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Ralefala D, Kasule M, Matshabane OP, Wonkam A, Matshaba M, de Vries J. Participant views on practical considerations for feedback of individual genetic research results: a case study from Botswana. Glob Bioeth 2023; 34:1-14. [PMID: 37063478 PMCID: PMC10101680 DOI: 10.1080/11287462.2023.2192329] [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: 04/18/2023] Open
Abstract
Key to discussions around feedback of individual results from genomics research are practical questions on how such results should be fed back, by who and when. However, there has been virtually no work investigating these practical considerations for feedback of individual genetic results in the context of low-and middle-income countries (LMICs), especially in Africa. Consequently, we conducted deliberative focus group discussions with 6 groups of adolescents (n = 44) who previously participated in a genomics study in Botswana as well as 6 groups of parents and caregivers (n = 49) of children who participated in the same study. We also conducted in-depth interviews with 6 adolescents and 6 parents or caregivers. Our findings revealed that both adolescents and parents would prefer to receive their individual genetic results in person, with adolescents preferring researchers to provide feedback, while parents preferred doctors who are associated with the study. Both adolescents and parents further expressed that feedback should be supported by counselling but differed on the timing of feedback, with preferences ranging from feedback as quickly as possible to feedback at project end. In conclusion, decisions on practicalities for feedback of results should be done in account of participants' context and considerations of participants' preferences.
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Affiliation(s)
- Dimpho Ralefala
- Faculty of Health Sciences, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Office of Research and Development, University of Botswana, Gaborone, Botswana
- Dimpho Ralefala ; Faculty of Health Sciences, Department of Medicine, University of Cape Town, Cape Town7925, South Africa; Office of Research and Development, University of Botswana, Gaborone, Botswana
| | - Mary Kasule
- Botswana-Baylor Children’s Clinical Centre of Excellence, Gaborone, Botswana
| | - Olivia P. Matshabane
- Faculty of Health Sciences, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Ambroise Wonkam
- Faculty of Health Sciences, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Faculty of Health Sciences and Groote Schuur Hospital, Cape Town, South Africa
| | - Mogomotsi Matshaba
- Botswana-Baylor Children’s Clinical Centre of Excellence, Gaborone, Botswana
- Baylor College of Medicine, Houston, TX, USA
| | - Jantina de Vries
- Faculty of Health Sciences, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Matshabane OP, Whitted CG, Koehly LM. Addressing diversity and inclusion challenges in global neuro-psychiatric and behavioral genomics research. Front Genet 2022; 13:1021649. [PMID: 36583023 PMCID: PMC9792473 DOI: 10.3389/fgene.2022.1021649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022] Open
Abstract
Advancements in neuro-psychiatric and behavioral genomics offer significant opportunities for better understanding the human brain, behavior and associated disorders. Such advancements may help us prevent, manage and/or cure complex conditions. The serious challenge confronted by these disciplines however is diversity. Both fields lack diversity in terms of genomic reference datasets needed for discovery research, engagement of diverse communities in translational research and in terms of diverse and multidisciplinary scientific teams. This is a challenge because diversity is needed on all levels in order to increase representation and inclusion of all populations across the globe as we move research activities forward. The lack of diversity can translate to an inability to use scientific innovations from these fields for the benefit of all people everywhere and signifies a missed opportunity to address pervasive global health inequities. In this commentary we identify three persistent barriers to reaching diversity targets while focusing on discovery and translational science. Additionally, we propose four suggestions on how to advance efforts and rapidly move towards achieving diversity and inclusion in neuro-psychiatric and behavioral genomics. Without systematically addressing the diversity gap within these fields, the benefits of the science may not be relevant and accessible to all people.
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Wilkinson A, Slack C, Thabethe S, Salzwedel J. " It's Almost as if Stakeholder Engagement is the Annoying 'Have-to-do'…": Can Ethics Review Help Address the "3 Ts" of Tokenism, Toxicity, and Tailoring in Stakeholder Engagement? J Empir Res Hum Res Ethics 2022; 17:292-303. [PMID: 35164594 PMCID: PMC9136363 DOI: 10.1177/15562646221078415] [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] [Indexed: 11/16/2022]
Abstract
Ethics guidance recommends that researchers engage stakeholders and that RECs review research for such engagement. The ethics review process may present a unique opportunity to support stakeholder engagement practices for HIV prevention studies. We conducted 28 interviews with experts from 12 countries to explore this issue, and analyzed the data using Thematic Analysis. We found that the value of engagement and review processes was strongly endorsed. However, we identified 3 major thematic complexities, namely: "Tokenism" where processes risk being "tick-box"; "Toxicity", where practices may inadvertently have negative consequences; and "Tailoring", where processes need careful variation in intensity. We make recommendations for how these "Ts" can be addressed during the review process to help contribute to thoughtful review of meaningful stakeholder engagement in research.
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Affiliation(s)
- Abigail Wilkinson
- HIV AIDS Vaccines Ethics Group (HAVEG), School of Applied Human Sciences, College of Humanities, 71874University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Catherine Slack
- HIV AIDS Vaccines Ethics Group (HAVEG), School of Applied Human Sciences, College of Humanities, 71874University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Siyabonga Thabethe
- HIV AIDS Vaccines Ethics Group (HAVEG), School of Applied Human Sciences, College of Humanities, 71874University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa
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Evaluating Community Engagement Strategies to Manage Stigma in Two African Genomics Studies Involving People Living with Schizophrenia or Rheumatic Heart Disease. GLOBAL HEALTH EPIDEMIOLOGY AND GENOMICS 2021; 2021:9926495. [PMID: 34527261 PMCID: PMC8415068 DOI: 10.1155/2021/9926495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022]
Abstract
In global health research and genomics research specifically, community engagement has gained prominence in enhancing ethical conduct, particularly in managing the risk of stigmatization, but there is minimal scientific evidence on how to do this effectively. This article reports on community engagement evaluation strategies in two African genomics studies: the Stigma in African Genomics Research study and the Genomics of Schizophrenia in South African Xhosa People (SAX) study. Within the Stigma in African Genomics Research study, a self-report rating scale and open-ended questions were used to track participant responses to an experiential theatre workshop. The workshop focused on participant experiences of living with schizophrenia or rheumatic heart disease (RHD). While the schizophrenia group reported more alienation and less stigma resistance than the RHD group, both groups demonstrated increased stigma resistance over time, after participating in the workshops. Hearing from others living with and managing the same illness normalised participants' own experiences and encouraged them. Within the SAX study, a short rating scale and qualitative feedback methods were used to evaluate a Mental Health Literacy Day targeting mental health stigma. Information talks about (i) the symptoms of schizophrenia and treatment options and (ii) the illness experiences of a patient in recovery were rated as the most helpful on the day. Audience members reported that these talks challenged negative perceptions about severe mental illness. Three important learnings emerged from these evaluations: firstly, integration of evaluation strategies at the research study planning phase is likely to promote more effective community engagement. Secondly, a combination of quantitative and qualitative methods that draw on simple descriptive statistics and thematic analysis can provide nuanced perspectives about the value of community engagement. Thirdly, such evidence is necessary in establishing and promoting the science of community engagement in genomics research and health research more broadly.
