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Ewuoso C, Berkman B, Wonkam A, de Vries J. Should institutions fund the feedback of individual findings in genomic research? JOURNAL OF MEDICAL ETHICS 2024; 50:569-574. [PMID: 35710317 DOI: 10.1136/medethics-2021-107992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
The article argues the thesis that institutions have a prima facie obligation to fund the feedback of individual findings in genomic research conducted on the African continent by drawing arguments from an underexplored Afro-communitarian view of distributive justice and rights of researchers to be aided. Whilst some studies have explored how institutions have a duty to support return as a form of ancillary care or additional foreseeable service in research by mostly appealing to dominant principles and theories in the Global North, this mostly normative study explores this question by appealing to underexplored African philosophy. This is a new way of thinking about institutional responsibility to fund feedback and responds to the call to decolonise health research in Africa. Further studies are required to study how this prima facie obligation will interact with social contexts and an institution's extant relationships to find an actual duty. The research community should also work out procedures, policies and governance structures to facilitate feedback. In our opinion, though the impacts of feeding back can inform how institutions think about their actual duty, these do not obliterate the binding duty to fund feedback.
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Affiliation(s)
- Cornelius Ewuoso
- Steve Biko Centre for Bioethics, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
| | - Benjamin Berkman
- Department of Bioethics, National Institutes of Health, Bethesda, Maryland, USA
| | - Ambroise Wonkam
- Division of Human Genetics, University of Cape Town, Cape Town, South Africa
- McKusick-Nathans Institute and Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jantina de Vries
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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Musvipwa F, Wonkam A, Berkman B, de Vries J. Perspectives of researchers, science policy makers and research ethics committee members on the feedback of individual genetic research findings in African genomics research. BMC Med Ethics 2024; 25:67. [PMID: 38849807 PMCID: PMC11157929 DOI: 10.1186/s12910-024-01068-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 09/07/2023] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Genetic research can yield information that is unrelated to the study's objectives but may be of clinical or personal interest to study participants. There is an emerging but controversial responsibility to return some genetic research results, however there is little evidence available about the views of genomic researchers and others on the African continent. METHODS We conducted a continental survey to solicit perspectives of researchers, science policy makers and research ethics committee members on the feedback of individual genetic research findings in African genomics research. RESULTS A total of 110 persons participated in the survey with 51 complete and 59 incomplete surveys received. Data was summarised using descriptive analysis. Overall, our respondents believed that individual genetic research results that are clinically actionable should be returned to study participants apparently because participants have a right to know things about their health, and it might also be a means for research participation to be recognized. Nonetheless, there is a need for development of precise guidance on how to return individual genetic research findings in African genomics research. DISCUSSION Participants should receive information that could promote a healthier lifestyle; only clinically actionable findings should be returned, and participants should receive all important information that is directly relevant to their health. Nevertheless, detailed guidelines should inform what ought to be returned. H3Africa guidelines stipulate that it is generally considered good practice for researchers to feedback general study results, but there is no consensus about whether individual genomic study results should also be fed back. The decision on what individual results to feedback, if any, is very challenging and the specific context is important to make an appropriate determination.
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Affiliation(s)
- Faith Musvipwa
- Department of Medicine, University of Cape Town, Cape Town, South Africa.
- Ethics Lab Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
| | - Ambroise Wonkam
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Johns Hopkins Department of Genetic Medicine, Baltimore, USA
| | - Benjamin Berkman
- NIH Department of Bioethics, Department of Bioethics Bethesda, Bethesda, USA
| | - Jantina de Vries
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Ethics Lab Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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3
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Ochieng J, Kwagala B, Barugahare J, Möller M, Moodley K. Awareness, experiences and perceptions regarding genetic testing and the return of genetic and genomics results in a hypothetical research context among patients in Uganda: a qualitative study. JOURNAL OF MEDICAL ETHICS 2024:jme-2022-108885. [PMID: 38290855 DOI: 10.1136/jme-2022-108885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/18/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND Genetic testing presents unique ethical challenges for research and clinical practice, particularly in low-resource settings. To address such challenges, context-specific understanding of ethical, legal and social issues is essential. Return of genetics and genomics research (GGR) results remains an unresolved yet topical issue particularly in African settings that lack appropriate regulation and guidelines. Despite the need to understand what is contextually acceptable, there is a paucity of empirical research and literature on what constitutes appropriate practice with respect to GGR.The study assessed patients' awareness, experiences and perceptions regarding genetic testing and the return of GGR results in a hypothetical context. METHODS This cross-sectional study employed a qualitative exploratory approach. Respondents were patients attending the medical outpatient unit of Mulago National Hospital. Three deliberative focus group discussions involving 18 respondents were conducted. Data were analysed through thematic analysis. RESULTS Three main themes and several subthemes were identified. Most respondents were aware of genetic testing, supportive of GGR and receiving results. However, only a few had undergone genetic testing due to cost constraints. They articulated the need for adequate information and genetic counselling to inform decision-making. Privacy of results was important to respondents while others were willing to share results. CONCLUSION There was general awareness and support for GGR and the return of results. Stigmatisation emerged as a barrier to disclosure of results for some. Global health inequity impacts access and affordability of genetic testing and counselling in Africa and should be addressed as a matter of social justice.
