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Ndukwe SO, Patel H, Shelton B, Concha-Garcia S, Dullano C, Solso S, Hendrickx S, Riggs PK, Villa TJ, Kaytes A, Taylor J, Little SJ, Lessard D, Arora AK, Costiniuk CT, Eskaf S, Smith DM, Gianella S, Dubé K. People with HIV at the end-of-life and their next-of-kin/loved ones are willing to participate in interventional HIV cure-related research. AIDS 2024; 38:235-243. [PMID: 37861674 PMCID: PMC10842373 DOI: 10.1097/qad.0000000000003754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
INTRODUCTION The Last Gift study at the University of California San Diego (UCSD), United States enrolls terminally ill people with HIV (PWH) in HIV cure research. METHODS From 2017 to 2022, we conducted surveys with Last Gift participants and their next-of-kin/loved ones to evaluate willingness to participate in different types of HIV cure research at the end of life (EOL). We analyzed willingness data descriptively. RESULTS We surveyed 17 Last Gift participants and 17 next-of-kin/loved ones. More than half of Last Gift participants ( n = 10; 58.8%) expressed willingness to participate in studies involving totally new treatments or approaches ('first-in-human' studies), a combination of different approaches, the use of unique antibodies, proteins or molecules, or therapeutic vaccines. Under one-quarter of Last Gift participants ( n = 4; 23.5%) expressed willingness to participate in research involving interventions that may shorten their life expectancy to benefit medical research. Most Last Gift participants and their next-of-kin/loved ones also expressed high acceptance for various types of donations and biopsies at the EOL (e.g. hair donations and skin, lymph node or gut biopsies). DISCUSSION Knowing whether people would be willing to participate in different types of EOL HIV cure research can help inform the design of future innovative studies. As a research community, we have a duty to design studies with adequate safeguards to preserve the public trust in research and honor PWH's important gift to humanity.
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Affiliation(s)
- Samuel O. Ndukwe
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego (UCSD), CA, USA
- UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Hursch Patel
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego (UCSD), CA, USA
- UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Brittany Shelton
- Department of Public Health, College of Education, Health and Human Sciences, University of Tennessee Knoxville, TN, USA
| | - Susanna Concha-Garcia
- Antiviral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
- HIV Neurobehavioral Research Center, University of California San Diego, San Diego, CA, USA
| | - Cheryl Dullano
- Antiviral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
| | - Stephanie Solso
- Antiviral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
| | - Steven Hendrickx
- Antiviral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
| | - Patricia K. Riggs
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego (UCSD), CA, USA
| | - Thomas J. Villa
- HIV Obstruction by Programmed Epigenetics (HOPE) Collaboratory Community Advisory Board, Rockville, MD, USA
| | - Andy Kaytes
- UCSD Antiviral Research Center Community Advisory Board, San Diego, CA, USA
| | - Jeff Taylor
- UCSD Antiviral Research Center Community Advisory Board, San Diego, CA, USA
- HIV + Aging Research Project Palm Springs (HARP-PS), Palm Springs, CA, USA
| | - Susan J. Little
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego (UCSD), CA, USA
- Antiviral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
| | - David Lessard
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, Division of Infectious Diseases, McGill University Health Center (MUCH), Montreal, QC, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Montreal, QC, Canada
- Center for Outcome Research and Evaluation, Research Institute of the McGill University Health Center, Montreal, QC, Canada
| | - Anish K. Arora
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Montreal, QC, Canada
- Center for Outcome Research and Evaluation, Research Institute of the McGill University Health Center, Montreal, QC, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Cecilia T. Costiniuk
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, Division of Infectious Diseases, McGill University Health Center (MUCH), Montreal, QC, Canada
- Department of Medicine, Division of Infectious Diseases and Department of Microbiology and Immunology, McGill University, Montreal, QC, Canada
- Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Shadi Eskaf
- Public Health Research Consultant, Chapel Hill, NC, USA
| | - Davey M. Smith
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego (UCSD), CA, USA
- Antiviral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
| | - Sara Gianella
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego (UCSD), CA, USA
- Antiviral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
| | - Karine Dubé
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego (UCSD), CA, USA
- UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
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Noorman MAJ, de Wit JBF, Marcos TA, Stutterheim SE, Jonas KJ, den Daas C. The Importance of Social Engagement in the Development of an HIV Cure: A Systematic Review of Stakeholder Perspectives. AIDS Behav 2023; 27:3789-3812. [PMID: 37329470 PMCID: PMC10589186 DOI: 10.1007/s10461-023-04095-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/19/2023]
Abstract
As research into the development of an HIV cure gains prominence, assessing the perspectives of stakeholders becomes imperative. It empowers stakeholders to determine priorities and influence research processes. We conducted a systematic review of the empirical literature on stakeholder perspectives. PubMed, Embase, Web of Science, and Scopus were searched for empirical, peer-reviewed articles, published before September 2022. Our analysis of 78 papers showed that stakeholders could be divided into three categories: people with HIV, key populations, and professionals. Following thematic synthesis, two main themes were distinguished: stakeholders' perspectives on HIV cure research and stakeholders' perspectives on HIV cure. Research on perspectives on HIV cure research showed that stakeholders' hypothetical willingness to participate (WTP) in HIV cure research was relatively high, while actual WTP was found to be lower. Studies also identified associated (individual) characteristics of hypothetical WTP, as well as facilitators and barriers to hypothetical participation. Additionally, we reported research on experiences of actual HIV cure research participation. Our analysis of stakeholder perceptions of HIV cure showed that most stakeholders preferred a cure that could eliminate HIV and outlined positive associated impacts. Furthermore, we observed that most included studies were conducted among PWHIV, and in the Global North. To empower stakeholders, we recommend that future research include an even greater diversity of stakeholders and incorporate theories of behavior to further explore how stakeholders decide to meaningfully engage in every stage of HIV cure research.