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Wolde TT, Musesengwa R, Palk A, Mwaka ES, Naanyu V, Addissie A, Tadele G. Ethics review of multicenter neuro-psychiatric & neurodevelopmental genetics research protocols: a case study of the NeuroDev & NeuroGap-Psychosis studies. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16809.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Complex research such as neuropsychiatric genetics presents unique challenges for research ethics committees (REC), particularly in Africa where genetics research on mental & neurological disorders is still in its infancy. To reflect on these experiences of reviewing Neuropsychiatric Genetic studies we use two multicenter studies, the NeuroDev and NeuroGap-Psychosis studies. We explored the content of the national guidelines and regulatory frameworks and the processes for ethics review in the participating African countries, to identify regulatory challenges, and to recommend areas for improvement. We also held reflective discussions with REC members involved in the review of the two studies were interviewed discussing their experiences of reviewing the two studies from the point of view of an African REC/REC member who reviewed the studies. Across all sites, a distinct theme was that the RECs did not have adequate knowledge and expertise for reviewing genetics and genomics studies in general. The review of guidelines showed the need to proactively update guidelines to meet the increasing complexity of research, ensure awareness creation, and continual capacity building of REC members.
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Chemonges Wanyama E, Dicko B, Pare Toe L, Coulibaly MB, Barry N, Bayala Traore K, Diabate A, Drabo M, Kayondo JK, Kekele S, Kodio S, Ky AD, Linga RR, Magala E, Meda WI, Mukwaya S, Namukwaya A, Robinson B, Samoura H, Sanogo K, Thizy D, Traoré F. Co-developing a common glossary with stakeholders for engagement on new genetic approaches for malaria control in a local African setting. Malar J 2021; 20:53. [PMID: 33478519 PMCID: PMC7818942 DOI: 10.1186/s12936-020-03577-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/31/2020] [Indexed: 11/19/2022] Open
Abstract
Stakeholder engagement is an essential pillar for the development of innovative public health interventions, including genetic approaches for malaria vector control. Scientific terminologies are mainly lacking in local languages, yet when research activities involve international partnership, the question of technical jargon and its translation is crucial for effective and meaningful communication with stakeholders. Target Malaria, a not-for-profit research consortium developing innovative genetic approaches to malaria vector control, carried out a linguistic exercise in Mali, Burkina Faso and Uganda to establish the appropriate translation of its key terminology to local languages of sites where the teams operate. While reviewing the literature, there was no commonly agreed approach to establish such glossary of technical terms in local languages of the field sites where Target Malaria operates. Because of its commitment to the value of co-development, Target Malaria decided to apply this principle for the linguistic work and to take the opportunity of this process to empower communities to take part in the dialogue on innovative vector control. The project worked with linguists from other institutions (whether public research ones or private language centre) who developed a first potential glossary in the local language after better understanding the project scientific approach. This initial glossary was then tested during focus groups with community members, which significantly improved the proposed translations by making them more appropriate to the local context and cultural understanding. The stepwise process revealed the complexity and importance of elaborating a common language with communities as well as the imbrication of language with cultural aspects. This exercise demonstrated the strength of a co-development approach with communities and language experts as a way to develop knowledge together and to tailor communication to the audience even in the language used.
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Affiliation(s)
| | - Bakara Dicko
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Lea Pare Toe
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Mamadou B Coulibaly
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Nourou Barry
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | | | - Abdoulaye Diabate
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Mouhamed Drabo
- Department of Life Sciences, Imperial College London, London, UK
| | - Jonathan K Kayondo
- Department of Entomology, Uganda Virus Research Institute, Entebbe, Uganda
| | - Souleymane Kekele
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | - Souleymane Kodio
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Anselme Dinyiri Ky
- Institut de Recherche en Sciences de la Santé, Bobo-Dioulasso, Burkina Faso
| | | | - Emmanuel Magala
- Department of Entomology, Uganda Virus Research Institute, Entebbe, Uganda
| | | | - Solome Mukwaya
- Department of Entomology, Uganda Virus Research Institute, Entebbe, Uganda
| | - Annet Namukwaya
- Department of Entomology, Uganda Virus Research Institute, Entebbe, Uganda
| | | | - Hatouma Samoura
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Kadiatou Sanogo
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Delphine Thizy
- Department of Life Sciences, Imperial College London, London, UK.
| | - Fatoumata Traoré
- Malaria Research and Training Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
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Kong C, Efrem M, Campbell M. Education versus screening: the use of capacity to consent tools in psychiatric genomics. JOURNAL OF MEDICAL ETHICS 2020; 46:137-143. [PMID: 31563871 DOI: 10.1136/medethics-2019-105396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 07/30/2019] [Accepted: 08/01/2019] [Indexed: 06/10/2023]
Abstract
Informed consent procedures for participation in psychiatric genomics research among individuals with mental disorder and intellectual disability can often be unclear, particularly because the underlying ethos guiding consent tools reflects a core ethical tension between safeguarding and inclusion. This tension reflects important debates around the function of consent tools, as well as the contested legitimacy of decision-making capacity thresholds to screen potentially vulnerable participants. Drawing on human rights, person-centred psychiatry and supported decision-making, this paper problematises the use of consent procedures as screening tools in psychiatric genomics studies, particularly as increasing normative emphasis has shifted towards the empowerment and participation of those with mental disorder and intellectual disabilities. We expound on core aspects of supported decision-making, such as relational autonomy and hermeneutic competence, to orient consent procedures towards a more educative, participatory framework that is better aligned with developments in disability studies. The paper concludes with an acknowledgement of the pragmatic and substantive challenges in adopting this framework in psychiatric genomics studies if this participatory ethos towards persons with mental disorder and intellectual disability is to be fully realised.
