community engagement experiences and related barriers to engaging communities in health research focusing on infectious diseases of poverty in SSA. The systematic review was conducted following the JBI methodology for qualitative systematic reviews. The review included both published and unpublished studies. A thematic analysis approach was used for data synthesis. A total of 40 studies were included in the review. Community engagement in the conceptualization of the research project, analysis, dissemination, and interpretation of the result was rare. On top of this, almost all the research projects engaged the community at a lower level of engagement (i.e., informing or consulting the community at some point in the research process), suggesting the importance of integrating communities in the entire research cycle. The lack of shared control over the research by the community was one of the significant challenges mentioned. This review uncovered that community engagement in the research process is minimal. Nevertheless, the review generated valuable evidence that can inform researchers and research stakeholders to promote effective community engagement in the research process addressing infectious diseases of poverty. Despite these, it requires rigorous primary studies to examine the applicability and usefulness of community engagement, including developing valid metrics of engagement, standardizations of reporting community engagements, and views and understandings of communities and stakeholders on the values, expectations, and concepts of community engagement in research.
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Affiliation(s)
- Zewdie Birhanu Koricha
- Public Health Faculty, Department of Health, Behaviour and Society, Jimma University, Jimma, Ethiopia
- Ethiopian Evidence-Based Healthcare and Development Centre: a JBI Centre of Excellence, Jimma University, Jimma, Ethiopia
| | - Yosef Gebreyohannes Abraha
- Public Health Faculty, Department of Health, Behaviour and Society, Jimma University, Jimma, Ethiopia
- Ethiopian Public Health Institute, Knowledge Translation Directorate, Addis Ababa, Ethiopia
- The Ethiopian Public Health Institute, Ethiopian Knowledge Translation Group for Health: a JBI Affiliated Group, Addis Ababa, Ethiopia
| | - Sabit Ababor Ababulgu
- Public Health Faculty, Department of Health, Behaviour and Society, Jimma University, Jimma, Ethiopia
- Ethiopian Public Health Institute, Knowledge Translation Directorate, Addis Ababa, Ethiopia
- The Ethiopian Public Health Institute, Ethiopian Knowledge Translation Group for Health: a JBI Affiliated Group, Addis Ababa, Ethiopia
| | - Gelila Abraham
- Public Health Faculty, Department of Health, Behaviour and Society, Jimma University, Jimma, Ethiopia
- Ethiopian Evidence-Based Healthcare and Development Centre: a JBI Centre of Excellence, Jimma University, Jimma, Ethiopia
- Health Policy & Management Department, Jimma Institute of Health, Jimma University, Jimma, Ethiopia
| | - Sudhakar Morankar
- Public Health Faculty, Department of Health, Behaviour and Society, Jimma University, Jimma, Ethiopia
- Ethiopian Evidence-Based Healthcare and Development Centre: a JBI Centre of Excellence, Jimma University, Jimma, Ethiopia
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Choi J, May SB, Dang BN, Markham C, McGlone M, Cuccaro PM. Acceptability of a Future HIV Vaccine: A Rapid Scoping Review. J Acquir Immune Defic Syndr 2024; 96:197-207. [PMID: 38905472 DOI: 10.1097/qai.0000000000003416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/29/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND A HIV vaccine is not available yet, but perceptions of HIV vaccines will be important to explore before their roll-out for effective vaccine promotion. This article presents the findings of a rapid scoping review of the literature to identify individual, social, and vaccine-related factors associated with the acceptability of a future HIV vaccine. METHODS We searched 5 databases (Medline OVID, Embase, PsycINFO, Web of Science, and Cochrane) using relevant keywords and Medical Subject Headings. All articles, regardless of study design, publication year, and geographic location, were included if they examined HIV vaccine acceptability and its underlying factors. RESULTS We retrieved 2386 unique articles, of which 76 were included in the final review. Perceived benefits (34.2%) and perceived susceptibility (25.0%) were primary individual factors of HIV vaccine acceptability. Misinformation (17.1%) and distrust (22.4%) regarding future HIV vaccines, HIV stigma (30.3%), and social support (10.5%) were social factors of HIV vaccine acceptability. Vaccine efficacy (42.1%), cost (28.9%), and side effects (67.1%) were common vaccine characteristics influencing HIV vaccine acceptability. Altruism (10.5%) and risk compensation (26.3%) were also key factors. CONCLUSIONS Our analyses revealed that skeptical beliefs, negative perceptions, and misconceptions about HIV vaccines are real barriers to their acceptability. To alleviate HIV vaccine hesitancy and address trust concerns, strategic vaccine communication should be disseminated by trustworthy sources. Messages should impart accurate vaccine information and emphasize both individual and social benefits of HIV vaccination, as well as leverage social support in increasing willingness to get a future HIV vaccine.