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Affiliation(s)
- Maaike A J Noorman
- Department of Interdisciplinary Social Science, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands.
| | - John B F de Wit
- Department of Interdisciplinary Social Science, Utrecht University, PO Box 80140, 3508 TC, Utrecht, The Netherlands
| | - Tamika A Marcos
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Sarah E Stutterheim
- Department of Health Promotion and Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Kai J Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Chantal den Daas
- Institute of Applied Health Sciences, Health Psychology Group, University of Aberdeen, Aberdeen, UK
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Dubé K, Shelton B, Patel H, Ndukwe SO, Concha-Garcia S, Dullano C, Solso S, Hendrickx S, Kaytes A, Taylor J, Villa TJ, Little SJ, Riggs PK, Lessard D, Arora AK, Costiniuk CT, Eskaf S, Smith DM, Gianella S. Perceived risks and benefits of enrolling people with HIV at the end of life in cure research in Southern California, United States. J Virus Erad 2023; 9:100328. [PMID: 37440872 PMCID: PMC10334343 DOI: 10.1016/j.jve.2023.100328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/30/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction Although current antiretroviral therapy allows most people with HIV (PWH) to experience normal longevity with a good quality of life, an HIV cure remains elusive due to HIV reservoir formation within deep tissues. An HIV cure remains highly desirable to the community of PWH. This study reports on the perceived risks and benefits of participation in the Last Gift study, a study aimed at characterizing HIV reservoirs via post-mortem autopsy, among PWH at the end of life (EOL) and their next-of-kin (NOK)/loved ones. Methods Last Gift participants (PWH with a terminal illness and/or near the end of life) and their NOK/loved ones were surveyed for perceptions of risks, benefits, and meaning for participation in the Last Gift study. Results The average age of the 17 Last Gift participants was 66.6 years, 3 were females, 1 person identified as Hispanic, and 15 as Caucasian. The average age of the 17 NOK/loved ones was 56.7 years, and relationships to Last Gift participants included partner/spouse, sibling, friend, child, parent, grandparent, and nephew. The only perceived personal risk of the Last Gift among participants was the blood draws (3/17). NOK/loved ones perceived the following risks: blood draws (2/17), physical pain (3/17), worry that something bad will happen (2/17), and unpleasant side effects (1/17). Participants in Last Gift and NOK/loved ones indicated the study had various positive social effects. For both participants and NOK/loved ones, the most frequent perceived personal benefit of the Last Gift was the satisfaction of supporting HIV cure research. Discussion Participants perceived minimal personal and societal risks and valued the altruistic benefits of participating in the Last Gift study. Last Gift participants and NOK/loved ones were cautious about possible personal risks of EOL HIV cure research but still viewed that the emotional, psychological and societal benefits of participation outweighed potential risks.
