1
|
Khirikoekkong N, Asarath SA, Nosten S, Hanboonkunupakarn B, Jatupornpimol N, Roest J, Parker M, Nosten F, McGready R, Cheah PY, Kelley M. Culturally responsive research ethics: How the socio-ethical norms of Arr-nar/Kreng-jai inform research participation at the Thai-Myanmar border. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001875. [PMID: 37141207 PMCID: PMC10159138 DOI: 10.1371/journal.pgph.0001875] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 04/12/2023] [Indexed: 05/05/2023]
Abstract
Despite advances, international research ethics guidelines still tend to consist of high-level ethical principles reflecting residual influence from North American and European traditions of ethics. Local ethics committees and community advisory boards can offer more culturally-sensitive approaches to training but most institutions lack substantive practical ethics guidance to engage rich moral understandings in day-to-day research practice in diverse cultural contexts. To address this gap, we conducted an international series of qualitative research ethics case studies, linked prospectively to active research programs in diverse settings. Here, we share findings from two case studies with a research team working on malaria and hepatitis B prevention with pregnant women in clinics serving migrants along the Thai-Myanmar border. In this sociocultural ethical analysis, we consider how core ethical requirements of voluntary participation, provision of fair benefits, and understandings of research risks and burdens are shaped, enriched, and in some instances challenged, by deep-seated and widespread Burmese, Karen and Thai cultural norms known as Arr-nar (in Burmese and Karen) or Kreng-jai (in Thai), encompassing multiple meanings including consideration for others and graciousness. We offer a model illustrating how one might map ethically significant sociocultural influences across the research practice pathway and close with lessons for developing a more culturally responsive research ethics practice in other international settings.
Collapse
Affiliation(s)
- Napat Khirikoekkong
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Supa-At Asarath
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Suphak Nosten
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Borimas Hanboonkunupakarn
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nattapat Jatupornpimol
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Jennifer Roest
- Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Michael Parker
- Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Francois Nosten
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Rose McGready
- Shoklo Malaria Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Centre for Tropical Medicine & Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Maureen Kelley
- Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
2
|
Harper A, Pratt B. Combatting neo-Colonialism in Health Research: What can Aboriginal Health Research Ethics and Global Health Research Ethics Teach Each Other? J Empir Res Hum Res Ethics 2022; 17:431-454. [PMID: 34931853 DOI: 10.1177/15562646211058253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The ethics of research involving Aboriginal populations and low and middle-income country populations each developed out of a long history of exploitative research projects and partnerships. Commonalities and differences between the two fields have not yet been examined. This study undertook two independent literature searches for Aboriginal health research ethics and global health research ethics. Content analysis identified shared and differently emphasised ethical principles and concepts between the two fields. Shared ethical concepts like "benefit" and "capacity development" have been developed to guide collaborations in both Aboriginal health research and global health research. However, Aboriginal health research ethics gives much greater prominence to ethical principles that assist in decolonising research practice such as "self-determination", "community-control", and "community ownership". The paper argues that global health research ethics would benefit from giving greater emphasis to these principles to guide research practice, while justice as approached in global health research ethics may inform Aboriginal health research practice. With increasing attention being drawn to the need to decolonise global health research, the lessons Aboriginal health research ethics can offer may be especially timely.
Collapse
Affiliation(s)
- Adrian Harper
- School of Population and Global Health, University of Melbourne, Australia
| | - Bridget Pratt
- School of Population and Global Health, University of Melbourne, Australia
- Queensland Bioethics Centre, 1513Australian Catholic University, Australia
| |
Collapse
|
3
|
Choy RKM, Bourgeois AL, Ockenhouse CF, Walker RI, Sheets RL, Flores J. Controlled Human Infection Models To Accelerate Vaccine Development. Clin Microbiol Rev 2022; 35:e0000821. [PMID: 35862754 PMCID: PMC9491212 DOI: 10.1128/cmr.00008-21] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The timelines for developing vaccines against infectious diseases are lengthy, and often vaccines that reach the stage of large phase 3 field trials fail to provide the desired level of protective efficacy. The application of controlled human challenge models of infection and disease at the appropriate stages of development could accelerate development of candidate vaccines and, in fact, has done so successfully in some limited cases. Human challenge models could potentially be used to gather critical information on pathogenesis, inform strain selection for vaccines, explore cross-protective immunity, identify immune correlates of protection and mechanisms of protection induced by infection or evoked by candidate vaccines, guide decisions on appropriate trial endpoints, and evaluate vaccine efficacy. We prepared this report to motivate fellow scientists to exploit the potential capacity of controlled human challenge experiments to advance vaccine development. In this review, we considered available challenge models for 17 infectious diseases in the context of the public health importance of each disease, the diversity and pathogenesis of the causative organisms, the vaccine candidates under development, and each model's capacity to evaluate them and identify correlates of protective immunity. Our broad assessment indicated that human challenge models have not yet reached their full potential to support the development of vaccines against infectious diseases. On the basis of our review, however, we believe that describing an ideal challenge model is possible, as is further developing existing and future challenge models.
Collapse
Affiliation(s)
- Robert K. M. Choy
- PATH, Center for Vaccine Innovation and Access, Seattle, Washington, USA
| | - A. Louis Bourgeois
- PATH, Center for Vaccine Innovation and Access, Seattle, Washington, USA
| | | | - Richard I. Walker
- PATH, Center for Vaccine Innovation and Access, Seattle, Washington, USA
| | | | - Jorge Flores
- PATH, Center for Vaccine Innovation and Access, Seattle, Washington, USA
| |
Collapse
|
4
|
Chi PC, Owino EA, Jao I, Bejon P, Kapulu M, Marsh V, Kamuya D. Ethical considerations around volunteer payments in a malaria human infection study in Kenya: an embedded empirical ethics study. BMC Med Ethics 2022; 23:46. [PMID: 35443642 PMCID: PMC9019790 DOI: 10.1186/s12910-022-00783-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/11/2022] [Indexed: 11/10/2022] Open
Abstract
Human Infection Studies (HIS) have emerged as an important research approach with the potential to fast track the global development of vaccines and treatments for infectious diseases, including in low resource settings. Given the high level of burdens involved in many HIS, particularly prolonged residency and biological sampling requirements, it can be challenging to identify levels of study payments that provide adequate compensation but avoid 'undue' levels of inducement to participate. Through this embedded ethics study, involving 97 healthy volunteers and other research stakeholders in a malaria HIS programme in Kenya, and using in-depth interviews, focus group discussions and observations during and after a malaria HIS, we give a grounded account of ethical issues emerging in relation to study payments in this setting. While careful community, national, international scientific and ethics review processes meant that risks of serious harm were highly unlikely, the levels of motivation to join HIS seen could raise concerns about study payments being too high. Particular value was placed on the reliability, rather than level, of study payment in this setting, where subsistence livelihoods are common. Study volunteers were generally clear about the study aims at the point of recruitment, and this knowledge was retained over a year later, although most reported experiencing more burdens than anticipated at enrolment. Strict study screening procedures, regular clinical and laboratory monitoring of volunteers, with prompt treatment with antimalarial at predetermined endpoints suggested that the risks of serious harm were highly unlikely. Ethical concerns emerged in relation to volunteers' attempts to conceal symptoms, hoping to prolong residency periods and increase study payments; and volunteers making decisions that compromised important family relationships and personal values. Our findings support an interpretation that, although study volunteers were keen to join the study to access cash payments, they also paid attention to other features of the study and the general clinical research landscape, including levels of risk associated with study participation. Overall, our analysis shows that the ethical concerns emerging from the study payments can be addressed through practical measures, hinged on reducing burdens and strengthening communication, raising important issues for research policy and planning.