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Affiliation(s)
- Jihye Choi
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX
| | - Sarah B May
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX
| | - Bich N Dang
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX
- VA Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, TX; and
| | - Christine Markham
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX
| | - Matthew McGlone
- Department of Communication Studies, Moody College of Communication, The University of Texas at Austin, Austin, TX
| | - Paula M Cuccaro
- Department of Health Promotion and Behavioral Sciences, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston School of Public Health, Houston, TX
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Meskell P, Biesty LM, Dowling M, Roche K, Meehan E, Glenton C, Devane D, Shepperd S, Booth A, Cox R, Chan XHS, Houghton C. Factors that impact on recruitment to vaccine trials in the context of a pandemic or epidemic: a qualitative evidence synthesis. Cochrane Database Syst Rev 2023; 9:MR000065. [PMID: 37655964 PMCID: PMC10472890 DOI: 10.1002/14651858.mr000065.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND The World Health Organization declared the COVID-19 pandemic on 11 March 2020. Vaccine development and deployment were swiftly prioritised as a method to manage and control disease spread. The development of an effective vaccine relies on people's participation in randomised trials. Recruitment to vaccine trials is particularly challenging as it involves healthy volunteers who may have concerns around the potential risks and benefits associated with rapidly developed vaccines. OBJECTIVES To explore the factors that influence a person's decision to participate in a vaccine trial in the context of a pandemic or epidemic. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was June 2021. SELECTION CRITERIA We included qualitative studies and mixed-methods studies with an identifiable qualitative component. We included studies that explored the perspectives of adults aged 18 years or older who were invited to take part in vaccine trials in the context of a pandemic or epidemic. DATA COLLECTION AND ANALYSIS We assessed the title, abstracts and full texts identified by the search. We used a sampling frame to identify data-rich studies that represented a range of diseases and geographical spread. We used QSR NVivo to manage extracted data. We assessed methodological limitations using an adapted version of the Critical Skills Appraisal Programme (CASP) tool for qualitative studies. We used the 'best-fit framework approach' to analyse and synthesise the evidence from our included studies. We then used the Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) assessment to assess our confidence in each finding and develop implications for practice. MAIN RESULTS We included 34 studies in our review. Most studies related to HIV vaccine trials. The other studies related to Ebola virus, tuberculosis, Zika virus and COVID-19. We developed 20 key findings, under three broad themes (with seven subthemes), that described the factors that people consider when deciding whether to take part in a vaccine trial for a pandemic or epidemic disease. Our GRADE-CERQual confidence was high in nine of the key findings, moderate in 10 key findings and low in one key finding. The main reason for downgrading review findings were concerns regarding the relevance and adequacy of the underlying data. As a result of the over-representation of HIV studies, our GRADE-CERQual assessment of some findings was downgraded in terms of relevance because the views described may not reflect those of people regarding vaccine trials for other pandemic or epidemic diseases. Adequacy relates to the degree of richness and quantity of data supporting a review finding. Moderate concerns about adequacy resulted in a downgrading of some review findings. Some factors were considered to be under the control of the trial team. These included how trial information was communicated and the inclusion of people in the community to help with trial information dissemination. Aspects of trial design were also considered under control of the trial team and included convenience of participation, provision of financial incentives and access to additional support services for those taking part in the trial. Other factors influencing people's decision to take part could be personal, from family, friends or wider society. From a personal perceptive, people had concerns about vaccine side effects, vaccine efficacy and possible impact on their daily lives (carer responsibilities, work, etc.). People were also influenced by their families, and the impact participation may have on relationships. The fear of stigma from society influenced the decision to take part. Also, from a societal perspective, the level of trust in governments' involvement in research and trial may influence a person's decision. Finally, the perceived rewards, both personal and societal, were influencing factors on the decision to participate. Personal rewards included access to a vaccine, improved health and improved disease knowledge, and a return to normality in the context of a pandemic or epidemic. Potential societal rewards included helping the community and contributing to science, often motivated by the memories of family and friends who had died from the disease. AUTHORS' CONCLUSIONS This review identifies many of the factors that influence a person's decision to take part in a vaccine trial, and these reflect findings from reviews that examine trials more broadly. However, we also recognise some factors that become more important in connection with a vaccine trial in the context of a pandemic or epidemic. These factors include the potential stigma of taking part, the possible adverse effects of a vaccine, the added motivation for helping society, the role of community leaders in trial dissemination, and the level of trust placed in governments and companies developing vaccines. These specific influences need to be considered by trial teams when designing, and communicating about, vaccine trials in the context of a pandemic or epidemic.