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Affiliation(s)
- Camillia Kong
- School of Law, Birkbeck University of London Institute for Criminal Policy Research, School of Law, London, UK
| | - Mehret Efrem
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Megan Campbell
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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8
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Gulsuner S, Stein DJ, Susser ES, Sibeko G, Pretorius A, Walsh T, Majara L, Mndini MM, Mqulwana SG, Ntola OA, Casadei S, Ngqengelele LL, Korchina V, van der Merwe C, Malan M, Fader KM, Feng M, Willoughby E, Muzny D, Baldinger A, Andrews HF, Gur RC, Gibbs RA, Zingela Z, Nagdee M, Ramesar RS, King MC, McClellan JM. Genetics of schizophrenia in the South African Xhosa. Science 2020; 367:569-573. [PMID: 32001654 PMCID: PMC9558321 DOI: 10.1126/science.aay8833] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/18/2019] [Indexed: 07/20/2023]
Abstract
Africa, the ancestral home of all modern humans, is the most informative continent for understanding the human genome and its contribution to complex disease. To better understand the genetics of schizophrenia, we studied the illness in the Xhosa population of South Africa, recruiting 909 cases and 917 age-, gender-, and residence-matched controls. Individuals with schizophrenia were significantly more likely than controls to harbor private, severely damaging mutations in genes that are critical to synaptic function, including neural circuitry mediated by the neurotransmitters glutamine, γ-aminobutyric acid, and dopamine. Schizophrenia is genetically highly heterogeneous, involving severe ultrarare mutations in genes that are critical to synaptic plasticity. The depth of genetic variation in Africa revealed this relationship with a moderate sample size and informed our understanding of the genetics of schizophrenia worldwide.
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Affiliation(s)
- S Gulsuner
- Department of Medicine, Department of Genome Sciences, and Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - D J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - E S Susser
- Mailman School of Public Health, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - G Sibeko
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - A Pretorius
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - T Walsh
- Department of Medicine, Department of Genome Sciences, and Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - L Majara
- Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - M M Mndini
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - S G Mqulwana
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - O A Ntola
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - S Casadei
- Department of Medicine, Department of Genome Sciences, and Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - L L Ngqengelele
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - V Korchina
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - C van der Merwe
- Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - M Malan
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - K M Fader
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - M Feng
- Mailman School of Public Health, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - E Willoughby
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - D Muzny
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - A Baldinger
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - H F Andrews
- Mailman School of Public Health, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - R C Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - R A Gibbs
- Human Genome Sequencing Center, Baylor College of Medicine, Houston, TX, USA
| | - Z Zingela
- Department of Psychology, Rhodes University, Makhanda (Grahamstown), South Africa
- Department of Psychiatry and Human Behavioral Sciences, Walter Sisulu University, Mthatha, South Africa
| | - M Nagdee
- Department of Psychology, Rhodes University, Makhanda (Grahamstown), South Africa
- Department of Psychiatry and Human Behavioral Sciences, Walter Sisulu University, Mthatha, South Africa
| | - R S Ramesar
- Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - M-C King
- Department of Medicine, Department of Genome Sciences, and Department of Psychiatry, University of Washington, Seattle, WA, USA.
| | - J M McClellan
- Department of Medicine, Department of Genome Sciences, and Department of Psychiatry, University of Washington, Seattle, WA, USA
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Masiye F. Commentary 2: Remuneration for Community Advisory Board (CAB) Members: A Call for Remuneration Guidelines for CAB Members in Biomedical Research. J Empir Res Hum Res Ethics 2019; 14:506-508. [PMID: 31779558 PMCID: PMC6886575 DOI: 10.1177/1556264619856223b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The commentary will focus on the definition and methods of community engagement (CE), reflection on the development of the educational video as part of the CE activities of the Biobanking Community Advisory Board (CAB) members as highlighted in the case study by Staunton et al and a call for remuneration guidelines for CAB members who participate in CE activities in low and middle income countries (LMICs) such as South Africa.
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Moodley K, Beyer C. Tygerberg Research Ubuntu-Inspired Community Engagement Model: Integrating Community Engagement into Genomic Biobanking. Biopreserv Biobank 2019; 17:613-624. [PMID: 31603696 PMCID: PMC6921246 DOI: 10.1089/bio.2018.0136] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Introduction: Community engagement (CE) is an ethical imperative in research, but the knowledge base for what constitutes effective and ethically sound CE is limited. Ubuntu, as a component of responsive communitarianism where communal welfare is valued together with individual autonomy, is useful in furthering our understanding of effective CE and how it could best be achieved. Similarly, a relative solidarity model serves as a compromise between extreme individualism and extreme communalism and is more appropriate in a heterogenous African context. Approaching CE from an Ubuntu philosophical perspective in southern Africa is particularly important in genomic biobanking, given the implications for individuals, families, and communities. Discussion: CE is often implemented in a tokenistic manner as an ancillary component of research. Understanding consent information is challenging where genomic biobanking is concerned due to scientific complexity. We started a process of CE around genomic biobanking and conducted empirical research in an attempt to develop a model to promote effective and ethically sound CE, using relative solidarity to create a nuanced application of Ubuntu. The TRUCE model is an eight-step model that uses social mapping to identify potential communities, establishes the scope of CE, and requires that communities are approached early. Co-creation strategies for CE are encouraged and co-ownership of knowledge production is emphasized. Recruiting and engaging communities at each stage of research is necessary. Evaluation and adaptation of CE strategies are included. Discussion and dissemination of results after the research is completed are encouraged. Conclusions: There is a significant gap between the theory of CE and its authentic application to research in Africa. This Ubuntu-inspired model facilitates bridging that gap and is particularly suited to genomic biobanking. The CE model enhances and complements the consent process and should be integrated into research as a funding and regulatory requirement where applicable.