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Affiliation(s)
- Karine Dubé
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, CA, USA
- UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Brittany Shelton
- Department of Public Health, College of Education, Health and Human Sciences, University of Tennessee Knoxville, TN, USA
| | - Hursch Patel
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, CA, USA
- UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Samuel O. Ndukwe
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, CA, USA
- UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Susanna Concha-Garcia
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
- HIV Neurobehavioral Research Center, University of California San Diego, San Diego, CA, USA
| | - Cheryl Dullano
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
| | - Stephanie Solso
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
| | - Steven Hendrickx
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
| | - Andy Kaytes
- AntiViral Research Center Community Advisory Board, San Diego, CA, USA
| | - Jeff Taylor
- AntiViral Research Center Community Advisory Board, San Diego, CA, USA
- HIV+Aging Research Project-Palm Springs (HARP-PS), Palm Springs, CA, USA
| | - Thomas J. Villa
- Reversing Immune Dysfunction (RID) Martin Delaney Collaboratory for HIV Cure Research Community Advisory Board, Rockville, MD, USA
| | - Susan J. Little
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, CA, USA
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
| | - Patricia K. Riggs
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, CA, USA
| | - David Lessard
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Center (MUCH), Montreal, QC, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Montreal, QC, Canada
- Center for Outcome Research and Evaluation, Research Institute of the McGill University Health Center, Montreal, QC, Canada
| | - Anish K. Arora
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Montreal, QC, Canada
- Center for Outcome Research and Evaluation, Research Institute of the McGill University Health Center, Montreal, QC, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Cecilia T. Costiniuk
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Center (MUCH), Montreal, QC, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, QC, Canada
- Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Shadi Eskaf
- Public Health Research Consultant, Chapel Hill, NC, USA
| | - Davey M. Smith
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, CA, USA
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
| | - Sara Gianella
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, CA, USA
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, USA
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Dubé K, Villa TJ, Taylor J, Kaytes A, Moore DJ, Little SJ, Chaillon A, Smith DM, Gianella S. A Community-Driven Framework to Prioritize the Use of Donated Human Biological Materials in the Context of HIV Cure-Related Research at the End of Life. Pathog Immun 2023; 8:1-16. [PMID: 37252012 PMCID: PMC10225111 DOI: 10.20411/pai.v8i1.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/09/2023] [Indexed: 05/31/2023] Open
Abstract
Initiated in 2017 after extensive community engagement, the Last Gift program enrolls altruistic volunteers willing to donate their cells and tissues at the end of life to allow studies on HIV reservoir dynamics across anatomical sites. As the Last Gift team received tissue requests outside the scope of HIV cure research, we noticed the absence of guiding frameworks to help prioritize the use of altruistically donated human biological materials. In this commentary, we present a proposed framework for prioritizing the use of donated human biological materials within and outside the end-of-life (EOL) HIV cure research context, using the Last Gift study as an example. First, we discuss regulatory and policy considerations, and highlight key ethical values to guide prioritization decisions. Second, we present our prioritization framework and share some of our experiences prioritizing requests for donated human biological materials within and outside EOL HIV cure research.
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Affiliation(s)
- Karine Dubé
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, CA
- AntiViral Research Center, University of California San Diego, San Diego, CA
- Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, NC
| | - Thomas J. Villa
- HIV Obstruction by Programmed Epigenetics Delaney Collaboratory Community Team, San Francisco, CA
- Reversing Immune Dysfunction Delaney Collaboratory for HIV Cure Research Community Advisory Board, La Jolla, CA
| | - Jeff Taylor
- Reversing Immune Dysfunction Delaney Collaboratory for HIV Cure Research Community Advisory Board, La Jolla, CA
- HIV + Aging Research Project – Palm Springs, Palm Springs, CA
- AntiViral Research Center Community Advisory Board, University of California San Diego, San Diego, CA
| | - Andy Kaytes
- Reversing Immune Dysfunction Delaney Collaboratory for HIV Cure Research Community Advisory Board, La Jolla, CA
- AntiViral Research Center Community Advisory Board, University of California San Diego, San Diego, CA
| | - David J. Moore
- Department of Psychiatry, School of Medicine, University of California San Diego, San Diego, CA
| | - Susan J. Little
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, CA
- AntiViral Research Center, University of California San Diego, San Diego, CA
| | - Antoine Chaillon
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, CA
| | - Davey M. Smith
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, CA
- AntiViral Research Center, University of California San Diego, San Diego, CA
| | - Sara Gianella
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, La Jolla, CA
- AntiViral Research Center, University of California San Diego, San Diego, CA
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Riggs PK, Chaillon A, Jiang G, Letendre SL, Tang Y, Taylor J, Kaytes A, Smith DM, Dubé K, Gianella S. Lessons for Understanding Central Nervous System HIV Reservoirs from the Last Gift Program. Curr HIV/AIDS Rep 2022; 19:566-579. [PMID: 36260191 PMCID: PMC9580451 DOI: 10.1007/s11904-022-00628-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE OF REVIEW Deep tissue HIV reservoirs, especially within the central nervous system (CNS), are understudied due to the challenges of sampling brain, spinal cord, and other tissues. Understanding the cellular characteristics and viral dynamics in CNS reservoirs is critical so that HIV cure trials can address them and monitor the direct and indirect effects of interventions. The Last Gift program was developed to address these needs by enrolling altruistic people with HIV (PWH) at the end of life who agree to rapid research autopsy. RECENT FINDINGS Recent findings from the Last Gift emphasize significant heterogeneity across CNS reservoirs, CNS compartmentalization including differential sensitivity to broadly neutralizing antibodies, and bidirectional migration of HIV across the blood-brain barrier. Our findings add support for the potential of CNS reservoirs to be a source of rebounding viruses and reseeding of systemic sites if they are not targeted by cure strategies. This review highlights important scientific, practical, and ethical lessons learned from the Last Gift program in the context of recent advances in understanding the CNS reservoirs and key knowledge gaps in current research.