Collapse
Affiliation(s)
- Primus Che Chi
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.
| | - Esther Awuor Owino
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Irene Jao
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Philip Bejon
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University Oxford, Oxford, UK
| | - Melissa Kapulu
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University Oxford, Oxford, UK
| | - Vicki Marsh
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University Oxford, Oxford, UK
| | - Dorcas Kamuya
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University Oxford, Oxford, UK
| |
Collapse
|
5
|
Bedeker A, Nichols M, Allie T, Tamuhla T, van Heusden P, Olorunsogbon O, Tiffin N. A framework for the promotion of ethical benefit sharing in health research. BMJ Glob Health 2022; 7:e008096. [PMID: 35144922 PMCID: PMC8845198 DOI: 10.1136/bmjgh-2021-008096] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/15/2022] [Indexed: 12/22/2022] Open
Abstract
There is an increasing recognition of the importance of including benefit sharing in research programmes in order to ensure equitable and just distribution of the benefits arising from research. Whilst there are global efforts to promote benefit sharing when using non-human biological resources, benefit sharing plans and implementation do not yet feature prominently in research programmes, funding applications or requirements by ethics review boards. Whilst many research stakeholders may agree with the concept of benefit sharing, it can be difficult to operationalise benefit sharing within research programmes. We present a framework designed to assist with identifying benefit sharing opportunities in research programmes. The framework has two dimensions: the first represents microlevel, mesolevel and macrolevel stakeholders as defined using a socioecological model; and the second identifies nine different types of benefit sharing that might be achieved during a research programme. We provide an example matrix identifying different types of benefit sharing that might be undertaken during genomics research, and present a case study evaluating benefit sharing in Africa during the SARS-CoV-2 pandemic. This framework, with examples, is intended as a practical tool to assist research stakeholders with identifying opportunities for benefit sharing, and inculcating intentional benefit sharing in their research programmes from inception.
Collapse
Affiliation(s)
- Anja Bedeker
- South African Medical Research Council Bioinformatics Unit, South African National Bioinformatics Institute, University of the Western Cape, Bellville, South Africa
| | - Michelle Nichols
- College of Nursing, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Taryn Allie
- Computational Biology Division, Integrative Biomedical Sciences, University of Cape Town, Cape Town, South Africa
| | - Tsaone Tamuhla
- Computational Biology Division, Integrative Biomedical Sciences, University of Cape Town, Cape Town, South Africa
| | - Peter van Heusden
- South African Medical Research Council Bioinformatics Unit, South African National Bioinformatics Institute, University of the Western Cape, Bellville, South Africa
| | - Olorunyomi Olorunsogbon
- Department of Health promotion and Education, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Nicki Tiffin
- South African Medical Research Council Bioinformatics Unit, South African National Bioinformatics Institute, University of the Western Cape, Bellville, South Africa
- Computational Biology Division, Integrative Biomedical Sciences, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
6
|
Campbell JI, Musiimenta A, Natukunda S, Eyal N, Haberer JE. "The research assistants kept coming to follow me up; I counted myself as a lucky person": Social support arising from a longitudinal HIV cohort study in Uganda. PLoS One 2022; 17:e0262989. [PMID: 35077497 PMCID: PMC8789171 DOI: 10.1371/journal.pone.0262989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 01/10/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Participation in longitudinal research studies in resource-limited settings often involves frequent interactions with study staff and other participants, as well as receipt of incentives and transportation reimbursements. Social support-receipt of material and emotional resources from one's social network-has been linked to antiretroviral adherence in sub-Saharan Africa. The extent to which social support arises from study participation, its range and depth, and its implications for observational study conduct, have not been extensively described. METHODS We conducted individual open-ended and semi-structured interviews with participants in a longitudinal, observational antiretroviral therapy adherence monitoring study in Mbarara, Uganda. Participants were asked about their experiences in the longitudinal study and their interactions with research staff. We also interviewed study research assistants (RAs). Deductive and inductive coding were used to identify content related to the experience of study participation. Codes were organized into themes, and relationships between themes were used to develop overarching categories. RESULTS Sixty longitudinal study participants and 6 RAs were interviewed. Instrumental and emotional social support emerged as pervasive and valued aspects of longitudinal study participation. Instrumental support that participants received consisted of enhanced linkage to medical care, health education, and direct and indirect material benefits. Emotional support consisted of perceptions of feeling "cared for" and social interactions that permitted escape from HIV-related stigma. Both instrumental and emotional support often arose through the close relationships participants formed with research staff and with each other. Study-derived social support motivated some participants to adhere to antiretroviral therapy-an unanticipated effect potentially influencing the longitudinal study's primary observational outcome. CONCLUSIONS Longitudinal study participation resulted in instrumental and emotional social support for participants. The depth of support participants experienced has implications for observational study design in resource-limited settings, including need to assess potential effects on study outcomes; consideration of social support during risk/benefit assessment in study ethics review and consent; and vigilance for consequences of social support loss when studies end.
Collapse
Affiliation(s)
| | - Angella Musiimenta
- Department of Information Technology, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Nir Eyal
- School of Public Health, Rutgers University, Piscataway, New Jersey, United States of America
- Department of Philosophy, Rutgers University, New Brunswick, New Jersey, United States of America
- Center for Population-Level Bioethics, Rutgers University, New Brunswick, New Jersey, United States of America
| | - Jessica E. Haberer
- Massachusetts General Hospital, Boston, Massachusetts, United States of America
| |
Collapse
|
7
|
Vincent R, Adhikari B, Duddy C, Richardson E, Wong G, Lavery J, Molyneux S. 'Working relationships' across difference - a realist review of community engagement with malaria research. Wellcome Open Res 2022; 7:13. [PMID: 37621950 PMCID: PMC10444998 DOI: 10.12688/wellcomeopenres.17192.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 08/26/2023] Open
Abstract
Background: Community engagement (CE) is increasingly accepted as a critical aspect of health research, because of its potential to make research more ethical, relevant and well implemented. While CE activities linked to health research have proliferated in Low and Middle Income Countries (LMICs), and are increasingly described in published literature, there is a lack of conceptual clarity around how engagement is understood to 'work', and the aims and purposes of engagement are varied and often not made explicit. Ultimately, the evidence base for engagement remains underdeveloped. Methods: To develop explanations for how and why CE with health research contributes to the pattern of outcomes observed in published literature , we conducted a realist review of CE with malaria research - a theory driven approach to evidence synthesis. Results: We found that community engagement relies on the development of provisional 'working relationships' across differences, primarily of wealth, power and culture. These relationships are rooted in interactions that are experienced as relatively responsive and respectful, and that bring tangible research related benefits. Contextual factors affecting development of working relationships include the facilitating influence of research organisation commitment to and resources for engagement, and constraining factors linked to the prevailing 'dominant health research paradigm context', such as: differences of wealth and power between research centres and local populations and health systems; histories of colonialism and vertical health interventions; and external funding and control of health research. Conclusions: The development of working relationships contributes to greater acceptance and participation in research by local stakeholders, who are particularly interested in research related access to health care and other benefits. At the same time, such relationships may involve an accommodation of some ethically problematic characteristics of the dominant health research paradigm, and thereby reproduce this paradigm rather than challenge it with a different logic of collaborative partnership.
Collapse
Affiliation(s)
- Robin Vincent
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Robin Vincent Learning and Evaluation Ltd, Sheffield, S89FH, UK
| | - Bipin Adhikari
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Claire Duddy
- Nuffield Department of Primary Health Care Services, University of Oxford, Oxford, OX2 6GG, UK
| | - Emma Richardson
- Health Research, Evidence and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
| | - Geoff Wong
- Nuffield Department of Primary Health Care Services, University of Oxford, Oxford, OX2 6GG, UK
| | - James Lavery
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, 30322, USA
- Center for Ethics, Emory University, Atlanta, Georgia, 30322, USA
| | - Sassy Molyneux
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, University of Oxford, Kilifi, 80108, Kenya
| | - The REAL team: Mary Chambers, Phaik Yeong Cheah, Al Davies, Kate Gooding, Dorcas Kamuya, Vicki Marsh, Noni Mumba, Deborah Nyirenda, and Paulina Tindana.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LG, UK
- Robin Vincent Learning and Evaluation Ltd, Sheffield, S89FH, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Primary Health Care Services, University of Oxford, Oxford, OX2 6GG, UK
- Health Research, Evidence and Impact, McMaster University, Hamilton, ON L8S 4L8, Canada
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, 30322, USA
- Center for Ethics, Emory University, Atlanta, Georgia, 30322, USA
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme, University of Oxford, Kilifi, 80108, Kenya
| |
Collapse
|
8
|
Munung NS, de Vries J. Benefit Sharing for Human Genomics Research: Awareness and Expectations of Genomics Researchers in Sub-Saharan Africa. Ethics Hum Res 2021; 42:14-20. [PMID: 33136331 DOI: 10.1002/eahr.500069] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Benefit sharing is an ethical issue that underscores the need to find a balance between access to genetic resources and the provision of fair benefits in exchange for access. The Human Genome Organisation (HUGO) is one of the few initiatives to have engaged with the topic of benefit sharing in human genomics. However, there is a lack of clarity on what benefit sharing entails in human genomics research and how it could be implemented in practice. This paper reports on a qualitative study that explored the views and expectations of benefit sharing by a group of genomics researchers in sub-Saharan Africa. Overall, while there was little awareness of benefit sharing among the researchers, there was support for benefit sharing in human genetics, and this was based on principles of fairness, solidarity, and reciprocity. This in-depth explorative study demonstrates the need for genomics research consortia in Africa to have open discussions on benefit sharing and to develop ethics frameworks for benefit sharing in population genomics studies in Africa. HUGO's statement on benefit sharing and the Nagoya Protocol could provide guidance.