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Affiliation(s)
- Pauline Meskell
- Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Linda M Biesty
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Maura Dowling
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | | | - Elaine Meehan
- Ageing Research Centre, School of Allied Health, University of Limerick, Limerick, Ireland
| | | | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
| | - Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, ScHARR, Sheffield, UK
| | - Rebecca Cox
- Department of Clinical Sciences, University of Bergen, Bergen, Norway
| | - Xin Hui S Chan
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Catherine Houghton
- School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland
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Esber AL, Jansen K, Dorsey-Spitz J, Robb ML, Streeck H, Crowell TA. Preparing for future European efficacy trials of interventions to prevent HIV and other sexually transmitted infections: Lessons on willingness to participate and barriers to participation from ten German clinics serving behaviorally vulnerable men who have sex with men. Vaccine X 2023; 14:100302. [PMID: 37128478 PMCID: PMC10148181 DOI: 10.1016/j.jvacx.2023.100302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 04/04/2023] [Accepted: 04/10/2023] [Indexed: 05/03/2023] Open
Abstract
Future efficacy testing of interventions to prevent HIV or other infections will require engagement of vulnerable populations. We characterized willingness to participate in a future HIV vaccine trial and barriers to participation among men who have sex with men in a 12-month German cohort study. Among 1015 participants at enrollment, 604 (60%) reported willingness, 60 (6%) were unwilling, 351 (35%) were unsure or refused to answer. Among those unwilling, the primary reason was fear of getting HIV. Among those willing, reasons included protection against HIV and furthering scientific knowledge. In a multivariable logistic regression model, higher odds of willingness to participate were seen among participants at the 12-month visit (aOR: 1.09, 95% CI: 1.04-1.15) and with prior knowledge of HIV vaccine research (aOR: 1.14, 95% CI: 1.06-1.23). Educating potential participants about vaccine research may facilitate recruitment and participation in future trials of HIV vaccine candidates and other prevention interventions.
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Affiliation(s)
- Allahna L. Esber
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
- Corresponding author at: 6720A Rockledge Drive, Suite 400, Bethesda, MD 20817, USA.