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Affiliation(s)
- Joseph Ochieng
- Anatomy, Makerere University College of Health Sciences, Kampala, Uganda
- Division of Medical Ethics and Law, University of Stellenbosch, Division of Medical Ethics and Law, Cape Town, South Africa
| | - Betty Kwagala
- Population Studies, Makerere University College of Business and Management Sciences, Kampala, Uganda
| | - John Barugahare
- Philosophy, Makerere University College of Humanities and Social Sciences, Kampala, Uganda
| | - Marlo Möller
- DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Keymanthri Moodley
- Centre for Medical Ethics and Law, University of Stellenbosch, Stellenbosch, Western Cape, South Africa
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MacDonald KR, Enane LA, McHenry MS, Davis NL, Whipple EC, Ott MA. Ethical Aspects of Involving Adolescents in HIV Research: A Systematic Review of the Empiric Literature. J Pediatr 2023; 262:113589. [PMID: 37399918 PMCID: PMC11119419 DOI: 10.1016/j.jpeds.2023.113589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To evaluate the ethics of involving adolescents in HIV research, we conducted a systematic review of the empiric literature. METHODS Electronic databases Ovid Medline, Embase, and CINAHL were systematically searched using controlled vocabulary terms related to ethics, HIV, specified age groups, and empiric research studies. We reviewed titles and abstracts, including studies that collected qualitative or quantitative data, evaluated ethical issues in HIV research, and included adolescents. Studies were appraised for quality, data were extracted, and studies were analyzed using narrative synthesis. RESULTS We included 41 studies: 24 qualitative, 11 quantitative, 6 mixed methods; 22 from high-income countries (HIC), 18 from low- or middle-income countries (LMIC), and 1 from both HIC and LMIC. Adolescent, parent, and community perspectives assert the benefits of involving minors in HIV research. Participants in LMIC expressed mixed views regarding parental consent requirements and confidentiality, given adolescents' both increasing autonomy and continued need for adult support. In studies in HIC, sexual or gender minority youth would not participate in research if parental consent were required or if there were confidentiality concerns. There was variation in the comprehension of research concepts, but adolescents generally demonstrated good comprehension of informed consent. Informed consent processes can be improved to increase comprehension and study accessibility. Vulnerable participants face complex social barriers that should be considered in study design. CONCLUSIONS Data support the inclusion of adolescents in HIV research. Empiric research can inform consent processes and procedural safeguards to ensure appropriate access.
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Affiliation(s)
- Katherine R MacDonald
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - Leslie A Enane
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN
| | - Megan S McHenry
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN
| | - Neilkant L Davis
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Elizabeth C Whipple
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN
| | - Mary A Ott
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN
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Nabukenya S, Waitt C, Senyonga R, Castelnuovo B, Munabi IG, Kyaddondo D, Mwaka ES. Research Participants' Preferences for Individual Results of Pharmacogenomics Research: A Case of a Ugandan HIV Research Institute. J Empir Res Hum Res Ethics 2023; 18:218-232. [PMID: 37448227 PMCID: PMC10648306 DOI: 10.1177/15562646231187434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
Little is known about whether people living with HIV would like to receive their results from pharmacogenomics research. This study explored the factors influencing participants' preferences and the reasons for their desire to receive individual results from pharmacogenomics research. We employed a convergent parallel mixed methods study design comprising a survey of 225 research participants and 5 deliberative focus group discussions with 30 purposively selected research participants. Almost all (98%) participants wanted to receive individual pharmacogenomics research results. Reasons for the desire to receive results were reciprocity for valuable time and effort, preparing for future eventualities, and the right to information about their health. Overall, participants desire to receive feedback from pharmacogenomics research, particularly if results are well established and clinically actionable.