Collapse
Affiliation(s)
- Nchangwi Syntia Munung
- Faculty of health sciences in the Department of Medicine and in the Division of Human Genetics at the University of Cape Town in South Africa
| | - Jantina de Vries
- Faculty of health sciences in the Department of Medicine at the University of Cape Town in South Africa
| |
Collapse
|
9
|
Sudoi A, De Vries J, Kamuya D. A scoping review of considerations and practices for benefit sharing in biobanking. BMC Med Ethics 2021; 22:102. [PMID: 34315443 PMCID: PMC8317360 DOI: 10.1186/s12910-021-00671-x] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/19/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Despite the rapid global growth of biobanking over the last few decades, and their potential for the advancement of health research, considerations specific to the sharing of benefits that accrue from biobanks have received little attention. Questions such as the types and range of benefits that can arise in biobanking, who should be entitled to those benefits, when they should be provided, by whom and in what form remain mostly unanswered. We conducted a scoping review to describe benefit sharing considerations and practices in biobanking in order to inform current and future policy and practice. METHODS Drawing on the Arksey and O'Malley framework, we conducted a scoping review of the literature in three online databases (PubMed, Cochrane library, and Google Scholar). We extracted and charted data to capture general characteristics, definitions and examples of benefits and benefit sharing, justification for benefit sharing, challenges in benefit sharing, governance mechanisms as well as proposed benefit sharing mechanisms. RESULTS 29 articles published between 1999 and 2020 met the inclusion criteria for the study. The articles included 5 empirical and 24 non-empirical studies. Only 12 articles discussed benefit sharing as a stand-alone subject, while the remaining 17 integrated a discussion of benefits as one issue amongst others. Major benefit sharing challenges in biobanking were found to be those associated with uncertainties around the future use of samples and in resultant benefits. CONCLUSION Most of the benefit sharing definitions and approaches currently in use for biobanking are similar to those used in health research. These approaches may not recognise the distinct features of biobanking, specifically relating to uncertainties associated with the sharing and re-use of samples. We therefore support approaches that allow decisions about benefit sharing to be made progressively once it is apparent who samples are to be shared with, the intended purpose and expected benefits. We also highlight gaps in key areas informing benefit sharing in biobanking and draw attention to the need for further empirical research.
Collapse
Affiliation(s)
- Allan Sudoi
- Department of Health Systems and Research Ethics (HSRE), KEMRI-Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine, Coast, P.O. Box 230-80108, Kilifi, Kenya.
| | - Jantina De Vries
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Dorcas Kamuya
- Department of Health Systems and Research Ethics (HSRE), KEMRI-Wellcome Trust Research Programme, KEMRI Centre for Geographic Medicine, Coast, P.O. Box 230-80108, Kilifi, Kenya
| |
Collapse
|
10
|
Molyneux S, Sukhtankar P, Thitiri J, Njeru R, Muraya K, Sanga G, Walson JL, Berkley J, Kelley M, Marsh V. Model for developing context-sensitive responses to vulnerability in research: managing ethical dilemmas faced by frontline research staff in Kenya. BMJ Glob Health 2021; 6:e004937. [PMID: 34244204 PMCID: PMC8268889 DOI: 10.1136/bmjgh-2021-004937] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/20/2021] [Indexed: 01/02/2023] Open
Abstract
Health research in low-resource settings often involves individuals and populations defined as 'vulnerable'. There is growing attention in the literature to the ethical dilemmas that frontline research staff face while conducting such research. However, there is little documented as to how research staff might support one another in identifying and handling these dilemmas in different contexts. Over the course of conducting empirical ethics research embedded in the Childhood Acute Illness & Nutrition Network, we developed an approach to examine and respond to the ethical issues and dilemmas faced by the study teams, particularly frontline staff. In this paper we describe the specific tools and approach we developed, which centred on regular cross-team ethics reflection sessions, and share lessons learnt. We suggest that all studies involving potentially vulnerable participants should incorporate activities and processes to support frontline staff in identifying, reflecting on and responding to ethical dilemmas, throughout studies. We outline the resources needed to do this and share piloted tools for further adaptation and evaluation. Such initiatives should complement and feed into-and certainly not in any way replace or substitute for-strong institutional ethics review, safeguarding and health and safety policies and processes, as well broader staff training and career support initiatives.
Collapse
Affiliation(s)
- Sassy Molyneux
- KEMRI-Wellcome Research Programme, Centre for Geographic Medicine Research Coast, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Priya Sukhtankar
- Department of Child Health, Gloucester Hospitals NHS Foundation Trust, Gloucester, UK
| | - Johnstone Thitiri
- KEMRI-Wellcome Research Programme, Centre for Geographic Medicine Research Coast, Kilifi, Kenya
| | - Rita Njeru
- Ethox Centre and Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kui Muraya
- Kemri-Wellcome Trust, Centre for Geographic Medicine Research Coast, Nairobi, Kenya
| | - Gladys Sanga
- KEMRI-Wellcome Research Programme, Centre for Geographic Medicine Research Coast, Kilifi, Kenya
| | - Judd L Walson
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - James Berkley
- KEMRI-Wellcome Research Programme, Centre for Geographic Medicine Research Coast, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Maureen Kelley
- Ethox Centre and Wellcome Centre for Ethics & Humanities, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Vicki Marsh
- KEMRI-Wellcome Research Programme, Centre for Geographic Medicine Research Coast, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
11
|
Zakayo SM, Kimani MN, Sanga G, Njeru R, Charo A, Berkley JA, Walson JL, Kelley M, Marsh V, Molyneux S. Vulnerability, Agency, and the Research Encounter: Family Members' Experiences and Perceptions of Participating in an Observational Clinical Study in Kenya. J Empir Res Hum Res Ethics 2021; 16:238-254. [PMID: 33764228 PMCID: PMC7613023 DOI: 10.1177/15562646211005304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Pediatric clinical research in low-resourced countries involves individuals defined as "vulnerable" in research ethics guidance. Insights from research participants can strengthen the design and oversight of studies. We share family members' perspectives and experiences of an observational clinical study conducted in one Kenyan hospital as part of an integrated empirical ethics study. Employing qualitative methods, we explored how research encounters featured in family members' care-seeking journeys. Our data reveals that children's vulnerability is intricately interwoven with that of their families, and that research processes and procedures can inadvertently add to hidden burdens for families. In research, the potential for layered and intersecting situational and structural vulnerability should be considered, and participants' agency in constrained research contexts actively recognized and protected.
Collapse
Affiliation(s)
- Scholastica M Zakayo
- Health Systems and Research Ethics Department, 285561KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mary N Kimani
- Health Systems and Research Ethics Department, 285561KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Gladys Sanga
- Health Systems and Research Ethics Department, 285561KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Rita Njeru
- Health Systems and Research Ethics Department, 285561KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Anderson Charo
- Health Systems and Research Ethics Department, 285561KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - James A Berkley
- Health Systems and Research Ethics Department, 285561KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, 6396University of Oxford, Oxford, UK
| | - Judd L Walson
- Department of Global Health, 7284University of Washington, Seattle, USA
| | - Maureen Kelley
- The Ethox Centre, Nuffield Department of Population Health, 6396University of Oxford, Oxford, UK
| | - Vicki Marsh
- Health Systems and Research Ethics Department, 285561KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, 6396University of Oxford, Oxford, UK
| | - Sassy Molyneux
- Health Systems and Research Ethics Department, 285561KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, 6396University of Oxford, Oxford, UK
| |
Collapse
|
12
|
Sansom LJ, Minh TPN, Hill IE, Ha QNT, Trong TD, Vidaillac C, Quynh ND, Turner HC, Van Nuil JI, Phuong DNT, Kestelyn E. Towards a fair and transparent research participant compensation and reimbursement framework in Vietnam. Int Health 2021; 12:533-540. [PMID: 33165550 PMCID: PMC7651161 DOI: 10.1093/inthealth/ihaa066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/06/2020] [Accepted: 08/26/2020] [Indexed: 11/28/2022] Open
Abstract
Background Providing compensation for participants in clinical research is well established and while international guidelines exist, defining a context-specific and fair compensation for participants in low-resource settings is challenging due to ethical concerns and the lack of practical, national compensation and reimbursement frameworks. Methods We reviewed Oxford University Clinical Research Unit (OUCRU) internal reimbursement documentation over a 10-y period and conducted a scoping literature review to expand our knowledge of compensation and reimbursement practices including ethical concerns. We developed a preliminary reimbursement framework that was presented to community advisory boards (CAB) and clinical investigators to assess its applicability, fairness and transparency. Results The main topics discussed at the workshops centered on fairness and whether the reimbursements could be perceived as financial incentives. Other decisive factors in the decision-making process were altruism and the loss of caregivers’ earnings. Investigators raised the issue of additional burdens, whereas the CAB members were focused on non-monetary elements such as the healthcare quality the patients would receive. All elements discussed were reviewed and, where possible, incorporated into the final framework. Conclusion Our new reimbursement framework provides a consistent, fair and transparent decision-making process and will be implemented across all future OUCRU clinical research in Vietnam.