| | | | - Julie Dorsey-Spitz
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Merlin L. Robb
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Hendrik Streeck
- Institute of Virology, University Hospital, Bonn, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Bonn, Cologne, Germany
- Institute of HIV Research, University Duisburg Essen, Essen, Germany
| | - Trevor A. Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
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Mutisya EM, Muturi-Kioi V, Abaasa A, Nyasani D, Kabuti RW, Lunani L, Kotikot T, Mundia M, Mutua G, Ombati G, Nduta H, Price MA, Kimani J, Anzala AO. Feasibility of conducting HIV prevention trials among key populations in Nairobi, Kenya. BMC Public Health 2022; 22:2385. [PMID: 36536335 PMCID: PMC9762985 DOI: 10.1186/s12889-022-14875-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To assess the feasibility of conducting HIV prevention trials among key populations in Nairobi, Kenya. BACKGROUND HIV prevention trials require the inclusion of those at high risk of HIV infection and their informed decision to take part and remain in the clinical trial to the end is crucial. In Kenya key populations including men who have sex with men (MSM) and female sex workers (FSW) are, disproportionately, at high risk of HIV infection when compared to the general population. Few trials testing biomedical prevention products against HIV have enrolled Kenyan FSW and MSM. METHODS We performed simulated vaccine efficacy trial (SiVET) using licensed hepatitis B vaccines as substitutes for a HIV vaccine candidate and included randomization for those immune to hep B. The SiVET was an observational study designed to mimic the rigors of a clinical trial; we assessed HIV risk, provided risk counselling and prevention tools and performed HIV testing at baseline and periodically until the end of the trial. MSM and FSW were enrolled at a ratio of 4:1. Volunteers were assigned to either hepatitis B vaccine or placebo. RESULTS Recruitment took approximately 24 months between Sep 2015 and Sep 2017. Of the 368 volunteers screened, 250 (200 MSM and 50 FSW) were enrolled. Reasons for exclusion at screening included: being positive for HIV (n = 7), hepatitis (n = 14), other pre-existing medical conditions (n = 41), eligible but chose not to enrol (n = 47). Most of the volunteers adhered to study procedures and attended their study visits within the study window. These include volunteers who received the second vaccination 244 (98%), the third vaccination 228 (91%) and, the final study visit 217 (87%). The reasons volunteers discontinued from the study early included: relocation and loss to follow up (n = 14). A total of 8 cases of HIV infection were observed in 174.5 Person Years at Risk (PYAR), all among MSM, including 5 seroconversions identified at the last study visit, for a HIV incidence of 4.58 cases/ 100 PYAR, among MSM enrolled in the study. CONCLUSION Our findings suggest that it is possible to conduct HIV prevention trials among key populations in Nairobi with a good adherence to a vaccine efficacy trial schedule. Despite HIV prevention efforts, we also noted a high incidence of HIV infection. This demonstrates the need for effective HIV prevention products in these populations.
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Affiliation(s)
| | | | - Andrew Abaasa
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Delvin Nyasani
- KAVI-Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Rhoda W Kabuti
- SWOP-PHDA, University of Nairobi/University of Manitoba, Nairobi, Kenya
| | - Laura Lunani
- KAVI-Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Timothy Kotikot
- KAVI-Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Moses Mundia
- KAVI-Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | | | - Geoffrey Ombati
- KAVI-Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Hannah Nduta
- KAVI-Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
| | - Matt A Price
- IAVI, New York, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Joshua Kimani
- SWOP-PHDA, University of Nairobi/University of Manitoba, Nairobi, Kenya
| | - Aggrey Omu Anzala
- KAVI-Institute of Clinical Research, University of Nairobi, Nairobi, Kenya
- School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
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Mitchell S, Bragg A, Moldovan I, Woods S, Melo K, Martin-Howard J, Gardiner P. Stigma as a Barrier to Participant Recruitment of Minority Populations in Diabetes Research: Development of a Community-Centered Recruitment Approach. JMIR Diabetes 2021; 6:e26965. [PMID: 33938811 PMCID: PMC8129881 DOI: 10.2196/26965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/16/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The development of evidence-based care geared towards Black and Latina women living with uncontrolled type 2 diabetes is contingent upon their active recruitment into clinical interventions. Well-documented impediments to recruitment include a historical mistrust of the research community and socioeconomic factors that limit awareness and access to research studies. Although sociocultural and socioeconomic factors deter minorities from participating in clinical research, it is equally important to consider the role of stigma in chronic disease intervention studies. OBJECTIVE We aim to share our discovery of diabetes-related stigma as an underrecognized impediment to recruitment for the Women in Control 2.0 virtual diabetes self-management education study. METHODS Our initial recruitment plan used traditional strategies to recruit minority women with uncontrolled type 2 diabetes, which included letters and phone calls to targeted patients, referrals from clinicians, and posted flyers. After engaging a patient advisory group and consulting with experts in community advocacy, diabetes-related stigma emerged as a prominent barrier to recruitment. The study team reviewed and revised recruitment scripts and outreach material in order to better align with the lived experience and needs of potential enrollees. RESULTS Using a more nuanced, community-centered recruitment approach, we achieved our target recruitment goal, enrolling 309 participants into the study, exceeding our target of 212. CONCLUSIONS There is a need for updated recruitment methods that can increase research participation of patients who experience internalized diabetes stigma. To address disparities in minority health, further research is needed to better understand diabetes-related stigma and devise strategies to avert or address it.