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Affiliation(s)
- Sylvia Nabukenya
- Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Institute, Kampala, Uganda
| | - Catriona Waitt
- Infectious Diseases Institute, Kampala, Uganda
- University of Liverpool, Liverpool, UK
| | - Ronald Senyonga
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - David Kyaddondo
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Erisa S. Mwaka
- Makerere University College of Health Sciences, Kampala, Uganda
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6
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Wolf SM, Green RC. Return of Results in Genomic Research Using Large-Scale or Whole Genome Sequencing: Toward a New Normal. Annu Rev Genomics Hum Genet 2023; 24:393-414. [PMID: 36913714 PMCID: PMC10497726 DOI: 10.1146/annurev-genom-101122-103209] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Genome sequencing is increasingly used in research and integrated into clinical care. In the research domain, large-scale analyses, including whole genome sequencing with variant interpretation and curation, virtually guarantee identification of variants that are pathogenic or likely pathogenic and actionable. Multiple guidelines recommend that findings associated with actionable conditions be offered to research participants in order to demonstrate respect for autonomy, reciprocity, and participant interests in health and privacy. Some recommendations go further and support offering a wider range of findings, including those that are not immediately actionable. In addition, entities covered by the US Health Insurance Portability and Accountability Act (HIPAA) may be required to provide a participant's raw genomic data on request. Despite these widely endorsed guidelines and requirements, the implementation of return of genomic results and data by researchers remains uneven. This article analyzes the ethical and legal foundations for researcher duties to offer adult participants their interpreted results and raw data as the new normal in genomic research.
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Affiliation(s)
- Susan M Wolf
- Law School and Medical School, University of Minnesota, Minneapolis, Minnesota, USA;
| | - Robert C Green
- Genomes2People Research Program, Harvard Medical School, Mass General Brigham, Broad Institute, and Ariadne Labs, Boston, Massachusetts, USA;
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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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8
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Ewuoso C, Wonkam A, de Vries J. Epistemic justice, African values and feedback of findings in African genomics research. Glob Bioeth 2022; 33:122-132. [PMID: 36185769 PMCID: PMC9518233 DOI: 10.1080/11287462.2022.2124019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This article draws on key normative principles grounded in important values – solidarity, partiality and friendliness – in African philosophy to think critically and deeply about the ethical challenges around returning individual genetic research findings in African genomics research. Precisely, we propose that the normative implication of solidarity, partiality and friendliness is that returning findings should be considered as a gesture of goodwill to participants to the extent that it constitutes acting for their well-being. Concretely, the value of friendliness may imply that one ought to return actionable results to participants even when their preferences regarding feedback are unknown. Notwithstanding, returning individual genetic results will have a cost implication. The cost of feeding back is relevant in the context of African genomics research projects, which are often funded by international sponsors and should be researched further.
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Affiliation(s)
- Cornelius Ewuoso
- Steve Biko Centre for Bioethics, University of Witwatersrand, Johannesburg, South Africa
| | - Ambroise Wonkam
- Division of Human Genetics, University of Cape Town, Cape Town, South Africa
- McKusick-Nathans Institute and Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jantina de Vries
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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9
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Ochieng J, Kwagala B, Barugahare J, Möller M, Moodley K. Feedback of individual genetic and genomics research results: A qualitative study involving grassroots communities in Uganda. PLoS One 2022; 17:e0267375. [PMID: 36399445 PMCID: PMC9674126 DOI: 10.1371/journal.pone.0267375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 10/10/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Genetics and genomics research (GGR) is associated with several challenges including, but not limited to, methods and implications of sharing research findings with participants and their family members, issues of confidentiality, and ownership of data obtained from samples. Additionally, GGR holds significant potential risk for social and psychological harms. Considerable research has been conducted globally, and has advanced the debate on return of genetic and genomics testing results. However, such investigations are limited in the African setting, including Uganda where research ethics guidance on return of results is deficient or suboptimal at best. The objective of this study was to assess perceptions of grassroots communities on if and how feedback of individual genetics and genomics testing results should occur in Uganda with a view to improving ethics guidance. METHODS This was a cross-sectional study that employed a qualitative exploratory approach. Five deliberative focus group discussions (FGDs) were conducted with 42 participants from grassroots communities representing three major ethnic groupings. These were rural settings and the majority of participants were subsistence farmers with limited or no exposure to GGR. Data were analysed through thematic analysis, with both deductive and inductive approaches applied to interrogate predetermined themes and to identify any emerging themes. NVivo software (QSR international 2020) was used to support data analysis and illustrative quotes were extracted. RESULTS All the respondents were willing to participate in GGR and receive feedback of results conditional upon a health benefit. The main motivation was diagnostic and therapeutic benefits as well as facilitating future health planning. Thematic analysis identified four themes and several sub-themes including 1) the need-to-know health status 2) paternity information as a benefit and risk; 3) ethical considerations for feedback of findings and 4) extending feedback of genetics findings to family and community. CONCLUSION Participation in hypothetical GGR as well as feedback of results is acceptable to individuals in grassroots communities. However, the strong therapeutic and/or diagnostic misconception linked to GGR is concerning given that hopes for therapeutic and/or diagnostic benefit are unfounded. Viewing GGR as an opportunity to confirm or dispute paternity was another interesting perception. These findings carry profound implications for consent processes, genetic counselling and research ethics guidance. Privacy and confidentiality, benefits, risks as well as implications for sharing need to be considered for such feedback of results to be conducted appropriately.