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Affiliation(s)
- Keymanthri Moodley
- Department of Medicine, Faculty of Medicine and Health Sciences, Centre for Medical Ethics & Law, Stellenbosch University, Cape Town, South Africa
- Address correspondence to: Keymanthri Moodley, MBChB, MFamMed, MPhil, FCFP (SA), Executive MBA, DPhil, Department of Medicine, Faculty of Medicine and Health Sciences, Centre for Medical Ethics & Law, Stellenbosch University, P.O. Box 241, Cape Town 7505, South Africa
| | - Chad Beyer
- Department of Medicine, Faculty of Medicine and Health Sciences, Centre for Medical Ethics & Law, Stellenbosch University, Cape Town, South Africa
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Tindana P, Yakubu A, Staunton C, Matimba A, Littler K, Madden E, Munung NS, de Vries J. Engaging research ethics committees to develop an ethics and governance framework for best practices in genomic research and biobanking in Africa: the H3Africa model. BMC Med Ethics 2019; 20:69. [PMID: 31623617 PMCID: PMC6798385 DOI: 10.1186/s12910-019-0398-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 08/25/2019] [Indexed: 11/10/2022] Open
Abstract
In the past decade, there has been an increase in genomic research and biobanking activities in Africa. Research initiatives such as the Human Heredity and Health in Africa (H3Africa) Consortium are contributing to the development of scientific capacity and infrastructure to support these studies on the continent. Despite this growth, genomic research and biobanking have raised important ethical challenges for key research stakeholders, including members of research ethics committees. One of these is the limited ethical and regulatory frameworks to guide the review and conduct of genomic studies, particularly in Africa. This paper is a reflection on a series of consultative activities with research ethics committees in Africa which informed the development of an ethics and governance framework for best practices in genomic research and biobanking in Africa. The paper highlights the engagement process and the lessoned learned.
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Affiliation(s)
- Paulina Tindana
- Department of Health Policy, Planning and Management, School of Public Health, College of Health Sciences, University of Ghana, Legon, Ghana.
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana.
| | - Aminu Yakubu
- Department of Health Planning, Research & Statistics, Federal Ministry of Health, Abuja, Nigeria
| | - Ciara Staunton
- School of Law, Middlesex University, Hendon, The Burroughs, London, UK
| | - Alice Matimba
- Advanced Courses and Scientific Conferences, Wellcome Genome Campus, Hinxton, UK
| | | | - Ebony Madden
- Division of Genomic Medicine, National Human Genome Research Institute, National Institutes of Health, Rockville, MD, USA
| | - Nchangwi Syntia Munung
- Department of Medicine, University of Cape Town, Observatory, Cape Town, 7925, South Africa
| | - Jantina de Vries
- Department of Medicine, University of Cape Town, Observatory, Cape Town, 7925, South Africa
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Zhao Y, Fitzpatrick T, Wan B, Day S, Mathews A, Tucker JD. Forming and implementing community advisory boards in low- and middle-income countries: a scoping review. BMC Med Ethics 2019; 20:73. [PMID: 31623624 PMCID: PMC6796331 DOI: 10.1186/s12910-019-0409-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 09/16/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Community advisory boards (CABs) have expanded beyond high-income countries (HICs) and play an increasing role in low- and middle-income country (LMIC) research. Much research has examined CABs in HICs, but less is known about CABs in LMICs. The purposes of this scoping review are to examine the creation and implementation of CABs in LMICs, including identifying frequently reported challenges, and to discuss implications for research ethics. METHODS We searched five databases (PubMed, Embase, Global Health, Scopus, and Google Scholar) for publications describing or evaluating CABs in LMICs. Two researchers independently reviewed articles for inclusion. Data related to the following aspects of CABs were extracted from included publications: time, country, financial support, research focus, responsibilities, and challenges. Thematic analyses were used to summarize textual data describing challenges. RESULTS Our search yielded 2005 citations, 83 of which were deemed eligible for inclusion. Most studies (65) were published between 2010 and 2017. Upper-middle-income countries were more likely to have studies describing CABs, with South Africa (17), China (8), and Thailand (7) having the greatest numbers. The United States National Institutes of Health was the main source of financial support for CABs. Many CABs (53/88, 60%) focused on HIV research. Thirty-four studies reported how CABs influenced the informed consent process for clinical trials or other aspects of research ethics. CAB responsibilities were related to clinical trials, including reviewing study protocols, educating local communities about research activities, and promoting the ethical conduct of research. Challenges faced by CABs included the following: incomplete ethical regulations and guidance; limited knowledge of science among members of communities and CABs; unstable and unbalanced power relationships between researchers and local communities; poor CAB management, including lack of formal participation structures and absence of CAB leadership; competing demands for time that limited participation in CAB activities; and language barriers between research staff and community members. Several challenges reflected shortcomings within the research team. CONCLUSIONS Our findings examine the formation and implementation of CABs in LMICs and identify several ethical challenges. These findings suggest the need for further ethics training among CAB members and researchers in LMICs.
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Affiliation(s)
- Yang Zhao
- University of North Carolina at Chapel Hill - Project China, No.2 Lujing Road, Guangzhou, 510095 China
| | - Thomas Fitzpatrick
- University of North Carolina at Chapel Hill - Project China, No.2 Lujing Road, Guangzhou, 510095 China
- University of Washington School of Medicine, Seattle, USA
| | - Bin Wan
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Suzanne Day
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Allison Mathews
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Joseph D. Tucker
- University of North Carolina at Chapel Hill - Project China, No.2 Lujing Road, Guangzhou, 510095 China
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, USA
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA
- Faculty of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
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13
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de Menil V, Hoogenhout M, Kipkemoi P, Kamuya D, Eastman E, Galvin A, Mwangasha K, de Vries J, Kariuki SM, Murugasen S, Mwangi P, Singh I, Stein DJ, Abubakar A, Newton CR, Donald KA, Robinson E. The NeuroDev Study: Phenotypic and Genetic Characterization of Neurodevelopmental Disorders in Kenya and South Africa. Neuron 2019; 101:15-19. [PMID: 30605655 DOI: 10.1016/j.neuron.2018.12.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The NeuroDev study will deeply phenotype cognition, behavior, dysmorphias, and neuromedical traits on an expected cohort of 5,600 Africans (1,800 child cases, 1,800 child controls, and 1,900 parents) and will collect whole blood for exome sequencing and biobanking.
