1
|
Sharma A, Apte A, Rajappa M, Vaz M, Vaswani V, Goenka S, Malhotra S, Sangoram R, Lakshminarayanan S, Jayaram S, Mathaiyan J, Farseena K, Mukerjee P, Jaswal S, Dongre A, Timms O, Shafiq N, Aggarwal R, Kaur M, Juvekar S, Sekhar A, Kang G. Perceptions about controlled human infection model (CHIM) studies among members of ethics committees of Indian medical institutions: A qualitative exploration. Wellcome Open Res 2023; 7:209. [PMID: 36969719 PMCID: PMC10031138 DOI: 10.12688/wellcomeopenres.17968.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 03/04/2023] Open
Abstract
Introduction: Controlled Human Infection Model (CHIM) studies provide a unique platform for studying the pathophysiology of infectious diseases and accelerated testing of vaccines and drugs in controlled settings. However, ethical issues shroud them as the disease-causing pathogen is intentionally inoculated into healthy consenting volunteers, and effective treatment may or may not be available. We explored the perceptions of the members of institutional ethics committees (IECs) in India about CHIM studies. Methods: This qualitative exploratory study, conducted across seven sites in India, included 11 focused group discussions (FGD) and 31 in-depth interviews (IDI). A flexible approach was used with the aid of a topic guide. The data were thematically analyzed using grounded theory and an inductive approach. Emerging themes and sub-themes were analyzed, and major emergent themes were elucidated. Results: Seventy-two IEC members participated in the study including 21 basic medical scientists, 29 clinicians, 9 lay people, 6 legal experts and 7 social scientists. Three major themes emerged from this analysis—apprehensions about conduct of CHIM studies in India, a perceived need for CHIM studies in India and risk mitigation measures needed to protect research participants and minimize the associated risks. Conclusion: Development of a specific regulatory and ethical framework, training of research staff and ethics committee members, and ensuring specialized research infrastructure along with adequate community sensitization were considered essential before initiation of CHIM studies in India.
Collapse
Affiliation(s)
- Abhishek Sharma
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, 160014, India
| | - Aditi Apte
- KEM Hospital Research Centre, Pune, Maharashtra, 411011, India
| | - Medha Rajappa
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | - Manjulika Vaz
- St John's Medical College, Bengaluru, Karnataka, 560034, India
| | - Vina Vaswani
- Yenepoya University, Mangalore, Karnataka, 575018, India
| | - Shifalika Goenka
- Centre for Chronic Disease Control (CCDC), Delhi, Delhi, 110016, India
| | - Samir Malhotra
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, 160014, India
| | - Rashmi Sangoram
- KEM Hospital Research Centre, Pune, Maharashtra, 411011, India
| | - Subitha Lakshminarayanan
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | - Suganya Jayaram
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | - Jayanthi Mathaiyan
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | | | - Prarthna Mukerjee
- Centre for Chronic Disease Control (CCDC), Delhi, Delhi, 110016, India
| | - Surinder Jaswal
- Tata Institute of Social Sciences, Mumbai, Maharashtra, 400088, India
| | - Amol Dongre
- Pramukhswami Medical College, Karamsad, Gujarat, 388325, India
| | - Olinda Timms
- St John's Medical College, Bengaluru, Karnataka, 560034, India
| | - Nusrat Shafiq
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, 160014, India
| | - Rakesh Aggarwal
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | - Manmeet Kaur
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, 160014, India
| | - Sanjay Juvekar
- KEM Hospital Research Centre, Pune, Maharashtra, 411011, India
| | - Amrita Sekhar
- Translational Health Science and Technology Institute, Faridabad, Haryana, 101213, India
| | - Gagandeep Kang
- Christian Medical College, Vellore, Tamil Nadu, 632004, India
| |
Collapse
|
2
|
Sharma A, Apte A, Rajappa M, Vaz M, Vaswani V, Goenka S, Malhotra S, Sangoram R, Lakshminarayanan S, Jayaram S, Mathaiyan J, Farseena K, Mukerjee P, Jaswal S, Dongre A, Timms O, Shafiq N, Aggarwal R, Kaur M, Juvekar S, Sekhar A, Kang G. Perceptions about controlled human infection model (CHIM) studies among members of ethics committees of Indian medical institutions: A qualitative exploration. Wellcome Open Res 2022; 7:209. [PMID: 36969719 PMCID: PMC10031138 DOI: 10.12688/wellcomeopenres.17968.