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Affiliation(s)
- Joseph Ochieng
- Makerere University School of Biomedical Sciences, Kampala, Uganda
- Centre for Medical Ethics and Law, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Betty Kwagala
- Makerere University School of Statistics and Planning, Kampala, Uganda
| | | | - Marlo Möller
- Division of Molecular Biology and Human Genetics, DSI-NRF Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Keymanthri Moodley
- Centre for Medical Ethics and Law, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
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10
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Simwinga M, Ndubani R, Schaap A, Ziba D, Bwalya C, Belemu S, Ngwenya F, Bwalya J, Shanaube K, Hoddinott G, White R, Bock P, Fidler S, Hayes R, Seeley J, Ayles H, Bond V. Disseminating complex primary outcome results from a community-randomised trial to Zambian communities: lessons learned using a community dialogue approach in the HPTN 071 (PopART) trial. Lancet HIV 2022; 9:e801-e808. [PMID: 36191598 PMCID: PMC10577308 DOI: 10.1016/s2352-3018(22)00226-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 08/09/2022] [Accepted: 08/10/2022] [Indexed: 10/14/2022]
Abstract
The HPTN 071 (PopART) trial of universal HIV testing and treatment to reduce HIV incidence was conducted in nine communities in South Africa and 12 in Zambia. The trial's primary outcome results were complicated to explain. Dissemination of these complicated results in participating communities in Zambia was done using a community dialogue approach. The approach, which involved interactive activities and a gradual and systematic approach to discussion of results in each community, facilitated respect and inclusion of participants in the dissemination process. The use of local language, pictures, images, and familiar analogies enhanced comprehension of the findings and created a two-way communication process between researchers and participants. The dialogue approach enabled both groups to use community perspectives, lived experiences, and local socio-structural features to interpret the trial results. Further, community members reflected on what the results meant to them individually and collectively. Although this community dialogue was both productive and appreciated, making this community interpretation apparent across disciplines in key quantitative scientific outputs remained a challenge.
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Affiliation(s)
| | | | - Albertus Schaap
- Zambart, Lusaka, Zambia; Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene &Tropical Medicine, London, UK
| | | | | | | | | | | | | | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | | | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Sarah Fidler
- Department of Infectious Disease, Imperial College London, London, UK
| | - Richard Hayes
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene &Tropical Medicine, London, UK
| | - Janet Seeley
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene &Tropical Medicine, London, UK
| | - Helen Ayles
- Zambart, Lusaka, Zambia; Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene &Tropical Medicine, London, UK
| | - Virginia Bond
- Zambart, Lusaka, Zambia; Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene &Tropical Medicine, London, UK
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11
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Ochieng J, Kwagala B, Barugahare J, Mwaka E, Ekusai-Sebatta D, Ali J, Sewankambo NK. Perspectives and experiences of researchers regarding feedback of incidental genomic research findings: A qualitative study. PLoS One 2022; 17:e0273657. [PMID: 36037169 PMCID: PMC9423610 DOI: 10.1371/journal.pone.0273657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 08/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background
There is a plethora of unanswered ethical questions about sharing incidental findings in genetics and genomics research. Yet understanding and addressing such issues is necessary for communicating incidental findings with participants. We explored researchers’ perspectives and experiences regarding feedback of incidental genomics findings to participants.
Methods
This was a qualitative study using semi-structured interview schedules for In-depth interviews. Thirty respondents were purposively selected based on role as genetics and genomics researchers in Uganda. Data were analysed through content analysis to identify emerging themes using a comprehensive thematic matrix. QSR International NVivo software was used to support data analysis.
Results
a). On perceptions, sharing of incidental findings was acceptable and four themes emerged including role of professional judgement; role of ethics committees and ethical guidelines; optimal disclosure practices; limits to professional duty and uncertainty and; b). on practices, sharing had been carried out by some researchers and a theme on experience and practices emerged.
Conclusion
Feedback of incidental genomics research findings to participants is generally acceptable to researchers. Some researchers. Challenges include lack of ethical guidelines and uncertainty about the findings.