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Affiliation(s)
- Suzanne Mitchell
- Boston Medical Center, Boston, MA, United States
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Alexa Bragg
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, United States
| | | | | | | | - Jessica Martin-Howard
- Department of Family Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Paula Gardiner
- Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA, United States
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Willingness to participate in future HIV vaccine trials among men who have sex with men and female sex workers living in Nairobi, Kenya. PLoS One 2020; 15:e0238028. [PMID: 32834018 PMCID: PMC7444816 DOI: 10.1371/journal.pone.0238028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 08/08/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate factors associated with willingness to participate in future HIV vaccine trials among men who have sex with men and female sex workers living in Nairobi, Kenya. Background Working with ‘key populations’, those at elevated risk of HIV acquisition, is important to conduct efficient HIV prevention trials. In Nairobi Kenya, HIV infection is higher in men who have sex with men (MSM) and female sex workers (FSW) than in the general adult population, hence the need to establish if they would be willing to participate in future HIV vaccine trials. Methods We administered a structured questionnaire to MSM and FSW enrolled in a simulated vaccine efficacy trial (SiVET). The SiVET was an observational study designed to mimic the rigors of a clinical trial to assess HIV risk characteristics at baseline. After 12–15 months of follow-up, a structured questionnaire was administered to evaluate hypothetical willingness to participate in future HIV vaccine trials. Results Of 250 persons (80% MSM by design) enrolled in SiVET, 214 attended the final study visit and 174 (81%) of them expressed hypothetical willingness to participate in future HIV vaccine trials. These were 82% of MSM and 80% of FSW of those who attended the final study visit. Having a very good experience in the SiVET trial predicted willingness to participate in future HIV vaccine trials. Motivating factors for participation included a desire to receive education about HIV (59%) and to receive healthcare (57%). Conclusions Our data demonstrate high willingness among key populations in Kenya, to participate in future HIV vaccine trials after completing participation in a SiVET. The findings suggest that these groups might be a reliable target population for consideration in future HIV vaccine trials. Assessment of willingness to participate in these populations provides important information that may help to inform future education and recruitment efforts for vaccine trials. Improving the research experience for members of key populations could impact their willingness to participate in HIV vaccine trials.
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Iseselo MK, Tarimo EA, Sandstrom E, Kulane A. What motivates or demotivates injecting drug users to participate in hypothetical HIV vaccine efficacy trials? A qualitative study from urban Tanzania. East Afr Health Res J 2020; 4:128-139. [PMID: 34308230 PMCID: PMC8279304 DOI: 10.24248/eahrj.v4i2.636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 11/30/2020] [Indexed: 11/27/2022] Open
Abstract
Background: HIV vaccine efficacy trials require the active participation of volunteers who are committed and adherent to the study protocol. However, information about the influence of Injecting Drug Users (IDUs) to participate in HIV vaccine efficacy trials in low-income countries is inadequate. The present study explored the factors that motivate or hinder IDUs from participating in HIV vaccine efficacy trials in Dar es Salaam, Tanzania. Methods: A qualitative descriptive study design was employed among IDUs at Muhimbili National Hospital (MNH). A purposeful sampling technique was used to recruit the participants. Three (3) focus group discussions (FGDs) and 10 In-Depth Interviews (IDIs) were used to collect the data. The data from participants were audio-recorded, transcribed, and analysed using the content analysis approach. Findings: The participants reported that altruism and the desire to reduce risks of HIV infection were the motivators to participate in hypothetical HIV vaccine trials. In addition, participants reported to consult close relatives towards motivation to participate in the vaccine trial. In contrast, the perceived fear of vaccine side effects, lack of information about HIV vaccine studies, and HIV-related stigma towards participants were described as barriers to participate in the HIV vaccine trials. Conclusion: Participation in a hypothetical HIV vaccine trial among IDUs is influenced by positive and negative factors. Actual recruitment plans could be made through a better explanation of HIV vaccine trials, the expected individual and collective benefits associated with the trials. Community involvement and sensitisation is likely to enhance participation in future HIV vaccine trials in Tanzania.