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Affiliation(s)
| | | | - Guochun Jiang
- Department of Biochemistry and Biophysics, Institute of Global Health and Infectious Diseases, UNC HIV Cure Center, Chapel Hill, NC, USA
| | | | - Yuyang Tang
- Department of Biochemistry and Biophysics, Institute of Global Health and Infectious Diseases, UNC HIV Cure Center, Chapel Hill, NC, USA
| | - Jeff Taylor
- AntiViral Research Center (AVRC) Community Advisory Board, University of California San Diego, San Diego, CA, USA
- HIV + Aging Research Project - Palm Springs (HARP-PS), Palm Springs, CA, USA
| | - Andrew Kaytes
- AntiViral Research Center (AVRC) Community Advisory Board, University of California San Diego, San Diego, CA, USA
| | | | - Karine Dubé
- Department of Medicine, UCSD, San Diego, CA, USA
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Lessard D, Dubé K, Bilodeau M, Keeler P, Margolese S, Rosenes R, Sinyavskaya L, Durand M, Benko E, Kovacs C, Guerlotté C, Tharao W, Arnold K, Masching R, Taylor D, Sousa J, Ostrowski M, Taylor J, Kaytes A, Smith D, Gianella S, Chomont N, Angel JB, Routy JP, Cohen ÉA, Lebouché B, Costiniuk CT. Willingness of Older Canadians with HIV to Participate in HIV Cure Research Near and After the End of Life: A Mixed-Method Study. AIDS Res Hum Retroviruses 2022; 38:670-682. [PMID: 35778845 PMCID: PMC9483839 DOI: 10.1089/aid.2022.0006] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
HIV cure research requires interrogating latent HIV reservoirs in deep tissues, which necessitates autopsies to avoid risks to participants. An HIV autopsy biobank would facilitate this research, but such research raises ethical issues and requires participant engagement. This study explores the willingness to participate in HIV cure research at the end of life. Participants include Canadians with HIV [people with HIV (PWHIV)] aged 55 years or older. Following a mixed-method study design, all participants completed a phone or online survey, and a subset of participants participated in in-depth phone or videoconference interviews. We produced descriptive statistics of quantitative data and a thematic analysis of qualitative data. Barriers and facilitators were categorized under domains of the Theoretical Domains Framework. From April 2020 to August 2021, 37 participants completed the survey (mean age = 69.9 years old; mean duration of HIV infection = 28.5 years), including 15 interviewed participants. About three quarters of participants indicated being willing to participate in hypothetical medical studies toward the end of life (n = 30; 81.1%), in HIV biobanking (n = 30; 81.1%), and in a research autopsy (n = 28; 75.7%) to advance HIV cure research, mainly for altruistic benefits. The main perceived risks had to do with physical pain and confidentiality. Barriers and facilitators were distributed across five domains: social/professional role and identity, environmental context and resources, social influences, beliefs about consequences, and capabilities. Participants wanted more information about study objectives and procedures, possible accommodations with their last will, and rationale for studies or financial interests funding studies. Our results indicate that older PWHIV would be willing to participate in HIV cure research toward the end of life, HIV biobanking, and research autopsy. However, a dialogue should be initiated to inform participants thoroughly about HIV cure studies, address concerns, and accommodate their needs and preferences. Additional work is required, likely through increased community engagement, to address educational needs.
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Affiliation(s)
- David Lessard
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre (MUHC), Montreal, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Montreal, Canada
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Karine Dubé
- Department of Medicine, The Last Gift Team, Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, San Diego, California, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | - Shari Margolese
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
| | - Ron Rosenes
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
| | - Liliya Sinyavskaya
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada
| | - Madeleine Durand
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | | | | | - Charlotte Guerlotté
- COCQ-Sida, Montreal, Canada
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
| | - Wangari Tharao
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
- Women's Health in Women's Hands, Canada and African and Black Diaspora Global Network on HIV and AIDS, Toronto, Canada
- African and Caribbean Council on HIV/AIDS in Ontario, Toronto, Canada
| | - Keresa Arnold
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
- African and Caribbean Council on HIV/AIDS in Ontario, Toronto, Canada
| | - Renée Masching
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
- Canadian Aboriginal AIDS Network, Dartmouth, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada
| | - Darien Taylor
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
| | - José Sousa
- Canadian HIV Cure Enterprise (CanCURE) Community Advisory Board, Toronto, Canada
| | - Mario Ostrowski
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada
| | - Jeff Taylor
- Department of Medicine, The Last Gift Team, Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, San Diego, California, USA
| | - Andy Kaytes
- Department of Medicine, The Last Gift Team, Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, San Diego, California, USA
| | - Davey Smith
- Department of Medicine, The Last Gift Team, Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, San Diego, California, USA
| | - Sara Gianella
- Department of Medicine, The Last Gift Team, Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, San Diego, California, USA
| | - Nicolas Chomont
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal and Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Canada
| | - Jonathan B. Angel
- Ottawa Hospital Research Institute and Division of Infectious Disease, The Ottawa Hospital, Ottawa, Canada
| | - Jean-Pierre Routy
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre (MUHC), Montreal, Canada