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Affiliation(s)
- Joseph Ochieng
- Makerere University School of Biomedical Sciences, Kampala, Uganda
- * E-mail:
| | - Betty Kwagala
- Makerere University School of Business and Management Studies, Kampala, Uganda
| | - John Barugahare
- Makerere University School of Liberal and Performing Arts, Kampala, Uganda
| | - Erisa Mwaka
- Makerere University School of Biomedical Sciences, Kampala, Uganda
| | | | - Joseph Ali
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, United States of America
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12
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Ewuoso C, Obengo T, Atuire C. Solidarity, Afro-communitarianism, and COVID-19 vaccination. J Glob Health 2022; 12:03046. [PMID: 35938906 PMCID: PMC9360628 DOI: 10.7189/jogh.12.03046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Cornelius Ewuoso
- Steve Biko Centre for Bioethics, University of Witwatersrand, Johannesburg, South Africa
| | - Tom Obengo
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Caesar Atuire
- Department of Philosophy and Classics, University of Ghana, Accra, Ghana.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
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13
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Wonkam A, Munung NS, Dandara C, Esoh KK, Hanchard NA, Landoure G. Five Priorities of African Genomics Research: The Next Frontier. Annu Rev Genomics Hum Genet 2022; 23:499-521. [PMID: 35576571 DOI: 10.1146/annurev-genom-111521-102452] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To embrace the prospects of accurately diagnosing thousands of monogenic conditions, predicting disease risks for complex traits or diseases, tailoring treatment to individuals' pharmacogenetic profiles, and potentially curing some diseases, research into African genomic variation is a scientific imperative. African genomes harbor millions of uncaptured variants accumulated over 300,000 years of modern humans' evolutionary history, with successive waves of admixture, migration, and natural selection combining with extensive ecological diversity to create a broad and exceptional genomic complexity. Harnessing African genomic complexity, therefore, will require sustained commitment and equitable collaboration from the scientific community and funding agencies. African governments must support academic public research and industrial partnerships that build the necessary genetic medicine workforce, utilize the emerging genomic big data to develop expertise in computer science and bioinformatics, and evolve national and global governance frameworks that recognize the ethical implications of data-driven genomic research and empower its application in African social, cultural, economic, and religious contexts. Expected final online publication date for the Annual Review of Genomics and Human Genetics, Volume 23 is October 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Ambroise Wonkam
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; , , .,Current affiliation: McKusick-Nathans Institute of Genetic Medicine and Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA;
| | - Nchangwi S Munung
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; , ,
| | - Collet Dandara
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; , ,
| | - Kevin K Esoh
- Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; , ,
| | - Neil A Hanchard
- Center for Precision Health Research, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA;
| | - Guida Landoure
- Faculty of Medicine and Odontostomatology, University of Sciences, Techniques, and Technology of Bamako, Bamako, Mali;
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14
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Return of genomic results does not motivate intent to participate in research for all: Perspectives across 22 countries. Genet Med 2022; 24:1120-1129. [PMID: 35125311 DOI: 10.1016/j.gim.2022.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/23/2021] [Accepted: 01/03/2022] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The aim of this study was to determine how attitudes toward the return of genomic research results vary internationally. METHODS We analyzed the "Your DNA, Your Say" online survey of public perspectives on genomic data sharing including responses from 36,268 individuals across 22 low-, middle-, and high-income countries, and these were gathered in 15 languages. We analyzed how participants responded when asked whether return of results (RoR) would motivate their decision to donate DNA or health data. We examined variation across the study countries and compared the responses of participants from other countries with those from the United States, which has been the subject of the majority of research on return of genomic results to date. RESULTS There was substantial variation in the extent to which respondents reported being influenced by RoR. However, only respondents from Russia were more influenced than those from the United States, and respondents from 20 countries had lower odds of being partially or wholly influenced than those from the United States. CONCLUSION There is substantial international variation in the extent to which the RoR may motivate people's intent to donate DNA or health data. The United States may not be a clear indicator of global attitudes. Participants' preferences for return of genomic results globally should be considered.
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15
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Adigun M, Ojebuyi B, Akinyemi J, Wahab K, Akpalu A, Sarfo FS, Owolabi LF, Musbahu R, Bello A, Obiako R, Ogunronbi M, Nichols M, Jenkins C, Jegede A, Kalaria R, Owolabi M, Ovbiagele B, Arulogun O, Akinyemi R. Symbolic Legislation and the Regulation of Stroke Biobanking and Genomics Research in Sub-Saharan Africa. THE THEORY AND PRACTICE OF LEGISLATION 2022; 9:404-424. [PMID: 35198212 PMCID: PMC8863338 DOI: 10.1080/20508840.2022.2025741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Stroke is a major cause of death in Sub-Saharan Africa (SSA) and genetic factors appear to play a part. This led to the development of stroke bio-banking and genomics research in SSA. Existing stroke studies have focused on causes, incidence rates, fatalities and effects. However, scant attention has been paid to the legal issues about stroke bio-banking and genomics research in the sub-region. Therefore, this article examines how genomics research and stroke bio-banking in SSA can be regulated through legislation. The article reports that there are germane issues to be addressed such as appropriate consent model, commercial use of biological samples, ownership right in biological samples and return of research results but that the position of the law on these issues is not satisfactory because there are no statute directly regulating them while existing regulations in these countries are either absent, outdated, conservative or difficult to navigate. The article therefore applies the theory of symbolic legislation and argues for legislative intervention through positive symbolic approach. It recommends that the statute to be enacted should only address policy issues by way of legal rules without being detailed while the understanding of the rules should be fostered in explanatory notes. The explanatory notes should contain examples borne of decided cases, cases settled out of court and the ethical guidelines prepared by Human Heredity and Health in Africa (H3 Africa). Where they are inadequate, recourse may be had to other ethical guidelines subject to the demands of local circumstances.