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Affiliation(s)
- Masunga K Iseselo
- Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Department of Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.,Equity and Health Policy Research Group, Department of Global Public Health, KarolinskaInstitutet, Tomtebodavägen 18A, 171 77 Stockholm, Sweden
| | - Edith Am Tarimo
- Department of Nursing Management, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Eric Sandstrom
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Tomtebodavägen 18A, 171 77 Stockholm, Sweden
| | - Asli Kulane
- Equity and Health Policy Research Group, Department of Global Public Health, KarolinskaInstitutet, Tomtebodavägen 18A, 171 77 Stockholm, Sweden
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Connochie D, Tingler RC, Bauermeister JA. Young men who have sex with men's awareness, acceptability, and willingness to participate in HIV vaccine trials: Results from a nationwide online pilot study. Vaccine 2019; 37:6494-6499. [PMID: 31522806 DOI: 10.1016/j.vaccine.2019.08.076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND New cases of human immunodeficiency virus (HIV) among young men who have sex with men (YMSM) underscore the need to examine their willingness to use biomedical prevention methods, including an acceptable and efficacious HIV vaccine. We examined whether YMSM's vaccine altruism and vaccine-related socials concerns factors were associated with HIV vaccine acceptability across two vaccine efficacy scenarios, and their awareness and willingness to participate in HIV vaccine research. METHODS This secondary analysis uses data from a mHealth trial with YMSM at heightened HIV risk (N = 137; 50% racial/ethnic minority; M = 21.7 years). Most YMSM (91.2%) had tested for HIV, and 17.5% (N = 24) reported a prior STI.We used paired-samples t-test to compare differences in efficacy acceptability (50% vs 85%), followed by multivariable regressions examining whether vaccine attitudes (altruism and social concerns) were associated with vaccine acceptability and awareness and willingness to participate in HIV vaccine trials. We controlled for age, education, race/ethnicity, prior HIV testing, and STI diagnosis in our analyses. RESULTS Acceptability for the HIV vaccine with 85% efficacy (M = 8.86; SD = 1.76) was greater than acceptability in the 50% efficacy scenario (M = 7.60; SD = 2.58). Altruistic attitudes were associated with greater vaccine acceptability at 50% (β = 0.62) and 85% (β = 0.59) efficacy. Higher educational attainment was negatively associated with a vaccine with 50% efficacy (β = -0.20, but not for 85% efficacy. Greater vaccine-related social concerns were negatively associated with HIV vaccine research awareness (AOR = 0.38 (95% CI: 0.22, 0.67). Willingness to participate in a HIV vaccine trial was positively associated with age (β = 0.18) and altruism (β = 0.60), and negatively associated with education (β = -0.21). CONCLUSIONS YMSM find HIV vaccines as an acceptable prevention modality and are willing to participate in HIV vaccine trials. Findings highlight the need to consider YMSM's altruistic and social concerns attitudes in HIV vaccine research and explore how to leverage these attitudes in research campaigns. ClinicalTrials.gov Identifier: NCT02842060.