| | - Éric A. Cohen
- Institut de Recherche Clinique de Montréal, Montreal, Canada
- Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montreal, Canada
| | - Bertrand Lebouché
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre (MUHC), Montreal, Canada
- Canadian Institutes of Health Research Strategy for Patient-Oriented Research Mentorship Chair in Innovative Clinical Trials, Montreal, Canada
- Centre for Outcome Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Cecilia T. Costiniuk
- Chronic Viral Illness Service, Division of Infectious Diseases, Department of Medicine, McGill University Health Centre (MUHC), Montreal, Canada
- Division of Infectious Diseases, Department of Medicine, McGill University, Montreal, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, Canada
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Langer SL, Castro FG, Chen ACC, Davis KC, Joseph RP, Kim WS, Larkey L, Lee RE, Petrov ME, Reifsnider E, Youngstedt SD, Shaibi GQ. Recruitment and retention of underrepresented and vulnerable populations to research. Public Health Nurs 2021; 38:1102-1115. [PMID: 34240459 DOI: 10.1111/phn.12943] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/22/2021] [Accepted: 06/23/2021] [Indexed: 11/28/2022]
Abstract
Per principles outlined in the Belmont Report, research involving human subjects should minimize risks to participants and maximize benefits to participants and society. Recruitment of participants should be equitable. Once enrolled, participants have the right to withdraw at any point. Researchers must balance these principles with pressures to meet enrollment goals and, in the context of repeated-measures designs, retain participants across time. The purpose of this perspective is to describe the approach and corresponding activities for recruiting and retaining underrepresented and vulnerable populations that are the focus of a transdisciplinary academic research center. To this effort, we offer diverse disciplinary backgrounds, experience working with a wide range of populations (from infants to older adults and across multiple health conditions), and spanning a variety of research designs. Effective strategies offered include partnering with community entities, approaching potential participants where they are and at a time of readiness, using population-appropriate modes of communication and data collection, conducting study activities in familiar settings and at convenient times, maintaining frequent contact, and offering meaningful incentives. These strategies are consistent with population-specific reports found in the extant literature and underscore their cross-cutting nature, with adaptations based on participant and community partner needs and preferences.
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Affiliation(s)
- Shelby L Langer
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Felipe González Castro
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Angela Chia-Chen Chen
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Kelly Cue Davis
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Rodney P Joseph
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Wonsun Sunny Kim
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Linda Larkey
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Rebecca E Lee
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Megan E Petrov
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Elizabeth Reifsnider
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Shawn D Youngstedt
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
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8
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Dubé K, Kanazawa J, Taylor J, Dee L, Jones N, Roebuck C, Sylla L, Louella M, Kosmyna J, Kelly D, Clanton O, Palm D, Campbell DM, Onaiwu MG, Patel H, Ndukwe S, Henley L, Johnson MO, Saberi P, Brown B, Sauceda JA, Sugarman J. Ethics of HIV cure research: an unfinished agenda. BMC Med Ethics 2021; 22:83. [PMID: 34193141 PMCID: PMC8243312 DOI: 10.1186/s12910-021-00651-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 06/23/2021] [Indexed: 02/07/2023] Open
Abstract
Background The pursuit of a cure for HIV is a high priority for researchers, funding agencies, governments and people living with HIV (PLWH). To date, over 250 biomedical studies worldwide are or have been related to discovering a safe, effective, and scalable HIV cure, most of which are early translational research and experimental medicine. As HIV cure research increases, it is critical to identify and address the ethical challenges posed by this research. Methods We conducted a scoping review of the growing HIV cure research ethics literature, focusing on articles published in English peer-reviewed journals from 2013 to 2021. We extracted and summarized key developments in the ethics of HIV cure research. Twelve community advocates actively engaged in HIV cure research provided input on this summary and suggested areas warranting further ethical inquiry and foresight via email exchange and video conferencing. Discussion Despite substantial scholarship related to the ethics of HIV cure research, additional attention should focus on emerging issues in six categories of ethical issues: (1) social value (ongoing and emerging biomedical research and scalability considerations); (2) scientific validity (study design issues, such as the use of analytical treatment interruptions and placebos); (3) fair selection of participants (equity and justice considerations); (4) favorable benefit/risk balance (early phase research, benefit-risk balance, risk perception, psychological risks, and pediatric research); (5) informed consent (attention to language, decision-making, informed consent processes and scientific uncertainty); and (6) respect for enrolled participants and community (perspectives of people living with HIV and affected communities and representation). Conclusion HIV cure research ethics has an unfinished agenda. Scientific research and bioethics should work in tandem to advance ethical HIV cure research. Because the science of HIV cure research will continue to rapidly advance, ethical considerations of the major themes we identified will need to be revisited and refined over time.