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Affiliation(s)
- Muyiwa Adigun
- Department of Public Law, Faculty of Law, University of Ibadan, Ibadan, Nigeria
| | - Babatunde Ojebuyi
- Department of Communication and Language Arts, Faculty of Arts, University of Ibadan, Ibadan, Nigeria
| | - Joshua Akinyemi
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Nigeria
| | - Kolawole Wahab
- Neurology Unit, Department of Medicine, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Albert Akpalu
- University of Ghana Medical School, CHS, Accra, Ghana
| | - Fred S. Sarfo
- Neurology Unit, Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Lukman F. Owolabi
- Neurology Unit, Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Rabiu Musbahu
- Neurology Unit, Department of Medicine, Bayero University/Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Abiodun Bello
- Neurology Unit, Department of Medicine, University of Ilorin/University of Ilorin Teaching Hospital, Ilorin, Nigeria
| | - Reginald Obiako
- Neurology Unit, Department of Medicine, Ahmadu Bello University Teaching Hospital, Shika, Zaria, Nigeria
| | - Mayowa Ogunronbi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Michelle Nichols
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Carolyn Jenkins
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Ayodele Jegede
- Department of Sociology, Faculty of The Social Sciences, University of Ibadan, Ibadan, Nigeria
| | - Rajesh Kalaria
- Neurovascular Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Mayowa Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bruce Ovbiagele
- Department of Neurology, University of California San Francisco, San Francisco, CA, United States
| | - Oyedunni Arulogun
- Department of Health Promotion and Education, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Rufus Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
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16
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Matimba A, Ali S, Littler K, Madden E, Marshall P, McCurdy S, Nembaware V, Rodriguez L, Seeley J, Tindana P, Yakubu A, de Vries J. Guideline for feedback of individual genetic research findings for genomics research in Africa. BMJ Glob Health 2022; 7:e007184. [PMID: 35017180 PMCID: PMC8753388 DOI: 10.1136/bmjgh-2021-007184] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/08/2021] [Indexed: 12/25/2022] Open
Abstract
As human genomics research in Africa continues to generate large amounts of data, ethical issues arise regarding how actionable genetic information is shared with research participants. The Human Heredity and Health in Africa Consortium (H3Africa) Ethics and Community Engagement Working group acknowledged the need for such guidance, identified key issues and principles relevant to genomics research in Africa and developed a practical guideline for consideration of feeding back individual genetic results of health importance in African research projects. This included a decision flowchart, providing a logical framework to assist in decision-making and planning for human genomics research projects. Although presented in the context of the H3Africa Consortium, we believe the principles described, and the decision flowchart presented here is applicable more broadly in African genomics research.
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Affiliation(s)
- Alice Matimba
- Wellcome Connecting Science, Wellcome Genome Campus, Hinxton, UK
| | - Stuart Ali
- Akili Labs (Pty) Ltd, Johannesburg, South Africa
| | - Katherine Littler
- Health Ethics & Governance Unit, World Health Organization, Geneve, Switzerland
| | - Ebony Madden
- National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
| | - Patricia Marshall
- Department of Bioethics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sheryl McCurdy
- Center for Health Promotion and Prevention Research, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Victoria Nembaware
- Division of Human Genetics, Deparment of Pathology, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Laura Rodriguez
- National Human Genome Research Institute, NIH, Bethesda, Maryland, USA
| | - Janet Seeley
- Department of Global Health & Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Paulina Tindana
- School of Public Health, University of Ghana, Legon, Greater Accra, Ghana
| | - Aminu Yakubu
- Center for Bioethics and Research, Ibadan, Oyo, Nigeria
- National Health Research Ethics Committee, Federal Ministry of Health, Nigeria, Nigeria
- 54gene, Nigeria, Nigeria
| | - Jantina de Vries
- Department of Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
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17
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Matshabane OP, De Vries J. Social and Epistemic Justice: Are We Really Including Africa in the Bioethics Discourse? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2022; 22:30-32. [PMID: 34962195 PMCID: PMC9728488 DOI: 10.1080/15265161.2021.2001107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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18
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Ochieng J, Kwagala B, Barugahare J, Mwaka E, Ekusai-Sebatta D, Ali J, Sewankambo NK. Perspectives and ethical considerations for return of genetics and genomics research results: a qualitative study of genomics researchers in Uganda. BMC Med Ethics 2021; 22:154. [PMID: 34798900 PMCID: PMC8603565 DOI: 10.1186/s12910-021-00724-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The return of genetics and genomics research results has been a subject of ongoing global debate. Such feedback is ethically desirable to update participants on research findings particularly those deemed clinically significant. Although there is limited literature, debate continues in African on what constitutes appropriate practice regarding the return of results for genetics and genomics research. This study explored perspectives and ethical considerations of Ugandan genomics researchers regarding the return of genetics and genomics research results. METHODS This was a qualitative study that employed in-depth