Collapse
Affiliation(s)
- Lucy J Sansom
- Oxford University Clinical Research Unit, University of Oxford, Centre for Tropical Medicine, 764, Vo Van Kiet, Ho Chi Minh City, Vietnam
| | - Trang Pham Nguyen Minh
- Oxford University Clinical Research Unit, University of Oxford, Centre for Tropical Medicine, 764, Vo Van Kiet, Ho Chi Minh City, Vietnam
| | - Iona E Hill
- Oxford University Clinical Research Unit, University of Oxford, Centre for Tropical Medicine, 764, Vo Van Kiet, Ho Chi Minh City, Vietnam
- Department of Pure and Applied Chemistry, Technology and Innovation Centre, University of Strathclyde, 99 George St, Glasgow G1 1RD, UK
| | - Quyen Nguyen Than Ha
- Oxford University Clinical Research Unit, University of Oxford, Centre for Tropical Medicine, 764, Vo Van Kiet, Ho Chi Minh City, Vietnam
| | - Thuan Dang Trong
- Oxford University Clinical Research Unit, University of Oxford, Centre for Tropical Medicine, 764, Vo Van Kiet, Ho Chi Minh City, Vietnam
| | - Celine Vidaillac
- Oxford University Clinical Research Unit, University of Oxford, Centre for Tropical Medicine, 764, Vo Van Kiet, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK
| | - Nhu Dong Quynh
- Oxford University Clinical Research Unit, University of Oxford, Centre for Tropical Medicine, 764, Vo Van Kiet, Ho Chi Minh City, Vietnam
| | - Hugo C Turner
- Oxford University Clinical Research Unit, University of Oxford, Centre for Tropical Medicine, 764, Vo Van Kiet, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, School of Public Health, Faculty of Medicine, Imperial College London, Level 2, Faculty Building South Kensington Campus, London SW7 2AZ, UK
| | - Jennifer Ilo Van Nuil
- Oxford University Clinical Research Unit, University of Oxford, Centre for Tropical Medicine, 764, Vo Van Kiet, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, New Richards Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LG, UK
| | - Dung Nguyen Thi Phuong
- Oxford University Clinical Research Unit, University of Oxford, Centre for Tropical Medicine, 764, Vo Van Kiet, Ho Chi Minh City, Vietnam
| | | |
Collapse
|
13
|
Chi PC, Owino E, Jao I, Marsh V, Kamuya D. Considering the Importance of Context for Ethical Practice on Reimbursement, Compensation and Incentives for Volunteers in Human Infection Controlled Studies. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:40-42. [PMID: 33616502 PMCID: PMC7613538 DOI: 10.1080/15265161.2020.1870771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
| | | | - Irene Jao
- KEMRI-Wellcome Trust Research Programme
| | | | | |
Collapse
|
14
|
Jamrozik E, Selgelid MJ. Should practice and policy be revised to allow for risk-proportional payment to human challenge study participants? JOURNAL OF MEDICAL ETHICS 2020; 46:835-836. [PMID: 33154089 PMCID: PMC7719901 DOI: 10.1136/medethics-2020-106900] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 10/19/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Euzebiusz Jamrozik
- Monash Bioethics Centre, Monash University, Clayton, Victoria, Australia
- Ethox & Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, United Kingdom
- Royal Melbourne Hospital Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael J Selgelid
- Monash Bioethics Centre, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
15
|
Jamrozik E, Selgelid MJ. Human infection challenge studies in endemic settings and/or low-income and middle-income countries: key points of ethical consensus and controversy. JOURNAL OF MEDICAL ETHICS 2020; 46:601-609. [PMID: 32381683 PMCID: PMC7476299 DOI: 10.1136/medethics-2019-106001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/26/2020] [Accepted: 03/11/2020] [Indexed: 05/04/2023]
Abstract
Human infection challenge studies (HCS) involve intentionally infecting research participants with pathogens (or other micro-organisms). There have been recent calls for more HCS to be conducted in low-income and middle-income countries (LMICs), where many relevant diseases are endemic. HCS in general, and HCS in LMICs in particular, raise numerous ethical issues. This paper summarises the findings of a project that explored ethical and regulatory issues related to LMIC HCS via (i) a review of relevant literature and (ii) 45 qualitative interviews with scientists and ethicists. Among other areas of consensus, we found that there was widespread agreement that LMIC HCS can be ethically acceptable, provided that they have a sound scientific rationale, are accepted by local communities and meet usual research ethics requirements. Unresolved issues include those related to (i) acceptable approaches to trade-offs between the scientific aim to produce generalisable results and the protection of participants, (iii) the sharing of benefits with LMIC populations, (iii) the acceptable limits to risks and burdens for participants, (iv) the potential for third-party risk and whether the degree of acceptable third-party risk is different in endemic settings, (v) the conditions under which (if any) it would be appropriate to recruit children for disease-causing HCS, (v) appropriate levels of payment to participants and (vi) appropriate governance of (LMIC) HCS. This paper provides preliminary analyses of these ethical considerations in order to (i) inform scientists and policymakers involved in the planning, conduct and/or governance of LMIC HCS and (ii) highlight areas warranting future research. Insofar as this article focuses on HCS in (endemic) settings where diseases are present and/or widespread, much of the analysis provided is relevant to HCS (in HICs or LMICs) involving pandemic diseases including COVID19.
Collapse
Affiliation(s)
- Euzebiusz Jamrozik
- Monash Bioethics Centre, Monash University, Melbourne, Victoria, Australia
- Department of General Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Michael J Selgelid
- Monash Bioethics Centre, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
16
|
Folayan MO, Peterson K. HIV prevention clinical trials' community engagement guidelines: inequality, and ethical conflicts. Glob Bioeth 2020; 31:47-66. [PMID: 32921972 PMCID: PMC7448920 DOI: 10.1080/11287462.2020.1773061] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In 2004 and 2005, the first clinical trials were launched to investigate the use of tenofovir for HIV prevention in Cambodia, Cameroon, Nigeria and Thailand. Controversies erupted over the ethical integrity of the research protocol. We reflect on the events that led to the controversies and identified that scientific and ethical concerns raised by members of local communities at each of these sites were erased by trialists, causing crisis that led to premature shut down the early PrEP trials. In the aftermath of these trials, the World Health Organisation, UNAIDS, and AVAC developed ethics guidelines intended to recognize the concerns as authentic, and developed guidelines to improve researchers’ engagement of communities in biomedical HIV prevention trial design and implementation. Our findings suggest that the ethics guidelines are limited in its ability to address power inequalities that leads to voice erasures and non-recognition of local competencies. Rather the ethical documents enabled trialists to gain a new sense of authority through the interpretations of ethical research conduct enabling trialists regain power that can further entrench inequality and voice erasures. To address concerns with what seems an intractable problem, we suggested models of engagement for off-shored research may be the option.
Collapse
Affiliation(s)
- Morenike O Folayan
- New HIV Vaccine and Microbicide Advocacy Society, Nigeria.,Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Kristin Peterson
- Department of Anthropology, University of California, Irvine, USA
| |
Collapse
|
17
|
Daftary A, Viens AM. Solidarity in Global Health Research-Are the Stakes Equal? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:59-62. [PMID: 32364485 DOI: 10.1080/15265161.2020.1745945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Amrita Daftary
- School of Global Health, York University
- Centre for the AIDS Programme of Research in South Africa, University of KwaZulu Natal
| | - A M Viens
- School of Global Health, York University
| |
Collapse
|
18
|
Pratt B, Cheah PY, Marsh V. Solidarity and Community Engagement in Global Health Research. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:43-56. [PMID: 32364467 PMCID: PMC7613329 DOI: 10.1080/15265161.2020.1745930] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Community engagement (CE) is gaining prominence in global health research. A number of ethical goals-spanning the instrumental, intrinsic, and transformative-have been ascribed to CE in global health research. This paper draws attention to an additional transformative value that CE is not typically linked to but that seems very relevant: solidarity. Both are concerned with building relationships and connecting parties that are distant from one another. This paper first argues that furthering solidarity should be recognized as another ethical goal for CE in global health research. It contends that, over time, CE can build the bases of solidaristic relationships-moral imagination, recognition, understanding, empathy-between researchers and community members. Applying concepts from existing accounts of solidarity, the paper develops preliminary ideas about who should be engaged and how to advance solidarity. The proposed approach is compared to current CE practice in global health research. Finally, the paper briefly considers how solidaristic CE could affect how global health research is performed.