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: Controlled Human Infection Model (CHIM) studies provide a unique platform for studying the pathophysiology of infectious diseases and accelerated testing of vaccines and drugs in controlled settings. However, ethical issues shroud them as the disease-causing pathogen is intentionally inoculated into healthy consenting volunteers, and effective treatment may or may not be available. We explored the perceptions of the members of institutional ethics committees (IECs) in India about CHIM studies. Methods: This qualitative exploratory study, conducted across seven sites in India, included 11 focused group discussions (FGD) and 31 in-depth interviews (IDI). A flexible approach was used with the aid of a topic guide. The data were thematically analyzed using grounded theory and an inductive approach. Emerging themes and sub-themes were analyzed, and major emergent themes were elucidated. Results: Seventy-two IEC members participated in the study including 21 basic medical scientists, 29 clinicians, 9 lay people, 6 legal experts and 7 social scientists. Three major themes emerged from this analysis—apprehensions about conduct of CHIM studies in India, a perceived need for CHIM studies in India and risk mitigation measures needed to protect research participants and minimize the associated risks. Conclusion: Development of a specific regulatory and ethical framework, training of research staff and ethics committee members, and ensuring specialized research infrastructure along with adequate community sensitization were considered essential before initiation of CHIM studies in India.
Collapse
Affiliation(s)
- Abhishek Sharma
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, 160014, India
| | - Aditi Apte
- KEM Hospital Research Centre, Pune, Maharashtra, 411011, India
| | - Medha Rajappa
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | - Manjulika Vaz
- St John's Medical College, Bengaluru, Karnataka, 560034, India
| | - Vina Vaswani
- Yenepoya University, Mangalore, Karnataka, 575018, India
| | - Shifalika Goenka
- Centre for Chronic Disease Control (CCDC), Delhi, Delhi, 110016, India
| | - Samir Malhotra
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, 160014, India
| | - Rashmi Sangoram
- KEM Hospital Research Centre, Pune, Maharashtra, 411011, India
| | - Subitha Lakshminarayanan
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | - Suganya Jayaram
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | - Jayanthi Mathaiyan
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | | | - Prarthna Mukerjee
- Centre for Chronic Disease Control (CCDC), Delhi, Delhi, 110016, India
| | - Surinder Jaswal
- Tata Institute of Social Sciences, Mumbai, Maharashtra, 400088, India
| | - Amol Dongre
- Pramukhswami Medical College, Karamsad, Gujarat, 388325, India
| | - Olinda Timms
- St John's Medical College, Bengaluru, Karnataka, 560034, India
| | - Nusrat Shafiq
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, 160014, India
| | - Rakesh Aggarwal
- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Puducherry, 605006, India
| | - Manmeet Kaur
- Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, Chandigarh, 160014, India
| | - Sanjay Juvekar
- KEM Hospital Research Centre, Pune, Maharashtra, 411011, India
| | - Amrita Sekhar
- Translational Health Science and Technology Institute, Faridabad, Haryana, 101213, India
| | - Gagandeep Kang
- Christian Medical College, Vellore, Tamil Nadu, 632004, India
| |
Collapse
|
3
|
Egesa M, Ssali A, Tumwesige E, Kizza M, Driciru E, Luboga F, Roestenberg M, Seeley J, Elliott AM. Ethical and practical considerations arising from community consultation on implementing controlled human infection studies using Schistosoma mansoni in Uganda. Glob Bioeth 2022; 33:78-102. [PMID: 35814190 PMCID: PMC9258062 DOI: 10.1080/11287462.2022.2091503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 11/28/2021] [Indexed: 11/21/2022] Open
Abstract
Issues related to controlled human infection studies using Schistosoma mansoni (CHI-S) were explored to ensure the ethical and voluntary participation of potential CHI-S volunteers in an endemic setting in Uganda. We invited volunteers from a fishing community and a tertiary education community to guide the development of informed consent procedures. Consultative group discussions were held to modify educational materials on schistosomiasis, vaccines and the CHI-S model and similar discussions were held with a test group. With both groups, a mock consent process was conducted. Fourteen in-depth key informant interviews and three group discussions were held to explore perceptions towards participating in a CHI-S. Most of the participants had not heard of the CHI-S. Willingness to take part depended on understanding the study procedures and the consenting process. Close social networks were key in deciding to take part. The worry of adverse effects was cited as a possible hindrance to taking part. Volunteer time compensation was unclear for a CHI-S. Potential volunteers in these communities are willing to take part in a CHI-S. Community engagement is needed to build trust and time must be taken to share study procedures and ensure understanding of key messages.