interviews. Thirty participants were purposively selected based on their expertise as genomics researchers in Uganda. Data were analysed through content analysis along the main themes of the study using a comprehensive thematic matrix, to identify common patterns arising from the narratives. NVivo software 12 was used to support data analysis. RESULTS The return of genetics and genomics research results was generally acceptable to researchers, and some indicated that they had previously returned individual or aggregate results to participants and communities. The main reasons cited for sharing research results with participants included their clinical utility, actionability and overall benefit to society. Ethical considerations for appropriate return of results included a need for effective community engagement, genetic counselling prior to disclosure of the results, adequate informed consent, and proper assessment of the implications of, or consequences of returning of results. However, the approaches to return of results were perceived as unstandardized due to the lack of appropriate regulatory frameworks. CONCLUSIONS The return of genetic and genomic research results is generally acceptable to researchers despite the lack of appropriate regulatory frameworks. Ethical considerations for return of genetics and genomics research results are highly divergent, hence the need for national ethical guidelines to appropriately regulate the practice.
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Affiliation(s)
- Joseph Ochieng
- Department of Anatomy, College of Health Sciences, School of Biomedical Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
| | - Betty Kwagala
- School of Business and Management Studies, Makerere University, Kampala, Uganda
| | | | - Erisa Mwaka
- Department of Anatomy, College of Health Sciences, School of Biomedical Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Deborah Ekusai-Sebatta
- Department of Anatomy, College of Health Sciences, School of Biomedical Sciences, Makerere University, P.O Box 7072, Kampala, Uganda
| | - Joseph Ali
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Johns Hopkins Berman Institute of Bioethics, Baltimore, USA
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19
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Return of individual research results from genomic research: A systematic review of stakeholder perspectives. PLoS One 2021; 16:e0258646. [PMID: 34748551 PMCID: PMC8575249 DOI: 10.1371/journal.pone.0258646] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 10/02/2021] [Indexed: 12/19/2022] Open
Abstract
Despite the plethora of empirical studies conducted to date, debate continues about whether and to what extent results should be returned to participants of genomic research. We aimed to systematically review the empirical literature exploring stakeholders’ perspectives on return of individual research results (IRR) from genomic research. We examined preferences for receiving or willingness to return IRR, and experiences with either receiving or returning them. The systematic searches were conducted across five major databases in August 2018 and repeated in April 2020, and included studies reporting findings from primary research regardless of method (quantitative, qualitative, mixed). Articles that related to the clinical setting were excluded. Our search identified 221 articles that met our search criteria. This included 118 quantitative, 69 qualitative and 34 mixed methods studies. These articles included a total number of 118,874 stakeholders with research participants (85,270/72%) and members of the general public (40,967/35%) being the largest groups represented. The articles spanned at least 22 different countries with most (144/65%) being from the USA. Most (76%) discussed clinical research projects, rather than biobanks. More than half (58%) gauged views that were hypothetical. We found overwhelming evidence of high interest in return of IRR from potential and actual genomic research participants. There is also a general willingness to provide such results by researchers and health professionals, although they tend to adopt a more cautious stance. While all results are desired to some degree, those that have the potential to change clinical management are generally prioritized by all stakeholders. Professional stakeholders appear more willing to return results that are reliable and clinically relevant than those that are less reliable and lack clinical relevance. The lack of evidence for significant enduring psychological harm and the clear benefits to some research participants suggest that researchers should be returning actionable IRRs to participants.
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20
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Ralefala D, Kasule M, Matshabane OP, Wonkam A, Matshaba M, de Vries J. Participants' Preferences and Reasons for Wanting Feedback of Individual Genetic Research Results From an HIV-TB Genomic Study: A Case Study From Botswana. J Empir Res Hum Res Ethics 2021; 16:525-536. [PMID: 34662218 PMCID: PMC8642165 DOI: 10.1177/15562646211043985] [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
The feedback of individual results of genomics research is an ethical issue. However, which genetic results African participants would like to receive and why, remains unclear. A qualitative study was conducted to collect data from 44 adolescents and 49 parents/caregivers of adolescents enrolled in a genomic study in Botswana. Almost all the participants wanted to receive genetic results. Parents and caregivers wanted to receive results across all categories of genetic conditions discussed in the study, while adolescents were reluctant to receive results for severe, non-preventable, and unactionable conditions. Participants expressed different reasons for wanting feedback of results, including for awareness, improving lifestyle, accepting one' situation, and preparing for the future. Our findings also reveal that participants' context, relations, and empowerment are important to consider in interpreting their preferences for feedback of results.