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Affiliation(s)
- Victoria de Menil
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, 75 Ames Street, Cambridge, MA 02142, USA
| | - Michelle Hoogenhout
- Department of Paediatrics & Child Health, 4(th) Floor ICH Building, Red Cross War Memorial Children's Hospital and University of Cape Town, Rondebosch, South Africa
| | - Patricia Kipkemoi
- Neurosciences Unit, Clinical Department, KEMRI-Wellcome Trust Collaborative Research Programme, PO Box 230-80108, Kilifi, Kenya
| | - Dorcas Kamuya
- Department of Health Systems and Research Ethics, KEMRI-Wellcome Trust Collaborative Research Programme, Kilifi, Kenya
| | - Emma Eastman
- Department of Paediatrics & Child Health, 4(th) Floor ICH Building, Red Cross War Memorial Children's Hospital and University of Cape Town, Rondebosch, South Africa
| | - Alice Galvin
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, 75 Ames Street, Cambridge, MA 02142, USA; Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
| | - Katini Mwangasha
- Neurosciences Unit, Clinical Department, KEMRI-Wellcome Trust Collaborative Research Programme, PO Box 230-80108, Kilifi, Kenya
| | - Jantina de Vries
- Department of Medicine, University of Cape Town, Observatory, Cape Town 7925, South Africa
| | - Symon M Kariuki
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK; Neurosciences Unit, Clinical Department, KEMRI-Wellcome Trust Collaborative Research Programme, PO Box 230-80108, Kilifi, Kenya
| | - Serini Murugasen
- Department of Paediatrics & Child Health, 4(th) Floor ICH Building, Red Cross War Memorial Children's Hospital and University of Cape Town, Rondebosch, South Africa
| | - Paul Mwangi
- Neurosciences Unit, Clinical Department, KEMRI-Wellcome Trust Collaborative Research Programme, PO Box 230-80108, Kilifi, Kenya
| | - Ilina Singh
- Department of Psychiatry and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Dan J Stein
- Department of Psychiatry & Mental Health, and MRC Unit on Risk and Resilience in Mental Disorders, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Amina Abubakar
- Neurosciences Unit, Clinical Department, KEMRI-Wellcome Trust Collaborative Research Programme, PO Box 230-80108, Kilifi, Kenya.
| | - Charles R Newton
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK; Neurosciences Unit, Clinical Department, KEMRI-Wellcome Trust Collaborative Research Programme, PO Box 230-80108, Kilifi, Kenya
| | - Kirsten A Donald
- Department of Paediatrics & Child Health, 4(th) Floor ICH Building, Red Cross War Memorial Children's Hospital and University of Cape Town, Rondebosch, South Africa.
| | - Elise Robinson
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, 75 Ames Street, Cambridge, MA 02142, USA; Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; Analytic and Translational Genetics Unit, Massachusetts General Hospital, Richard B. Simches Building, 6(th) Floor, 185 Cambridge Street, Boston, MA 02114, USA.
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14
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Mlambo CK, Vernooij E, Geut R, Vrolings E, Shongwe B, Jiwan S, Fleming Y, Khumalo G. Experiences from a community advisory Board in the Implementation of early access to ART for all in Eswatini: a qualitative study. BMC Med Ethics 2019; 20:50. [PMID: 31311526 PMCID: PMC6636129 DOI: 10.1186/s12910-019-0384-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 06/20/2019] [Indexed: 11/10/2022] Open
Abstract
Background Engaging communities in community-based health research is increasingly being adopted in low- and middle-income countries. The use of community advisory boards (CABs) is one method of practicing community involvement in health research. To date, few studies provide in-depth accounts of the strategies that CAB members use to practice community engagement. We assessed the perspectives, experiences and practices of the first local CAB in Eswatini (formerly known as Swaziland), which was implemented as part of the MaxART Early Access to ART for All study. Methods Trained Swazi research assistants conducted two focus group discussions and 13 semi-structured interviews with CAB members who had been part of the MaxART study for at least 2.5 years. Interviews explored CAB composition and recruitment, the activities of CAB members, the mechanisms used to engage with communities and the challenges they faced in their role. Results The MaxART CAB played an active role in the implementation of the Early Access to Art for All study, and activities mainly focused on: (1) promoting ethical conduct, in particular privacy, consent and confidentiality; (2) communication and education, communicating about the study and educating the community on the benefits of HIV testing and early access to HIV treatment; and (3) liaising between the community and the research team. Strategies for interacting with communities were varied and included attending general community meetings, visiting health facilities and visiting public places such as cattle dipping tanks, buses, bars and churches. Differences in the approach to community engagement between CAB members living in the study areas and those residing outside were identified. Conclusion The experiences of the first CAB in Eswatini demonstrate that community engagement using CABs is a valuable mechanism for engaging communities in implementation studies. Considerations that could impact CAB functioning include clearly defining the scope of the CAB, addressing issues of CAB independence, the CAB budget, providing emotional support for CAB members, and providing continuous training and capacity building. These issues should be addressed during the early stages of CAB formation in order to optimize functioning.