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Affiliation(s)
- Karine Dubé
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC, 27599-7469, USA.
| | - John Kanazawa
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC, 27599-7469, USA
| | - Jeff Taylor
- HIV + Aging Research Project - Palm Springs (HARP-PS), Palm Springs, CA, USA.,AntiViral Research Center (AVRC) Community Advisory Board (CAB), San Diego, CA, USA.,Collaboratory of AIDS Researchers for Eradication (CARE) CAB, Chapel Hill, NC, USA
| | - Lynda Dee
- AIDS Action Baltimore, Baltimore, MD, USA.,Delaney AIDS Research Enterprise (DARE) Community Advisory Board (CAB), San Francisco, CA, USA
| | - Nora Jones
- BEAT-HIV Collaboratory CAB, Philadelphia, PA, USA
| | | | | | | | - Jan Kosmyna
- AIDS Clinical Trials Group (ACTG) Community Scientific Subcommittee (CSS) Ethics Working Group, Nationwide, USA
| | - David Kelly
- AIDS Clinical Trials Group (ACTG) Community Scientific Subcommittee (CSS) Ethics Working Group, Nationwide, USA
| | - Orbit Clanton
- AIDS Clinical Trials Group Global CAB, Washington, D.C., USA
| | - David Palm
- Collaboratory of AIDS Researchers for Eradication (CARE) CAB, Chapel Hill, NC, USA.,Institute of Global Health and Infectious Diseases HIV Treatment and Prevention CAB, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Danielle M Campbell
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board (CAB), San Francisco, CA, USA.,Charles R. Drew College of Medicine and Science, Los Angeles, CA, USA
| | - Morénike Giwa Onaiwu
- AIDS Clinical Trials Group (ACTG) Community Scientific Subcommittee (CSS) Ethics Working Group, Nationwide, USA.,Center for the Study of Women, Gender, and Sexuality (School of Humanities), Rice University, Houston, TX, USA
| | - Hursch Patel
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC, 27599-7469, USA
| | - Samuel Ndukwe
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC, 27599-7469, USA
| | - Laney Henley
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC, 27599-7469, USA
| | - Mallory O Johnson
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA, USA
| | - Parya Saberi
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA, USA
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside, Riverside, CA, USA
| | - John A Sauceda
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA, USA
| | - Jeremy Sugarman
- Johns Hopkins Berman Institute for Bioethics, Baltimore, MD, USA
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9
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Attitudes and perceptions of next-of-kin/loved ones toward end-of-life HIV cure-related research: A qualitative focus group study in Southern California. PLoS One 2021; 16:e0250882. [PMID: 33961653 PMCID: PMC8104928 DOI: 10.1371/journal.pone.0250882] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 04/15/2021] [Indexed: 01/02/2023] Open
Abstract
As end-of-life (EOL) HIV cure-related research expands, understanding perspectives of participants’ next-of-kin (NOK) is critical to maintaining ethical study conduct. We conducted two small focus groups and two one-on-one interviews using focus group guides with the NOK of Last Gift study participants at the University of California, San Diego (UCSD). Participating NOK included six individuals (n = 5 male and n = 1 female), including a grandmother, grandfather, partner, spouse, and two close friends. Researchers double-coded the transcripts manually for overarching themes and sub-themes using an inductive approach. We identified six key themes: 1) NOK had an accurate, positive understanding of the Last Gift clinical study; 2) NOK felt the study was conducted ethically; 3) Perceived benefits for NOK included support navigating the dying/grieving process and personal growth; 4) Perceived drawbacks included increased sadness, emotional stress, conflicted wishes between NOK and study participants, and concerns around potential invasiveness of study procedures at the EOL; 5) NOK expressed pride in loved ones’ altruism; and 6) NOK provided suggestions to improve the Last Gift study, including better communication between staff and themselves. These findings provide a framework for ethical implementation of future EOL HIV cure-related research involving NOK.
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10
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Perry KE, Dubé K, Concha-Garcia S, Patel H, Kaytes A, Taylor J, Javadi SS, Mathur K, Lo M, Brown B, Sauceda JA, Wohl DA, Little S, Hendrickx S, Rawlings SA, Smith DM, Gianella S. "My Death Will Not [Be] in Vain": Testimonials from Last Gift Rapid Research Autopsy Study Participants Living with HIV at the End of Life. AIDS Res Hum Retroviruses 2020; 36:1071-1082. [PMID: 32449625 PMCID: PMC7703253 DOI: 10.1089/aid.2020.0020] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
End-of-life (EOL) HIV cure-related research provides a novel approach to studying HIV reservoirs. The Last Gift is a rapid autopsy research study at the University of California San Diego that enrolls terminally ill people living with HIV (PLWHIV) with a desire to contribute to HIV cure-related research. We conducted in-depth baseline and follow-up interviews with Last Gift study participants. We analyzed interview data applying conventional content analysis. Since summer 2017, 13 participants have been enrolled (n = 11 males and 2 females; aged 45-89 years) and 8 participants interviewed. Terminal illnesses included cancers, heart diseases, and neurodegenerative illnesses. Our analysis revealed five key themes: (1) The Last Gift study has tremendous meaning for participants at the end of their life. (2) HIV-specific altruism was a primary motivator to join the Last Gift study, nested within the context of community, scientific advancement, and moral obligation. (3) Participants did not expect physical benefits yet they perceived emotional/psychological, financial, and societal/scientific benefits. (4) There were minimal participant-perceived risks and concerns. (5) Last Gift participants expressed immense gratitude toward study staff. The Last Gift study provides a framework for ethical HIV cure-related research at EOL and highlighted participants' perspectives, motivations, and experiences. Knowing how PLWHIV understand and experience such studies will remain critical to designing ethical, fully informed HIV cure research protocols that are acceptable to PLWHIV.