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Affiliation(s)
- Daniel Connochie
- Department of Family and Community Health, School of Nursing, 418 Curie Blvd., Rm 235L, University of Pennsylvania, Philadelphia, PA 19104, United States.
| | - Ryan C Tingler
- Department of Family and Community Health, School of Nursing, 418 Curie Blvd., Rm 235L, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - José A Bauermeister
- Department of Family and Community Health, School of Nursing, 418 Curie Blvd., Rm 235L, University of Pennsylvania, Philadelphia, PA 19104, United States
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Coulaud PJ, Préau M, Maradan G, Mora M, Traoré F, Oga M, Thio E, Ekon L, Dembele Keita B, Anoma C, Ter Tiero Dah E, Mensah E, Bernier A, Couderc C, Laurent C, Spire B. Taking empowerment into account: the response of community-based organisations to the HIV care needs of men who have sex with men in West Africa (CohMSM ANRS 12324 - Expertise France). AIDS Care 2019; 31:1403-1411. [PMID: 30829534 DOI: 10.1080/09540121.2019.1587358] [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: 10/27/2022]
Abstract
Empowerment is an ongoing process through which individuals and communities appropriate power and acquire the capability to function autonomously. Research on empowerment in men who have sex with men (MSM) is lacking in community-based contexts. We investigated the relationship between willingness to be empowered and HIV care needs in West African MSM accessing community-based organisations' (CBO) services. Fifty-three interviews were administered to HIV-negative MSM participating in the CohMSM study (Mali, Burkina Faso, Côte d'Ivoire, Togo). Five indicators of empowerment were identified from a discourse analysis: (i) motivation to access HIV services, (ii) willingness to improve HIV services, (iii) desire to be involved in new activities, (iv) desire to participate in such services, (v) willingness to collaborate in decision making. Based on these indicators, participants were classified into two profiles: high (19/53, 36%) and low (34/53, 64%) level of willingness to be empowered (HWE, LWE). Using a thematic analysis, HWE participants were focused on collective benefit (preventive follow-up, questions about MSM identity), while LWE participants were centred on individual benefit (medical care). CBOs should consider empowerment as a tool to advance collective health benefits for MSM. To improve empowerment in MSM, specific training on issues regarding sexual identity and stigma is needed for CBO providers.
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Affiliation(s)
- Pierre-Julien Coulaud
- INSERM, IRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Aix Marseille Univ , Marseille , France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur , Marseille , France
| | - Marie Préau
- INSERM, IRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Aix Marseille Univ , Marseille , France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur , Marseille , France.,GRePS Lyon 2 Université, Université de Lyon , Bron , France
| | - Gwenaelle Maradan
- INSERM, IRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Aix Marseille Univ , Marseille , France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur , Marseille , France
| | - Marion Mora
- INSERM, IRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Aix Marseille Univ , Marseille , France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur , Marseille , France
| | | | - Maxime Oga
- Programme PAC-CI Site ANRS , Abidjan , Côte d'Ivoire
| | - Elisabeth Thio
- Association African Solidarité , Ouagadougou , Burkina Faso
| | | | | | | | - Elias Ter Tiero Dah
- Association African Solidarité , Ouagadougou , Burkina Faso.,Centre Muraz , Bobo-Dioulasso , Burkina Faso
| | | | | | - Clotilde Couderc
- IRD, INSERM, Univ Montpellier, TransVIHMI , Montpellier , France
| | | | - Bruno Spire
- INSERM, IRD, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale (SESSTIM), Aix Marseille Univ , Marseille , France.,ORS PACA, Observatoire régional de la santé Provence-Alpes-Côte d'Azur , Marseille , France
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11
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Browne JL, Rees CO, van Delden JJM, Agyepong I, Grobbee DE, Edwin A, Klipstein-Grobusch K, van der Graaf R. The willingness to participate in biomedical research involving human beings in low- and middle-income countries: a systematic review. Trop Med Int Health 2019; 24:264-279. [PMID: 30565381 PMCID: PMC6850431 DOI: 10.1111/tmi.13195] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objectives To systematically review reasons for the willingness to participate in biomedical human subjects research in low‐ and middle‐income countries (LMICs). Methods Five databases were systematically searched for articles published between 2000 and 2017 containing the domain of ‘human subjects research’ in ‘LMICs’ and determinant ‘reasons for (non)participation’. Reasons mentioned were extracted, ranked and results narratively described. Results Ninety‐four articles were included, 44 qualitative and 50 mixed‐methods studies. Altruism, personal health benefits, access to health care, monetary benefit, knowledge, social support and trust were the most important reasons for participation. Primary reasons for non‐participation were safety concerns, inconvenience, stigmatisation, lack of social support, confidentiality concerns, physical pain, efficacy concerns and distrust. Stigmatisation was a major concern in relation to HIV research. Reasons were similar across different regions, gender, non‐patient or patient participants and real or hypothetical study designs. Conclusions Addressing factors that affect (non‐)participation in the planning process and during the conduct of research may enhance voluntary consent to participation and reduce barriers for potential participants.