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Affiliation(s)
| | - Eva Vernooij
- Department of Anthropology, Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Amsterdam, the Netherlands
| | - Roos Geut
- Department of Anthropology, Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Amsterdam, the Netherlands
| | | | - Buyisile Shongwe
- Swaziland National Network of People Living with HIV/AIDS, Mbabane, Swaziland
| | - Saima Jiwan
- Global Network of People Living with HIV, Amsterdam, the Netherlands
| | | | - Gavin Khumalo
- Swaziland National Network of People Living with HIV/AIDS, Mbabane, Swaziland
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15
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Cook N, Siddiqi N, Twiddy M, Kenyon R. Patient and public involvement in health research in low and middle-income countries: a systematic review. BMJ Open 2019; 9:e026514. [PMID: 31076471 PMCID: PMC6528003 DOI: 10.1136/bmjopen-2018-026514] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Patient and public involvement (PPI) is argued to lead to higher quality health research, which is more relatable to and helps empower the public. We synthesised the evidence to look for examples of PPI in health research in low/middle-income countries (LMICs), looking at levels of involvement and impact. Additionally, we considered the impact of who was undertaking the research on the level of involvement and reported impact. DESIGN Systematic review. DATA SOURCES EMBASE, Medline and PsychINFO, along with hand-searching references, grey literature, Google search and expert advice. ELIGIBILITY CRITERIA Any health research with evidence of patient or public involvement, with no language restrictions dated from 1978 to 1 Dec 2017. DATA EXTRACTION AND SYNTHESIS Data relating to stage and level of involvement, as well as impact, were extracted by one researcher (NC), and a coding framework was developed using an inductive approach to examine the impact of PPI on research. Extracted data were then independently coded by a second lay researcher (RK) to validate the data being collected. Discrepancies were referred to a third independent reviewer (MT) for review and consensus reached. RESULTS Sixty-two studies met the inclusion criteria. The review revealed the most common stage for PPI was in research planning, and the most common level of involvement was collaboration. Most studies did not provide evidence of effectiveness or elaborate on the impact of PPI, and they tended to report impact from the researcher's perspective. Where impact was mentioned, this generally related to increased relevance to the community, empowerment of participants and alterations in study design. CONCLUSIONS The literature describing approaches to and impact of PPI on LMIC health research is sparse. As PPI is essential to conducting high-quality research, it should be fully reported and evaluated at the end of the research project.
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Affiliation(s)
- Natalie Cook
- Department of Health Sciences, University of York, York, UK
- Hull York Medical School, York, UK
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, UK
- Hull York Medical School, York, UK
- Bradford District Care NHS Foundation Trust
| | - Maureen Twiddy
- Institute of Clinical and Applied Health Research, University of Hull, Hull, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Millum J, Campbell M, Luna F, Malekzadeh A, Karim QA. Ethical challenges in global health-related stigma research. BMC Med 2019; 17:84. [PMID: 31030670 PMCID: PMC6487527 DOI: 10.1186/s12916-019-1317-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 04/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is critically important to conduct research on stigmatized conditions, to include marginalized groups that experience stigma, and to develop interventions to reduce stigma. However, such research is ethically challenging. Though superficial reference is frequently made to these widely acknowledged challenges, few publications have focused on ethical issues in research on stigmatized groups or conditions. In fact, a brief literature review found only two such publications. MAIN TEXT At a recent Science of Stigma Reduction workshop comprising 60 stigma researchers from the USA and low and middle-income countries, the need for more robust and critical discussion of the ethics of the research was highlighted. In this paper we describe, illustrate through cases, and critically examine key ethical challenges that are more likely to arise because a research study focuses on health-related stigma or involves stigmatized groups or conditions. We examine the ethics of this research from two perspectives. First, through the lens of overprotection, where we discuss how the perception of stigma can impede ethical research, disrespect research participants, and narrow the research questions. Second, through the lens of research risks, where we consider how research with stigmatized populations can unintentionally result in harms. Research-related harms to participants include potential breaches of confidentiality and the exacerbation of stigma. Potential harms also extend to third parties, including families and populations who may be affected by the dissemination of research results. CONCLUSIONS Research with stigmatized populations and on stigmatized conditions should not be impeded by unnecessary or inappropriate protective measures. Nevertheless, it may entail different and greater risks than other health research. Investigators and research ethics committees must be particularly attentive to these risks and how to manage them.
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Affiliation(s)
- Joseph Millum
- Clinical Center Department of Bioethics, National Institutes of Health, 10/1C118, 10 Center Drive, Bethesda, MD, 20892, USA. .,Fogarty International Center, National Institutes of Health, 31 Center Dr, Bethesda, MD, 20892, USA.
| | - Megan Campbell
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Florencia Luna
- CONICET, Programa de Bioética, FLACSO Argentina, Tucumán 1966, C1050AAN, Caba, Argentina
| | - Arianne Malekzadeh
- Fogarty International Center, National Institutes of Health, 31 Center Dr, Bethesda, MD, 20892, USA
| | - Quarraisha Abdool Karim
- Centre for the AIDS Program of Research in South Africa, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Congella, 4013, South Africa
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17
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Bentley AR, Callier S, Rotimi C. The Emergence of Genomic Research in Africa and New Frameworks for Equity in Biomedical Research. Ethn Dis 2019; 29:179-186. [PMID: 30906167 DOI: 10.18865/ed.29.s1.179] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Individuals with African ancestry have the greatest genomic diversity in the world, yet they have been underrepresented in genomic research. To advance our understanding of human biology and our ability to trace human history, we must include more samples from Africans in genomic research. Additionally, inclusion of more samples from participants of recent African descent is imperative to provide equitable health care as genomics is increasingly used for diagnosis, treatment, and to understand disease risk. The Human Heredity and Health in Africa initiative (H3Africa) seeks to expand the number of Africans included in genomic research and to do so by expanding the research capacity on the continent. In this article, we discuss how H3Africa is endeavoring to achieve these goals while promoting equitable research collaborations.