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Affiliation(s)
- Kelly E. Perry
- Public Health Leadership Program, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Karine Dubé
- Public Health Leadership Program, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Susanna Concha-Garcia
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
- HIV Neurobehavioral Research Program, University of California San Diego, San Diego, California, USA
| | - Hursch Patel
- Public Health Leadership Program, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Andy Kaytes
- Community Advisory Board, AntiViral Research Center, San Diego, California, USA
| | - Jeff Taylor
- Community Advisory Board, AntiViral Research Center, San Diego, California, USA
- HIV+Aging Research Project–Palm Springs (HARP-PS), Palm Springs, California, USA
| | - Sogol Stephanie Javadi
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Kushagra Mathur
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Megan Lo
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside, Riverside, California, USA
| | - John A. Sauceda
- Department of Medicine, Division of Prevention Sciences, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California, USA
| | - David A. Wohl
- Department of Medicine, Institute of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Susan Little
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Steven Hendrickx
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Stephen A. Rawlings
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Davey M. Smith
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Sara Gianella
- Department of Medicine, University of California San Diego School of Medicine, AntiViral Research Center, University of California San Diego, San Diego, California, USA
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
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11
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Perry KE, Taylor J, Patel H, Javadi SS, Mathur K, Kaytes A, Concha-Garcia S, Little S, Smith D, Gianella S, Dubé K. "[It] is now my responsibility to fulfill that wish:" Clinical and rapid autopsy staff members' experiences and perceptions of HIV reservoir research at the end of life. PLoS One 2020; 15:e0242420. [PMID: 33206710 PMCID: PMC7673534 DOI: 10.1371/journal.pone.0242420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 11/03/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Little is known about the effects of HIV reservoir research at the end of life on staff members involved. Staff members' perceptions and experiences were assessed related to their involvement in the Last Gift, a rapid autopsy study at the University of California San Diego enrolling people living with HIV who are terminally ill and have a desire to contribute to HIV cure-related research. METHODS Two focus group discussions consisting of clinical (n = 7) and rapid research autopsy (n = 8) staff members were conducted to understand the perspectives of staff members and the impact the Last Gift rapid autopsy study had on them. The total sample consisted of 66.7% females and 33.3% males and was ethnically diverse (66.7% Caucasian, 6.7% African American, 20.0% Asian descent, 6.7% Hispanic descent and American Indian) with a range of experience in the HIV field from 1 year to 30 years. RESULTS Qualitative focus group data revealed five major themes underlying study staff members' multilayered mental and practical involvement: 1) positive perceptions of the Last Gift study, with sub-themes including Last Gift study participants' altruism, fulfillment, and control at the end of life, 2) perceptions of staff members' close involvement in the Last Gift study, with sub-themes related to staff members' cognitive processing, self-actualization and fulfillment, stress management and resilience, coping mechanisms, and gratitude toward Last Gift participants and toward the study itself, 3) considerations for successful and sustainable study implementation, such as ethical awareness and sustained community and patient engagement, 4) collaborative learning and organizational processes and the value of interdependence between staff members, and 5) considerations for potential study scale-up at other clinical research sites. DISCUSSION Understanding staff members' nuanced emotional and procedural experiences is crucial to the Last Gift study's sustainability and will inform similar cure research studies conducted with people living with HIV at the end of life. The study's potential reproducibility depends on a robust research infrastructure with established, interdependent clinical and rapid autopsy teams, continuous community engagement, and an ethical and well-informed engagement process with people living with HIV.