Collapse
Affiliation(s)
- Bridget Pratt
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Victoria, Australia
| | - Phaik Yeong Cheah
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
- The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Vicki Marsh
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| |
Collapse
|
19
|
Marsh V, Mwangome N, Jao I, Wright K, Molyneux S, Davies A. Who should decide about children's and adolescents' participation in health research? The views of children and adults in rural Kenya. BMC Med Ethics 2019; 20:41. [PMID: 31200697 PMCID: PMC6570858 DOI: 10.1186/s12910-019-0375-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 05/22/2019] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND International research guidance has shifted towards an increasingly proactive inclusion of children and adolescents in health research in recognition of the need for more evidence-based treatment. Strong calls have been made for the active involvement of children and adolescents in developing research proposals and policies, including in decision-making about research participation. Much evidence and debate on this topic has focused on high-income settings, while the greatest health burdens and research gaps occur in low-middle income countries, highlighting the need to take account of voices from more diverse contexts. METHODS Between January and March 2014, 56 community representatives and secondary school students were involved in eight group discussions to explore views on the acceptability of involving children and adolescents in research, and how these groups should be involved in decision-making about their own participation. Discussions were voice-recorded and transcriptions analyzed using Framework Analysis, combining deductive and inductive approaches. RESULTS Across these discussions, the idea of involving children and adolescents in decision-making about research participation was strongly supported given similar levels of responsibility carried in everyday life; existing capacity that should be recognized; the opportunity for learning involved; varying levels of parental control; and generational shifts towards greater understanding of science for adolescents than their parents. Joint decision-making processes were supported for older children and adolescents, with parental control influenced by perceptions of the risks involved in participation. CONCLUSIONS Moves towards more active involvement of children and adolescents in planning studies and in making decisions about their participation are supported by these findings from Kenya. Important emerging considerations include the need to take account of the nature of proposed studies and prevailing attitudes and understanding of research in identifying children's and adolescents' roles. More research is needed to expand diversity and develop approaches to joint assent and consent processes that would fairly represent children's and adolescents' wishes and interests, towards their long term benefit.
Collapse
Affiliation(s)
- Vicki Marsh
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Institute, PO Box 230, Kilifi, 80108 Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Peter Medawar Building, South Parks Road, Oxford, OX13SY UK
| | - Nancy Mwangome
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Institute, PO Box 230, Kilifi, 80108 Kenya
| | - Irene Jao
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Institute, PO Box 230, Kilifi, 80108 Kenya
| | - Katharine Wright
- UK Nuffield Council on Bioethics, 28 Bedford Square, London, WC1B 3JS UK
| | - Sassy Molyneux
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Institute, PO Box 230, Kilifi, 80108 Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Peter Medawar Building, South Parks Road, Oxford, OX13SY UK
| | - Alun Davies
- Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Institute, PO Box 230, Kilifi, 80108 Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Peter Medawar Building, South Parks Road, Oxford, OX13SY UK
| |
Collapse
|
20
|
Pratt B. Justice and public participation in universal health coverage: when is tiered coverage unfair and who should decide? Asian Bioeth Rev 2019; 11:5-19. [PMID: 33717297 PMCID: PMC7747285 DOI: 10.1007/s41649-018-0064-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 10/05/2018] [Indexed: 11/24/2022] Open
Abstract
Universal health coverage is often implemented within countries through several national insurance schemes that collectively cover their populations. Yet the extent of services and benefits available can vary substantially between different schemes. This paper argues that these variations in coverage comprise tiering and then reviews different accounts of health and social justice that consider whether and when a tiered health system is fair. Using these accounts, it shows that the fairness of tiering can be determined by assessing whether differences in coverage mean enrolees under some national insurance schemes do not achieve sufficient health or normal functioning and/or feel inferior relative to those belonging to other national insurance schemes. The paper further contends that these determinations of fairness should involve the people covered by different insurance schemes. Key universal health coverage questions to involve the public in answering are: Do the sum of differences between the schemes in your country generate feelings of unequal moral worth and/or mean enrolees struggle to achieve sufficient health or normal functioning? Which specific differences between health insurance schemes generate the greatest feelings of unequal moral worth in individuals? Which specific differences generate the greatest barriers to individuals achieving sufficient health or normal functioning? Rather than identifying which services to extend coverage to first, answering these questions will identify which disparities in services and benefits are the most morally urgent to address. Finally, some initial thoughts are offered on who from the public should be involved in making these decisions and how they might be involved as a matter of justice.
Collapse
Affiliation(s)
- Bridget Pratt
- Nossal Institute for Global Health and Centre for Health Equity, School of Population and Global Health, University of Melbourne, 207 Bouverie St, Carlton, Victoria 3053 Australia
| |
Collapse
|
21
|
Njue M, Njuguna P, Kapulu MC, Sanga G, Bejon P, Marsh V, Molyneux S, Kamuya D. Ethical considerations in Controlled Human Malaria Infection studies in low resource settings: Experiences and perceptions of study participants in a malaria Challenge study in Kenya. Wellcome Open Res 2018; 3:39. [PMID: 29806038 PMCID: PMC5954342 DOI: 10.12688/wellcomeopenres.14439.2] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2018] [Indexed: 01/08/2023] Open
Abstract
Background: The range and amount of volunteer infection studies, known as Controlled Human Infection Model (CHMI) studies, in Low-Middle Income Countries (LMICs) is increasing with rapid technological advancement, world-class laboratory facilities and increasing capacity development initiatives. However, the ethical issues these studies present in LMICs have not been empirically studied. We present findings of a descriptive social science study nested within a malaria volunteer infection study, on-going at the time of writing, at the KEMRI-Wellcome Trust Research Programme (KWTRP) on the Kenyan Coast. Methods: The study included non-participant observations, five group discussions with more than half of the CHMI study participants, two in-depth interviews with study team members, and an exit questionnaire administered to the participants. Results: Participants understood the key elements of the study, including that they would be deliberately infected with malaria parasites and may get malaria as a result, there would be regular blood draws, and they would spend up to 24 days in a residence facility away from their homes. The greatest motivation for participation was the monetary compensation of 20 USD per overnight stay given as a lump-sum at the end of their residency stay. Also appreciated were the health screening tests prior to enrolment and the positive relations with the study team. Concerns raised included the amount and regularity of blood draws experienced, and concerns that this type of research may feed into on-going rumours about research generally. Conclusion: With the increasing range and number of CHMI studies being conducted in LMICs, current ethical guidance are inadequate. This study highlights some of the ethical issues that could emerge in these settings, emphasizing the heavy responsibility placed on research review and regulatory systems, researchers and funders, as well as the importance of carefully tailored community engagement and consent processes.
Collapse
Affiliation(s)
- Maureen Njue
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Patricia Njuguna
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- World Health Organisation, Geneva, Switzerland
| | - Melissa C. Kapulu
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University Oxford, Oxford, OX3 7BN, UK
| | - Gladys Sanga
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Philip Bejon
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University Oxford, Oxford, OX3 7BN, UK
| | - Vicki Marsh
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University Oxford, Oxford, OX3 7BN, UK
| | - Sassy Molyneux
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University Oxford, Oxford, OX3 7BN, UK
| | - Dorcas Kamuya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| |
Collapse
|
22
|
Mweemba C, Ali J, Hyder AA. Providing monetary and non-monetary goods to research participants: perspectives and practices of researchers and Research Ethics Committees in Zambia. Glob Bioeth 2018; 31:90-103. [PMID: 33343185 PMCID: PMC7734108 DOI: 10.1080/11287462.2018.1527672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 08/20/2018] [Indexed: 11/29/2022] Open
Abstract
There are disagreements among ethicists on what comprises an "appropriate" good to offer research participants. Debates often focus on the type, quantity, timing, and ethical appropriateness of such offers, particularly in settings where participants may be socio-economically vulnerable, such as in parts of Zambia. This was a Cross-sectional online survey of researchers and Research Ethics Committees (RECs) designed to understand practices, attitudes and policies associated with provision of goods to research participants. Of 122 responding researchers, 69 met eligibility criteria. Responses were also received from five of the six Zambian RECs involved in reviewing research proposals. Forty-nine researchers (71.0%) confirmed previous experience offering goods to participants. Of these, 21 (42.9%) offered participants money only, 18 (36.7%) offered non-monetary goods, while the rest offered both monetary and non-monetary goods. Generally, goods were offered and approved by RECs to compensate for time, lost wages and transportation. One REC and 34.8% of researchers reported being subject to an institutional policy on offering goods to participants. While reimbursement is the main reason for offering goods to participants in Zambia, caution is required when deciding on the type and quantity of goods to offer given the potential for community mistrust and manipulation.