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Affiliation(s)
- Amy R Bentley
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Shawneequa Callier
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD.,Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Charles Rotimi
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
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18
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Mulder N, Abimiku A, Adebamowo SN, de Vries J, Matimba A, Olowoyo P, Ramsay M, Skelton M, Stein DJ. H3Africa: current perspectives. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2018; 11:59-66. [PMID: 29692621 PMCID: PMC5903476 DOI: 10.2147/pgpm.s141546] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Precision medicine is being enabled in high-income countries by the growing availability of health data, increasing knowledge of the genetic determinants of disease and variation in response to treatment (pharmacogenomics), and the decreasing costs of data generation, which promote routine application of genomic technologies in the health sector. However, there is uncertainty about the feasibility of applying precision medicine approaches in low- and middle-income countries, due to the lack of population-specific knowledge, skills, and resources. The Human Heredity and Health in Africa (H3Africa) initiative was established to drive new research into the genetic and environmental basis for human diseases of relevance to Africans as well as to build capacity for genomic research on the continent. Precision medicine requires this capacity, in addition to reference data on local populations, and skills to analyze and interpret genomic data from the bedside. The H3Africa consortium is collectively processing samples and data for over 70,000 participants across the continent, accompanied in most cases by rich clinical information on a variety of non-communicable and infectious diseases. These projects are increasingly providing novel insights into the genetic basis of diseases in indigenous populations, insights that have the potential to drive the development of new diagnostics and treatments. The consortium has also invested significant resources into establishing high-quality biorepositories in Africa, a bioinformatic network, and a strong training program that has developed skills in genomic data analysis and interpretation among bioinformaticians, wet-lab researchers, and health-care professionals. Here, we describe the current perspectives of the H3Africa consortium and how it can contribute to making precision medicine in Africa a reality.
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Affiliation(s)
- Nicola Mulder
- Computational Biology Division, Department of Integrative Biomedical Sciences, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Alash'le Abimiku
- International Research Center of Excellence, Institute of Human Virology, Abuja, Nigeria
| | - Sally N Adebamowo
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jantina de Vries
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Alice Matimba
- Advanced Courses and Scientific Conferences, Wellcome Genome Campus, Hinxton, UK
| | - Paul Olowoyo
- Federal Teaching Hospital, College of Medicine and Health Sciences, Afe Babalola University, Ado-Ekiti, Nigeria
| | - Michele Ramsay
- Sydney Brenner Institute for Molecular Bioscience, Division of Human Genetics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
| | - Michelle Skelton
- Computational Biology Division, Department of Integrative Biomedical Sciences, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town.,MRC Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
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19
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Staunton C, Tindana P, Hendricks M, Moodley K. Rules of engagement: perspectives on stakeholder engagement for genomic biobanking research in South Africa. BMC Med Ethics 2018; 19:13. [PMID: 29482536 PMCID: PMC5828421 DOI: 10.1186/s12910-018-0252-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 02/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Genomic biobanking research is undergoing exponential growth in Africa raising a host of legal, ethical and social issues. Given the scientific complexity associated with genomics, there is a growing recognition globally of the importance of science translation and community engagement (CE) for this type of research, as it creates the potential to build relationships, increase trust, improve consent processes and empower local communities. Despite this level of recognition, there is a lack of empirical evidence of the practise and processes for effective CE in genomic biobanking in Africa. METHODS To begin to address this vacuum, 17 in-depth face to face interviews were conducted with South African experts in genomic biobanking research and CE to provide insight into the process, benefits and challenges of CE in South Africa. Emerging themes were analysed using a contextualised thematic approach. RESULTS Several themes emerged concerning the conduct of CE in genomic biobanking research in Africa. Although the literature tends to focus on the local community in CE, respondents in this study described three different layers of stakeholder engagement: community level, peer level and high level. Community level engagement includes potential participants, community advisory boards (CAB) and field workers; peer level engagement includes researchers, biobankers and scientists, while high level engagement includes government officials, funders and policy makers. Although education of each stakeholder layer is important, education of the community layer can be most challenging, due to the complexity of the research and educational levels of stakeholders in this layer. CONCLUSION CE is time-consuming and often requires an interdisciplinary research team approach. However careful planning of the engagement strategy, including an understanding of the differing layers of stakeholder engagement, and the specific educational needs at each layer, can help in the development of a relationship based on trust between the research team and various stakeholder groups. Since the community layer often comprises vulnerable populations in low and middle income countries (LMICs), co-development of innovative educational tools on genomic biobanking is essential. CE is clearly a component of a broader process best described as stakeholder engagement.
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Affiliation(s)
- Ciara Staunton
- Department of Medicine, Centre for Medical Ethics and Law, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Paulina Tindana
- Navrongo Health Research Centre, Ghana Health Service, Navrongo, Ghana
| | - Melany Hendricks
- Department of Medicine, Centre for Medical Ethics and Law, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Keymanthri Moodley
- Department of Medicine, Centre for Medical Ethics and Law, Faculty of Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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20
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Adebamowo SN, Francis V, Tambo E, Diallo SH, Landouré G, Nembaware V, Dareng E, Muhamed B, Odutola M, Akeredolu T, Nerima B, Ozumba PJ, Mbhele S, Ghanash A, Wachinou AP, Ngomi N. Implementation of genomics research in Africa: challenges and recommendations. Glob Health Action 2018; 11:1419033. [PMID: 29336236 PMCID: PMC5769805 DOI: 10.1080/16549716.2017.1419033] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 12/08/2017] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND There is exponential growth in the interest and implementation of genomics research in Africa. This growth has been facilitated by the Human Hereditary and Health in Africa (H3Africa) initiative, which aims to promote a contemporary research approach to the study of genomics and environmental determinants of common diseases in African populations. OBJECTIVE The purpose of this article is to describe important challenges affecting genomics research implementation in Africa. METHODS The observations, challenges and recommendations presented in this article were obtained through discussions by African scientists at teleconferences and face-to-face meetings, seminars at consortium conferences and in-depth individual discussions. RESULTS Challenges affecting genomics research implementation in Africa, which are related to limited resources include ill-equipped facilities, poor accessibility to research centers, lack of expertise and an enabling environment for research activities in local hospitals. Challenges related to the research study include delayed funding, extensive procedures and interventions requiring multiple visits, delays setting up research teams and insufficient staff training, language barriers and an underappreciation of cultural norms. While many African countries are struggling to initiate genomics projects, others have set up genomics research facilities that meet international standards. CONCLUSIONS The lessons learned in implementing successful genomics projects in Africa are recommended as strategies to overcome these challenges. These recommendations may guide the development and application of new research programs in low-resource settings.