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Affiliation(s)
- Dimpho Ralefala
- 37716University of Cape Town, Cape Town, South Africa.,54547University of Botswana, Gaborone, Botswana
| | - Mary Kasule
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
| | | | | | - Mogomotsi Matshaba
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana.,3989Baylor College of Medicine, Houston, TX, USA
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21
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Staunton C, Kösters M, Pramstaller PP, Mascalzoni D. Return of research results (RoRR) to the healthy CHRIS cohort: designing a policy with the participants. J Community Genet 2021; 12:577-592. [PMID: 34241790 PMCID: PMC8554916 DOI: 10.1007/s12687-021-00536-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 06/06/2021] [Indexed: 11/30/2022] Open
Abstract
Legal, financial and organizational challenges and the absence of coherent international guidelines and legal frameworks still discourage many genetic studies to share individual research results with their participants. Studies and institutions deciding to return genetic results will need to design their own study-specific return policy after due consideration of the ethical responsibilities. The Cooperative Health Research in South Tyrol (CHRIS) study, a healthy cohort study, did not foresee the return of individual genomic results during its baseline phase. However, as it was expected that the follow-up phase would generate an increasing amount of reliable genetic results, an update of the return of research results (RoRR) policy became necessary. To inform this revision, an empirical study using mixed methods was developed to investigate the views of CHRIS research participants (20), local general practitioners (3) and the local genetic counselling service (1). During the interviews, three different examples of potential genetic results with a very diverse potential impact on participants were presented: breast cancer, Parkinson disease and Huntington disease. The CHRIS participants also completed a short questionnaire, collecting personal information and asking for a self-evaluation of their knowledge about genetics. This study made it clear that research participants want to make autonomous decisions on the disclosure or non-disclosure of their results. While the motivations for participants' decisions were very diverse, we were able to identify several common criteria that had a strong influence on their choices. Providing information on these factors is crucial to enable participants to make truly informed decisions.
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Affiliation(s)
- Ciara Staunton
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Via Galvani 31, 39100, Bolzano, Italy
- School of Law, Middlesex University, Room WG35, The Burroughs, Hendon, London, NW4 4BT, UK
| | - Maria Kösters
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Via Galvani 31, 39100, Bolzano, Italy
| | - Peter P Pramstaller
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Via Galvani 31, 39100, Bolzano, Italy
- Department of Neurology, Central Hospital, 39100, Bolzano, Italy
| | - Deborah Mascalzoni
- Institute for Biomedicine, Eurac Research, Affiliated Institute of the University of Lübeck, Via Galvani 31, 39100, Bolzano, Italy.
- Department of Public Health and Caring Science, Uppsala University, CRB, P.O. Box 256, 751 05, Uppsala, Sweden.
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22
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Ralefala D, Kasule M, Wonkam A, Matshaba M, de Vries J. Should Feedback of Individual Results be Integrated into the Consent Process in African Genomics? Participants' Views from an HIV-TB Genomics Research Project in Botswana. AJOB Empir Bioeth 2021; 13:48-56. [PMID: 34197280 DOI: 10.1080/23294515.2021.1941414] [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: 10/21/2022]
Abstract
BACKGROUND Whilst informed consent is a key component of considering whether individual genomic research results could or should be fed back to research participants, little is known about the views of African research participants on its role. METHODS We carried out a qualitative study to explore views of adolescents and parents or caregivers regarding informed consent for feedback of individual results from a genomics research project in Botswana. We conducted 24 deliberative focus group discussions with 93 participants (44 adolescents and 49 parents or caregivers) and 12 in-depth interviews (6 adolescents and 6 parents). RESULTS Our findings revealed that most participants would like to be informed about the possibility of discovering individual genetic results during the consent process and that consent be obtained for feedback during the enrollment process. They further expressed that in cases where prior consent to feedback was not obtained, then participants should be re-contacted where life-saving genetic information is discovered. Participants emphasized the need for researchers to ensure that participants' decisions regarding feedback of results are well-informed. Autonomy, transparency, and communication were identified as key values to uphold during the consent process. CONCLUSION In conclusion, obtaining participants' consent for feedback of results is important to ensure that their rights and wellbeing are protected in research. This is critical in building trust relationships between participants and researchers.
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Affiliation(s)
- Dimpho Ralefala
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Office of Research and Development, University of Botswana, Gaborone, Botswana
| | - Mary Kasule
- Botswana-Baylor Children's Clinical Centre of Excellence, Gaborone, Botswana
| | - Ambroise Wonkam
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Deputy Dean's Office, 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, Texas, USA
| | - Jantina de Vries
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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