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Affiliation(s)
- Joyce L Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Connie O Rees
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes J M van Delden
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Irene Agyepong
- Ghana Health Service, Research and Development Division, Accra, Ghana.,Public Health Faculty, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ama Edwin
- Department of Psychological Medicine and Mental Health, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rieke van der Graaf
- Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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12
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Day S, Blumberg M, Vu T, Zhao Y, Rennie S, Tucker JD. Stakeholder engagement to inform HIV clinical trials: a systematic review of the evidence. J Int AIDS Soc 2018; 21 Suppl 7:e25174. [PMID: 30334358 PMCID: PMC6192899 DOI: 10.1002/jia2.25174] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/20/2018] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Stakeholder engagement is an essential component of HIV clinical trials. We define stakeholder engagement as an input by individuals or groups with an interest in HIV clinical trials to inform the design or conduct of said trials. Despite its value, stakeholder engagement to inform HIV clinical trials has not been rigorously examined. The purpose of our systematic review is to examine stakeholder engagement for HIV clinical trials and compare it to the recommendations of the UNAIDS/AVAC Good Participatory Practice (GPP) guidelines. METHODS We used the PRISMA checklist and identified English language studies describing stakeholder engagement to inform HIV clinical trials. Four databases (PubMed, Ovid, CINAHL and Web of Science) and six journals were searched, with additional studies identified using handsearching and expert input. Two independent reviewers examined citations, abstracts and full texts. Data were extracted on country, engagement methods, stakeholder types and purpose of stakeholder engagement. Based on the GPP guidelines, we examined how frequently stakeholder engagement was conducted to inform clinical trial research question development, protocol development, recruitment, enrolment, follow-up, results and dissemination. RESULTS AND DISCUSSION Of the 917 citations identified, 108 studies were included in the analysis. Forty-eight studies (44.4%) described stakeholder engagement in high-income countries, thirty (27.8%) in middle-income countries and nine (8.3%) in low-income countries. Fourteen methods for stakeholder engagement were identified, including individual (e.g. interviews) and group (e.g. community advisory boards) strategies. Thirty-five types of stakeholders were engaged, with approximately half of the studies (60; 55.6%) engaging HIV-affected community stakeholders (e.g. people living with HIV, at-risk or related populations of interest). We observed greater frequency of stakeholder engagement to inform protocol development (49 studies; 45.4%) and trial recruitment (47 studies; 43.5%). Fewer studies described stakeholder engagement to inform post-trial processes related to trial results (3; 2.8%) and dissemination (11; 10.2%). CONCLUSIONS Our findings identify important directions for future stakeholder engagement research and suggestions for policy. Most notably, we found that stakeholder engagement was more frequently conducted to inform early stages of HIV clinical trials compared to later stages. In order to meet recommendations established in the GPP guidelines, greater stakeholder engagement across all clinical trial stages is needed.
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Affiliation(s)
- Suzanne Day
- Institute for Global Health and Infectious DiseasesUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Meredith Blumberg
- Institute for Global Health and Infectious DiseasesUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Thi Vu
- Institute for Global Health and Infectious DiseasesUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Yang Zhao
- University of North Carolina – Project ChinaGuangzhouChina
| | - Stuart Rennie
- Department of Social MedicineUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Center for BioethicsUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Joseph D. Tucker
- Institute for Global Health and Infectious DiseasesUniversity of North Carolina at Chapel HillChapel HillNCUSA
- University of North Carolina – Project ChinaGuangzhouChina
- School of MedicineUniversity of North Carolina at Chapel HillChapel HillNCUSA
- Faculty of Infectious DiseasesLondon School of Hygiene and Tropical MedicineLondonUK
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