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Affiliation(s)
- Sally N. Adebamowo
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Center for Bioethics and Research, Ibadan, Nigeria
| | - Veronica Francis
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Ernest Tambo
- Sydney Brenner Institute of Molecular Bioscience, University of Witwatersrand, Johannesburg, South Africa
| | - Seybou H. Diallo
- Faculté de Médecine et d’Odonstomatologie, Université des Sciences, des Techniques, et des Technologies de Bamako, Bamako, Mali
| | - Guida Landouré
- Faculté de Médecine et d’Odonstomatologie, Université des Sciences, des Techniques, et des Technologies de Bamako, Bamako, Mali
| | - Victoria Nembaware
- Department of Integrative Biomedical Sciences, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Eileen Dareng
- Office of Strategic Information and Research, Institute of Human Virology Nigeria, Abuja, Nigeria
- Department of Primary Care and Public Health, University of Cambridge, Cambridge, UK
| | - Babu Muhamed
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Cardiovascular Genetics, Hatter Institute for Cardiovascular Diseases Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Michael Odutola
- Office of Strategic Information and Research, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Teniola Akeredolu
- Office of Strategic Information and Research, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Barbara Nerima
- National Livestock Resources Research Institute, Tororo, Uganda
| | - Petronilla J. Ozumba
- Clinical Lab Molecular Virology Unit, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Slee Mbhele
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa
| | - Anita Ghanash
- Department of Parasitology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Ablo P. Wachinou
- National Hospital for Tuberculosis and Pulmonary Diseases, Cotonou, Benin Republic
| | - Nicholas Ngomi
- Health Challenges and Systems program, African Population and Health Research Center, Nairobi, Kenya
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21
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Tindana P, Campbell M, Marshall P, Littler K, Vincent R, Seeley J, de Vries J, Kamuya D. Developing the science and methods of community engagement for genomic research and biobanking in Africa. Glob Health Epidemiol Genom 2017; 2:e13. [PMID: 29276620 PMCID: PMC5732574 DOI: 10.1017/gheg.2017.9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/25/2017] [Accepted: 05/22/2017] [Indexed: 11/28/2022] Open
Abstract
Historically, community engagement (CE) in research has been implemented in the fields of public health, education and agricultural development. In recent years, international discussions on the ethical and practical goals of CE have been extended to human genomic research and biobanking, particularly in the African context. While there is some consensus on the goals and value of CE generally, questions remain about the effectiveness of CE practices and how to evaluate this. Under the auspices of the Human Heredity and Health in Africa Initiative (H3Africa), the H3Africa CE working group organized a workshop in Stellenbosch, South Africa in March 2016 to explore the extent to which communities should be involved in genomic research and biobanking and to examine various methods of evaluating the effectiveness of CE. In this paper, we present the key themes that emerged from the workshop and make a case for the development of a rigorous application, evaluation and learning around approaches for CE that promote a more systematic process of engaging relevant communities. We highlight the key ways in which CE should be embedded into genomic research and biobanking projects.
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Affiliation(s)
- P. Tindana
- Navrongo Health Research Centre, Ghana Health Service, P.O.Box 114, Navrongo, Ghana
| | - M. Campbell
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur, Observatory 7925, Cape Town, South Africa
| | - P. Marshall
- Department of Bioethics, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106-4976, USA
| | - K. Littler
- Wellcome Trust, Gibbs Building, 215 Euston Road, London NW1 2BE, UK
| | - R. Vincent
- Freelance International Development consultant, London, UK
| | - J. Seeley
- MRC/UVRI Uganda Research Unit on AIDS, P.O. Box 49, Entebbe, Uganda
| | - J. de Vries
- Department of Medicine, University of Cape Town, Office J52-16, UCT Centre for Clinical Research, Old Main Building, Groote Schuur Hospital, Observatory, 7925 Cape Town, South Africa
| | - D. Kamuya
- KEMRI/WELLCOME Trust Research Programme, Kilifi, Kenya
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22
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Kaplan B, Caddle-Steele C, Chisholm G, Esmond WA, Ferryman K, Gertner M, Goytia C, Hauser D, Richardson LD, Robinson M, Horowitz CR. A Culture of Understanding: Reflections and Suggestions from a Genomics Research Community Board. Prog Community Health Partnersh 2017; 11:161-165. [PMID: 28736408 PMCID: PMC5830277 DOI: 10.1353/cpr.2017.0020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
There has been limited community engagement in the burgeoning field of genomics research. In the wake of a new discovery of genetic variants that increase the risk of kidney failure and are almost unique to people of African ancestry, community and clinical leaders in Harlem, New York, formed a community board to inform the direction of related research. The board advised all aspects of a study to assess the impact of testing for these genetic variants at primary care sites that serve diverse populations, including explaining genetic risk to participants. By reflecting on the board's experiences, we found that community voices can have tangible impact on research that navigates the controversial intersection of race, ancestry, and genomics by heightening vigilance, fostering clear communication between researchers and the community, and encouraging researchers to cede some control. Our reflections and work provide a strong justification for longitudinal community partnerships in genomics research.
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de Vries J, Munung SN, Tindana P. Deliberation to Promote Shared Sovereignty in Health Research: Four Questions to Clarify Goals, Methods, and Scope. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2016; 16:50-52. [PMID: 27653401 PMCID: PMC5141257 DOI: 10.1080/15265161.2016.1214326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Abstract
Although community advisory boards (CABs) are widely used in clinical research, there is limited data regarding their composition and structure, especially in Africa. Our research provides the first qualitative study of the membership practices, selection methods, and qualifications of the six major HIV research centers that comprise the Ugandan National CAB Network (UNCN). Researchers conducted interviews ( n = 45) with CAB members and research liaisons at each of the sites. While selection practices and demographics varied between the sites, all six CABs exclusively followed a broad community membership model. Results suggest successful CABs are context dependent and thus distinct guidelines may be needed based on variables including CAB funding level, representation model, and research focus.
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Affiliation(s)
- Carlton Lawrence
- 1 Duke University, Durham, NC, USA.,2 Harvard Medical School, Boston, MA, USA
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