Collapse
Affiliation(s)
- Chris Mweemba
- Department of Health Policy and Management, School of Public Health, University of Zambia, Lusaka, Zambia
| | - Joseph Ali
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
| | - Adnan A. Hyder
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
| |
Collapse
|
23
|
Njue M, Njuguna P, Kapulu MC, Sanga G, Bejon P, Marsh V, Molyneux S, Kamuya D. Ethical considerations in Controlled Human Malaria Infection studies in low resource settings: Experiences and perceptions of study participants in a malaria Challenge study in Kenya. Wellcome Open Res 2018; 3:39. [PMID: 29806038 PMCID: PMC5954342 DOI: 10.12688/wellcomeopenres.14439.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2018] [Indexed: 11/20/2022] Open
Abstract
Background: The range and amount of volunteer infection studies, known as Controlled Human Infection Model (CHMI) studies, in Low-Middle Income Countries (LMICs) is increasing with rapid technological advancement, world-class laboratory facilities and increasing capacity development initiatives. However, the ethical issues these studies present in LMICs have not been empirically studied. We present findings of a descriptive social science study nested within a malaria volunteer infection study, on-going at the time of writing, at the KEMRI-Wellcome Trust Research Programme (KWTRP) on the Kenyan Coast. Methods: The study included non-participant observations, five group discussions with more than half of the CHMI study participants, two in-depth interviews with study team members, and an exit questionnaire administered to the participants. Results: Participants understood the key elements of the study, including that they would be deliberately infected with malaria parasites and may get malaria as a result, there would be regular blood draws, and they would spend up to 24 days in a residence facility away from their homes. The greatest motivation for participation was the monetary compensation of 20 USD per overnight stay given as a lump-sum at the end of their residency stay. Also appreciated were the health screening tests prior to enrolment and the positive relations with the study team. Concerns raised included the amount and regularity of blood draws experienced, and concerns that this type of research may feed into on-going rumours about research generally. Conclusion: With the increasing range and number of CHMI studies being conducted in LMICs, current ethical guidance for more than minimal risk studies is inadequate. This study highlights some of the ethical issues that could emerge in these settings, emphasizing the heavy responsibility placed on research review and regulatory systems, researchers and funders, as well as the importance of carefully tailored community engagement and consent processes.
Collapse
Affiliation(s)
- Maureen Njue
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Patricia Njuguna
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- World Health Organisation, Geneva, Switzerland
| | - Melissa C. Kapulu
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University Oxford, Oxford, OX3 7BN, UK
| | - Gladys Sanga
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Philip Bejon
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University Oxford, Oxford, OX3 7BN, UK
| | - Vicki Marsh
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University Oxford, Oxford, OX3 7BN, UK
| | - Sassy Molyneux
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University Oxford, Oxford, OX3 7BN, UK
| | - Dorcas Kamuya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| |
Collapse
|
24
|
Andanda P, Wathuta J. Human dignity as a basis for providing post-trial access to healthcare for research participants: a South African perspective. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2018; 21:139-155. [PMID: 28601920 DOI: 10.1007/s11019-017-9782-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This paper discusses the need to focus on the dignity of human participants as a legal and ethical basis for providing post-trial access to healthcare. Debate about post-trial benefits has mostly focused on access to products or interventions proven to be effective in clinical trials. However, such access may be modelled on a broad fair benefits framework that emphasises both collateral benefits and interventional products of research, instead of prescribed post-trial access alone (Legal and ethical regulation of biomedical research in developing countries p. 134, 2016). The wording of the current version of the Declaration of Helsinki could in fact be interpreted to broaden the scope to include other collateral benefits by applying such a broad fair benefits framework. We argue that this possibility should be utilised by low and middle income countries' (LMICs) health research ethics committees (RECs) in order to ensure that research participants who enrol in clinical trials so as to receive medical care continue to access care after the trial is concluded, as befits their dignity. Although each LMIC has unique concerns, nonetheless there are common challenges based especially on emerging issues, such as post-trial access to healthcare. Accordingly, the South African perspective is used to draw lessons that can benefit other LMICs.
Collapse
Affiliation(s)
- Pamela Andanda
- School of Law, University of the Witwatersrand, Johannesburg, South Africa.
- University of the Witwatersrand, Private Bag 3, WITS, Johannesburg, 2050, South Africa.
| | - Jane Wathuta
- School of Law, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
25
|
Ward CL, Shaw D, Anane-Sarpong E, Sankoh O, Tanner M, Elger B. The Ethics of Health Care Delivery in a Pediatric Malaria Vaccine Trial: The Perspectives of Stakeholders From Ghana and Tanzania. J Empir Res Hum Res Ethics 2017; 13:26-41. [PMID: 29179625 DOI: 10.1177/1556264617742236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study explores ethical issues raised in providing medical care to participants and communities of low-resource settings involved in a Phase II/III pediatric malaria vaccine trial (PMVT). We conducted 52 key informant interviews with major stakeholders of an international multi-center PMVT (GSK/PATH-MVI RTS,S) (NCT00866619) in Ghana and Tanzania. Based on their stakeholder experiences, the responses fell into three main themes: (a) undue inducement, (b) community disparities, and (c) broad therapeutic misconceptions. The study identified the critical ethical aspects, from the perspectives of stakeholders, of delivering health care during a PMVT. The study showed that integrating research into health care services needs to be addressed in a manner that upholds the favorable risk-benefit ratio of research and attends to the health needs of local populations. The implementation of research should aim to improve local standards of care through building a collaborative agenda with local institutions and systems of health.
Collapse
|
26
|
Koen J, Wassenaar D, Mamotte N. The 'over-researched community': An ethics analysis of stakeholder views at two South African HIV prevention research sites. Soc Sci Med 2017; 194:1-9. [PMID: 29035778 DOI: 10.1016/j.socscimed.2017.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 10/05/2017] [Accepted: 10/06/2017] [Indexed: 11/16/2022]
Abstract
Health research in resource-limited, multi-cultural contexts raises complex ethical concerns. The term 'over-researched community' (ORC) has been raised as an ethical concern and potential barrier to community participation in research. However, the term lacks conceptual clarity and is absent from established ethics guidelines and academic literature. In light of the concern being raised in relation to research in low- and middle-income countries (LMICs), a critical and empirical exploration of the meaning of ORC was undertaken. Guided by Emanuel et al.'s (2004) eight principles for ethically sound research in LMICs, this study examines the relevance and meaning of the terms 'over-research' and 'over-researched community' through an analysis of key stakeholder perspectives at two South African research sites. Data were collected between August 2007 and October 2008. 'Over-research' was found to represent a conglomeration of ethical concerns often used as a proxy for standard research ethics concepts. 'Over-research' seemed fundamentally linked to disparate positions and perspectives between different stakeholders in the research interaction, arising from challenges in inter-stakeholder relationships. 'Over-research' might be interpreted to mean exploitation. However, exploitation itself could mean different things. Using the term may lead to obscured understanding of real or perceived ethical concerns, making it difficult to identify and address the underlying concerns. It is recommended that the term be carefully and critically interrogated for clarity when used in research ethics discourse. Because it represents other legitimate concerns, it should not be dismissed without careful exploration.