Collapse
Affiliation(s)
- Moses Egesa
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Uganda Virus Research Institute, Entebbe, Uganda
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Agnes Ssali
- Social Aspects of Health Across the Life-Course Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Edward Tumwesige
- Social Aspects of Health Across the Life-Course Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Moses Kizza
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Emmanuella Driciru
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Fiona Luboga
- Uganda Virus Research Institute, Entebbe, Uganda
| | - Meta Roestenberg
- Social Aspects of Health Across the Life-Course Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Janet Seeley
- Social Aspects of Health Across the Life-Course Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Alison M. Elliott
- Immunomodulation and Vaccines Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
4
|
Mumba N, Njuguna P, Chi P, Marsh V, Awuor E, Hamaluba M, Mauncho C, Mwalukore S, Masha J, Mwangoma M, Kalama B, Alphan H, Wambua J, Bejon P, Kamuya D, Kapulu MC. Undertaking Community Engagement for a Controlled Human Malaria Infection Study in Kenya: Approaches and Lessons Learnt. Front Public Health 2022; 10:793913. [PMID: 35570883 PMCID: PMC9099019 DOI: 10.3389/fpubh.2022.793913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/15/2022] [Indexed: 11/13/2022] Open
Abstract
Human infection studies (HIS) involve deliberately infecting healthy volunteers with disease-causing pathogens under controlled conditions. These studies are "controlled" by way of using specific types of pathogens, including dose, and the availability of emergency medical facilities to research volunteers. Most HIS involve diseases whose treatment is known and are done to accelerate the development of novel therapeutics such as vaccines, to address emerging and existing infectious diseases. Traditionally, HIS have been conducted primarily in high-income countries (HICs) but are now increasingly being conducted in low-and-middle income countries (LMICs). In LMICs settings, HIS are likely to raise concerns among various stakeholders including participating populations and regulatory bodies, that are unfamiliar with this type of research. Deliberately infecting a healthy individual with a disease-causing pathogen seems to go against the normal practice of medicine of "do no harm". Such types of studies can give rise to increased rumors and jeopardize research participation in study activities, including non-HIS research. Community engagement can be one approach to address particular issues that HIS studies raise through meaningfully engaging with communities, where views and voices inform the conduct of HIS studies. In addition, engagement can inform the ethical conduct and acceptability of HIS studies in LMICs settings and provide opportunities for sharing information, listening to, and responding to concerns and views from potential participants, and the larger community in which the study would be conducted. Despite community engagement being an important aspect to consider, very few published and gray literature cover the types of approaches that have been used, and lessons learnt in engagement for HIS. This article outlinesthe community engagement approaches that were used to engage stakeholders and communities for malaria HIS-controlled human malaria infection (CHMI), undertaken in Kilifi, Kenya. It outlines the engagement activities across the research cycle, from activities conducted during protocol development, to planning, and implementation of the study. We discuss the challenges experienced, lessons learnt, and provide some recommendations for engagement around HIS.
Collapse
Affiliation(s)
- Noni Mumba
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - Patricia Njuguna
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya.,PATH Centre for Vaccine Innovation and Access, Nairobi, Kenya
| | - Primus Chi
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - Vicki Marsh
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Oxford University, Oxford, United Kingdom
| | - Esther Awuor
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mainga Hamaluba
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Oxford University, Oxford, United Kingdom
| | - Cynthia Mauncho
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - Salim Mwalukore
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - Johnson Masha
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mary Mwangoma
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - Betty Kalama
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - Hassan Alphan
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - Juliana Wambua
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya
| | - Philip Bejon
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Oxford University, Oxford, United Kingdom
| | - Dorcas Kamuya
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Oxford University, Oxford, United Kingdom
| | - Melissa C Kapulu
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, Kilifi, Kenya.,Centre for Tropical Medicine and Global Health, Oxford University, Oxford, United Kingdom
| |
Collapse
|