Collapse
Affiliation(s)
- Jennifer Koen
- HIV AIDS Vaccines Ethics Group, Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Private Bag X01 Scottsville, Pietermaritzburg, 3209, South Africa.
| | - Douglas Wassenaar
- South African Research Ethics Training Initiative, School of Applied Human Sciences, University of KwaZulu-Natal, Private Bag X01 Scottsville, Pietermaritzburg, 3209 South Africa.
| | - Nicole Mamotte
- South African Research Ethics Training Initiative, School of Applied Human Sciences, University of KwaZulu-Natal, Private Bag X01 Scottsville, Pietermaritzburg, 3209 South Africa.
| |
Collapse
|
27
|
Brown B, Galea JT, Davidson P, Khoshnood K. Transparency of participant incentives in HIV research. Lancet HIV 2016; 3:e456-7. [PMID: 27687034 PMCID: PMC5578702 DOI: 10.1016/s2352-3018(16)30150-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/15/2016] [Accepted: 08/16/2016] [Indexed: 12/27/2022]
Affiliation(s)
- Brandon Brown
- Center for Healthy Communities, Department of Social Medicine and Population Health, UCR School of Medicine, Riverside, CA, USA.
| | - Jerome T Galea
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA; Socios En Salud, Sucursal Peru, Lima, Peru
| | - Peter Davidson
- University of California, San Diego School of Medicine, Division of Global Public Health, UC San Diego Central Research Services Facility, La Jolla, CA, USA
| | | |
Collapse
|
28
|
Asante KP, Jones C, Sirima SB, Molyneux S. Clinical Trials Cannot Substitute for Health System Strengthening Initiatives or Specifically Designed Health Policy and Systems Research. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2016; 16:24-26. [PMID: 27216095 PMCID: PMC6616026 DOI: 10.1080/15265161.2016.1170242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
| | - Caroline Jones
- b University of Oxford and KEMRI Wellcome Trust Research Programme
| | | | - Sassy Molyneux
- b University of Oxford and KEMRI Wellcome Trust Research Programme
| |
Collapse
|
29
|
Kombe F, Folayan MO, Ambe J, Igonoh A, Abayomi A. Taking the bull by the horns: Ethical considerations in the design and implementation of an Ebola virus therapy trial. Soc Sci Med 2015; 148:163-70. [PMID: 26653137 PMCID: PMC6858863 DOI: 10.1016/j.socscimed.2015.11.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 08/27/2015] [Accepted: 11/11/2015] [Indexed: 01/05/2023]
Abstract
Ebola virus is categorized as one of the most dangerous pathogens in the world. Although there is no known cure for Ebola virus, there is some evidence that the severity of the disease can be curtailed using plasma from survivors. Although there is a general consensus on the importance of research, methodological and ethical challenges for conducting research in an emergency situation have been identified. Performing clinical trials is important, especially for health conditions that are of public health significance (including rare epidemics) to develop new therapies as well as to test the efficacy and effectiveness of new interventions. However, routine clinical trial procedures can be difficult to apply in emergency public health crises hence require a consideration of alternative approaches on how therapies in these situations are tested and brought to the market. This paper examines some of the ethical issues that arise when conducting clinical trials during a highly dangerous pathogen outbreak, with a special focus on the Ebola virus outbreak in West Africa. The issues presented here come from a review of a protocol that was submitted to the Global Emerging Pathogens Treatment Consortium (GET). In reviewing the proposal, which was about conducting a clinical trial to evaluate the safety and efficacy of using convalescent plasma in the management of Ebola virus disease, the authors deliberated on various issues, which were documented as minutes and later used as a basis for this paper. The experiences and reflections shared by the authors, who came from different regions and disciplines across Africa, present wide-ranging perspectives on the conduct of clinical trials during a dangerous disease outbreak in a resource-poor setting.
Collapse
Affiliation(s)
- Francis Kombe
- KEMRI-Wellcome Trust Research Programme (KWTRP), P.O Box 230, Kilifi, Kenya.
| | - Morenike O Folayan
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria; Global Emerging Pathogens Treatment Consortium (GET), 1 Mainland Hospital Road, Yaba, Lagos, Nigeria
| | - Jennyfer Ambe
- Global Emerging Pathogens Treatment Consortium (GET), 1 Mainland Hospital Road, Yaba, Lagos, Nigeria
| | - Adaora Igonoh
- Global Emerging Pathogens Treatment Consortium (GET), 1 Mainland Hospital Road, Yaba, Lagos, Nigeria
| | - Akin Abayomi
- Global Emerging Pathogens Treatment Consortium (GET), 1 Mainland Hospital Road, Yaba, Lagos, Nigeria; Division of Haematology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Private Bag X3, Parow Valley, 7505 Cape Town, Cape Town, South Africa
| |
Collapse
|
30
|
Jao I, Kombe F, Mwalukore S, Bull S, Parker M, Kamuya D, Molyneux S, Marsh V. Research Stakeholders' Views on Benefits and Challenges for Public Health Research Data Sharing in Kenya: The Importance of Trust and Social Relations. PLoS One 2015; 10:e0135545. [PMID: 26331716 PMCID: PMC4557837 DOI: 10.1371/journal.pone.0135545] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 07/22/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is increasing recognition of the importance of sharing research data within the international scientific community, but also of the ethical and social challenges this presents, particularly in the context of structural inequities and varied capacity in international research. Public involvement is essential to building locally responsive research policies, including on data sharing, but little research has involved stakeholders from low-to-middle income countries. METHODS Between January and June 2014, a qualitative study was conducted in Kenya involving sixty stakeholders with varying experiences of research in a deliberative process to explore views on benefits and challenges in research data sharing. In-depth interviews and extended small group discussions based on information sharing and facilitated debate were used to collect data. Data were analysed using Framework Analysis, and charting flow and dynamics in debates. FINDINGS The findings highlight both the opportunities and challenges of communicating about this complex and relatively novel topic for many stakeholders. For more and less research-experienced stakeholders, ethical research data sharing is likely to rest on the development and implementation of appropriate trust-building processes, linked to local perceptions of benefits and challenges. The central nature of trust is underpinned by uncertainties around who might request what data, for what purpose and when. Key benefits perceived in this consultation were concerned with the promotion of public health through science, with legitimate beneficiaries defined differently by different groups. Important challenges were risks to the interests of study participants, communities and originating researchers through stigmatisation, loss of privacy, impacting autonomy and unfair competition, including through forms of intentional and unintentional 'misuse' of data. Risks were also seen for science. DISCUSSION Given background structural inequities in much international research, building trust in this low-to-middle income setting includes ensuring that the interests of study participants, primary communities and originating researchers will be promoted as far as possible, as well as protected. Important ways of building trust in data sharing include involving the public in policy development and implementation, promoting scientific collaborations around data sharing and building close partnerships between researchers and government health authorities to provide checks and balances on data sharing, and promote near and long-term translational benefits.
Collapse
Affiliation(s)
- Irene Jao
- Health Systems and Research Ethics Department, Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya
| | - Francis Kombe
- Health Systems and Research Ethics Department, Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya
| | - Salim Mwalukore
- Health Systems and Research Ethics Department, Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya
| | - Susan Bull
- Ethox Centre, Nuffield Department of Population Health, Oxford University, Oxford, United Kingdom
| | - Michael Parker
- Ethox Centre, Nuffield Department of Population Health, Oxford University, Oxford, United Kingdom
| | - Dorcas Kamuya
- Health Systems and Research Ethics Department, Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya
- Ethox Centre, Nuffield Department of Population Health, Oxford University, Oxford, United Kingdom
| | - Sassy Molyneux
- Health Systems and Research Ethics Department, Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
| | - Vicki Marsh
- Health Systems and Research Ethics Department, Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, Oxford University, Oxford, United Kingdom
- * E-mail:
| |
Collapse
|
31
|
Jao I, Kombe F, Mwalukore S, Bull S, Parker M, Kamuya D, Molyneux S, Marsh V. Involving Research Stakeholders in Developing Policy on Sharing Public Health Research Data in Kenya: Views on Fair Process for Informed Consent, Access Oversight, and Community Engagement. J Empir Res Hum Res Ethics 2015; 10:264-77. [PMID: 26297748 PMCID: PMC4548475 DOI: 10.1177/1556264615592385] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Increased global sharing of public health research data has potential to advance scientific progress but may present challenges to the interests of research stakeholders, particularly in low-to-middle income countries. Policies for data sharing should be responsive to public views, but there is little evidence of the systematic study of these from low-income countries. This qualitative study explored views on fair data-sharing processes among 60 stakeholders in Kenya with varying research experience, using a deliberative approach. Stakeholders' attitudes were informed by perceptions of benefit and concerns for research data sharing, including risks of stigmatization, loss of privacy, and undermining scientific careers and validity, reported in detail elsewhere. In this article, we discuss institutional trust-building processes seen as central to perceptions of fairness in sharing research data in this setting, including forms of community involvement, individual prior awareness and agreement to data sharing, independence and accountability of governance mechanisms, and operating under a national framework.
Collapse
Affiliation(s)
- Irene Jao
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
| | - Francis Kombe
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | | | - Dorcas Kamuya
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya Oxford University, UK
| | - Sassy Molyneux
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya Oxford University, UK
| | - Vicki Marsh
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya Oxford University, UK
| |
Collapse
|
32
|
Njue M, Molyneux S, Kombe F, Mwalukore S, Kamuya D, Marsh V. Benefits in cash or in kind? A community consultation on types of benefits in health research on the Kenyan Coast. PLoS One 2015; 10:e0127842. [PMID: 26010783 PMCID: PMC4444261 DOI: 10.1371/journal.pone.0127842] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 03/20/2015] [Indexed: 12/02/2022] Open
Abstract
Background Providing benefits and payments to participants in health research, either in cash or in kind, is a common but ethically controversial practice. While much literature has concentrated on appropriate levels of benefits or payments, this paper focuses on less well explored ethical issues around the nature of study benefits, drawing on views of community members living close to an international health research centre in Kenya. Methods The consultation, including 90 residents purposively chosen to reflect diversity, used a two-stage deliberative process. Five half-day workshops were each followed by between two and four small group discussions, within a two week period (total 16 groups). During workshops and small groups, facilitators used participatory methods to share information, and promote reflection and debate on ethical issues around types of benefits, including cash, goods, medical and community benefits. Data from workshop and field notes, and voice recordings of small group discussions, were managed using Nvivo 10 and analysed using a Framework Analysis approach. Findings and Conclusions The methods generated in-depth discussion with high levels of engagement. Particularly for the most-poor, under-compensation of time in research carries risks of serious harm. Cash payments may best support compensation of costs experienced; while highly valued, goods and medical benefits may be more appropriate as an ‘appreciation’ or incentive for participation. Community benefits were seen as important in supporting but not replacing individual-level benefits, and in building trust in researcher-community relations. Cash payments were seen to have higher risks of undue inducement, commercialising relationships and generating family conflicts than other benefits, particularly where payments are high. Researchers should consider and account for burdens families may experience when children are involved in research. Careful context-specific research planning and skilled and consistent communication about study benefits and payments are important, including in mitigating potential negative effects.
Collapse
Affiliation(s)
- Maureen Njue
- Kenya Medical Research Institute (KEMRI)—Wellcome Trust Research Programme, PO Box 230–80108, Kilifi, Kenya
| | - Sassy Molyneux
- Kenya Medical Research Institute (KEMRI)—Wellcome Trust Research Programme, PO Box 230–80108, Kilifi, Kenya
- Centre for Tropical Medicine, Nuffield Department of Medicine Research Building, Oxford University, Old Road Campus, Headington, Oxford OX3 7FZ, United Kingdom
- Ethox Centre, Nuffield Department of Population Health, Oxford University, Old Road Campus, Headington, Oxford OX3 7LF, United Kingdom
| | - Francis Kombe
- Kenya Medical Research Institute (KEMRI)—Wellcome Trust Research Programme, PO Box 230–80108, Kilifi, Kenya
| | - Salim Mwalukore
- Kenya Medical Research Institute (KEMRI)—Wellcome Trust Research Programme, PO Box 230–80108, Kilifi, Kenya
| | - Dorcas Kamuya
- Kenya Medical Research Institute (KEMRI)—Wellcome Trust Research Programme, PO Box 230–80108, Kilifi, Kenya
- Centre for Tropical Medicine, Nuffield Department of Medicine Research Building, Oxford University, Old Road Campus, Headington, Oxford OX3 7FZ, United Kingdom
- Ethox Centre, Nuffield Department of Population Health, Oxford University, Old Road Campus, Headington, Oxford OX3 7LF, United Kingdom
| | - Vicki Marsh
- Kenya Medical Research Institute (KEMRI)—Wellcome Trust Research Programme, PO Box 230–80108, Kilifi, Kenya
- Centre for Tropical Medicine, Nuffield Department of Medicine Research Building, Oxford University, Old Road Campus, Headington, Oxford OX3 7FZ, United Kingdom
- Ethox Centre, Nuffield Department of Population Health, Oxford University, Old Road Campus, Headington, Oxford OX3 7LF, United Kingdom
- * E-mail:
| |
Collapse
|
33
|
Angwenyi V, Asante KP, Traoré A, Febir LG, Tawiah C, Kwarteng A, Ouédraogo A, Sirima SB, Owusu-Agyei S, Imoukhuede EB, Webster J, Chandramohan D, Molyneux S, Jones C. Health providers' perceptions of clinical trials: lessons from Ghana, Kenya and Burkina Faso. PLoS One 2015; 10:e0124554. [PMID: 25933429 PMCID: PMC4416706 DOI: 10.1371/journal.pone.0124554] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 03/15/2015] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Clinical trials conducted in Africa often require substantial investments to support trial centres and public health facilities. Trial resources could potentially generate benefits for routine health service delivery but may have unintended consequences. Strengthening ethical practice requires understanding the potential effects of trial inputs on the perceptions and practices of routine health care providers. This study explores the influence of malaria vaccine trials on health service delivery in Ghana, Kenya and Burkina Faso. METHODS We conducted: audits of trial inputs in 10 trial facilities and among 144 health workers; individual interviews with frontline providers (n=99) and health managers (n=14); and group discussions with fieldworkers (n=9 discussions). Descriptive summaries were generated from audit data. Qualitative data were analysed using a framework approach. RESULTS Facilities involved in trials benefited from infrastructure and equipment upgrades, support with essential drugs, access to trial vehicles, and placement of additional qualified trial staff. Qualified trial staff in facilities were often seen as role models by their colleagues; assisting with supportive supervision and reducing facility workload. Some facility staff in place before the trial also received formal training and salary top-ups from the trials. However, differential access to support caused dissatisfaction, and some interviewees expressed concerns about what would happen at the end of the trial once financial and supervisory support was removed. CONCLUSION Clinical trials function as short-term complex health service delivery interventions in the facilities in which they are based. They have the potential to both benefit facilities, staff and communities through providing the supportive environment required for improvements in routine care, but they can also generate dissatisfaction, relationship challenges and demoralisation among staff. Minimising trial related harm and maximising benefits requires careful planning and engagement of key actors at the outset of trials, throughout the trial and on its' completion.
Collapse
Affiliation(s)
- Vibian Angwenyi
- Department of Public Health Research, KEMRI/Wellcome Trust Research Programme (KWTRP), P.O. Box, 230–80108, Kilifi, Kenya
- * E-mail:
| | - Kwaku-Poku Asante
- Kintampo Health Research Centre (KHRC), P.O. Box 200, Kintampo, Ghana
| | - Abdoulaye Traoré
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), 01 BP 2208, Ouagadougou 01, Burkina Faso
| | | | - Charlotte Tawiah
- Kintampo Health Research Centre (KHRC), P.O. Box 200, Kintampo, Ghana
| | - Anthony Kwarteng
- Kintampo Health Research Centre (KHRC), P.O. Box 200, Kintampo, Ghana
| | - Alphonse Ouédraogo
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), 01 BP 2208, Ouagadougou 01, Burkina Faso
| | - Sodiomon Bienvenue Sirima
- Centre National de Recherche et de Formation sur le Paludisme (CNRFP), 01 BP 2208, Ouagadougou 01, Burkina Faso
| | - Seth Owusu-Agyei
- Kintampo Health Research Centre (KHRC), P.O. Box 200, Kintampo, Ghana
| | - Egeruan Babatunde Imoukhuede
- European Vaccine Initiative (EVI),Universitäts Klinikum Heidelberg, Im Neuenheimer Feld 326, 69120, Heidelberg, Germany
| | - Jayne Webster
- Disease Control Department, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, WC1E 7HT, London, United Kingdom
| | - Daniel Chandramohan
- Disease Control Department, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, WC1E 7HT, London, United Kingdom
| | - Sassy Molyneux
- Department of Public Health Research, KEMRI/Wellcome Trust Research Programme (KWTRP), P.O. Box, 230–80108, Kilifi, Kenya
- The Ethox Centre, Department of Public Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, United Kingdom
- The Centre for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, United Kingdom
| | - Caroline Jones
- Department of Public Health Research, KEMRI/Wellcome Trust Research Programme (KWTRP), P.O. Box, 230–80108, Kilifi, Kenya
- Disease Control Department, London School of Hygiene and Tropical Medicine (LSHTM), Keppel Street, WC1E 7HT, London, United Kingdom
- The Centre for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, United Kingdom
| |
Collapse
|