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Affiliation(s)
- Kelly E. Perry
- UNC Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| | - Jeff Taylor
- AntiViral Research Center Community Advisory Board, San Diego, CA, United States of America
- HIV + Aging Research Project–Palm Springs (HARP-PS), Palm Springs, CA, United States of America
| | - Hursch Patel
- UNC Gillings School of Global Public Health, Chapel Hill, NC, United States of America
| | - Sogol Stephanie Javadi
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, United States of America
| | - Kushagra Mathur
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, United States of America
| | - Andy Kaytes
- AntiViral Research Center Community Advisory Board, San Diego, CA, United States of America
| | - Susanna Concha-Garcia
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, United States of America
- HIV Neurobehavioral Research Center, University of California San Diego, San Diego, CA, United States of America
| | - Susan Little
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, United States of America
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, United States of America
| | - Davey Smith
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, United States of America
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, United States of America
| | - Sara Gianella
- AntiViral Research Center (AVRC), University of California San Diego, San Diego, CA, United States of America
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, CA, United States of America
| | - Karine Dubé
- UNC Gillings School of Global Public Health, Chapel Hill, NC, United States of America
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12
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Dubé K, Perry KE, Mathur K, Lo M, Javadi SS, Patel H, Concha-Garcia S, Taylor J, Kaytes A, Dee L, Campbell D, Kanazawa J, Smith D, Gianella S, Auerbach JD, Saberi P, Sauceda JA. Altruism: Scoping review of the literature and future directions for HIV cure-related research. J Virus Erad 2020; 6:100008. [PMID: 33294210 PMCID: PMC7695811 DOI: 10.1016/j.jve.2020.100008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/27/2020] [Accepted: 08/20/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The question of what motivates people to participate in research is particularly salient in the HIV field. While participation in HIV research was driven by survival in the 1980's and early 1990's, access to novel therapies became the primary motivator with the advent of combination antiretroviral therapy (cART) in the late 1990s. In the HIV cure-related research context, the concept of altruism has remained insufficiently studied. METHODS We conducted a scoping review to better contextualize and understand how altruism is or could be operationalized in HIV cure-related research. We drew from the fields of altruism in general, clinical research, cancer, and HIV clinical research-including the HIV prevention, treatment, and cure-related research fields. DISCUSSION Altruism as a key motivating factor for participation in clinical research has often been intertwined with the desire for personal benefit. The cancer field informs us that reasons for participation usually are multi-faceted and complex. The HIV prevention field offers ways to organize altruism-either by the types of benefits achieved (e.g., societal versus personal), or the origin of the values that motivate research participation. The HIV treatment literature reveals the critical role of clinical interactions in fostering altruism. There remains a dearth of in-depth knowledge regarding reasons surrounding research participation and the types of altruism displayed in HIV cure-related clinical research. CONCLUSION Lessons learned from various research fields can guide questions which will inform the assessment of altruism in future HIV cure-related research.
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Affiliation(s)
- Karine Dubé
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Kelly E. Perry
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Kushagra Mathur
- University of California San Diego (UCSD) School of Medicine, San Diego, CA, USA
| | - Megan Lo
- University of California San Diego (UCSD) School of Medicine, San Diego, CA, USA
| | - Sogol S. Javadi
- University of California San Diego (UCSD) School of Medicine, San Diego, CA, USA
| | - Hursch Patel
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Susanna Concha-Garcia
- AntiViral Research Center (AVRC), USA, San Diego, CA, USA
- HIV Neurobehavioral Research Program, UCSD, San Diego, CA, USA
| | - Jeff Taylor
- AVRC Community Advisory Board (CAB), San Diego, CA, USA
- amfAR Institute for HIV Cure Research CAB, San Francisco, CA, USA
- HIV + Aging Research Project – Palm Springs (HARP – PS), Palm Springs, CA, USA
| | - Andy Kaytes
- AVRC Community Advisory Board (CAB), San Diego, CA, USA
| | - Lynda Dee
- amfAR Institute for HIV Cure Research CAB, San Francisco, CA, USA
- AIDS Action Baltimore, Baltimore, MD, CA, USA
- Delaney AIDS Research Enterprise (DARE), CAB, San Francisco, CA, USA
| | - Danielle Campbell
- Delaney AIDS Research Enterprise (DARE), CAB, San Francisco, CA, USA
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
| | - John Kanazawa
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - David Smith
- AntiViral Research Center (AVRC), USA, San Diego, CA, USA
- Division of Infectious Diseases and Global Public Health, UCSD, San Diego, CA, USA
| | - Sara Gianella
- AntiViral Research Center (AVRC), USA, San Diego, CA, USA
- Division of Infectious Diseases and Global Public Health, UCSD, San Diego, CA, USA
| | - Judith D. Auerbach
- School of Medicine, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Parya Saberi
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA, USA
| | - John A. Sauceda
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA, USA
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13
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Sandstrom TS, Burke Schinkel SC, Angel JB. Medical Assistance in Death as a Unique Opportunity to Advance Human Immunodeficiency Virus Cure Research. Clin Infect Dis 2020; 69:1063-1067. [PMID: 30715211 DOI: 10.1093/cid/ciz068] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/12/2018] [Accepted: 01/18/2019] [Indexed: 12/31/2022] Open
Abstract
The inability to sample deep-tissue reservoirs in individuals living with human immunodeficiency virus (HIV) has greatly hindered accurate estimates of viral reservoir size and distribution. Animal models and collection of tissues during autopsies of HIV-positive individuals are 2 proposed solutions to this problem. Each, however, has its limitations. In this Viewpoint, we argue that tissue donation following medical assistance in death (MAiD) will form an invaluable resource for the characterization of the viral reservoir in the context of current HIV cure research. In support, we discuss a recent instance in which an individual living with HIV chose to donate their body/tissues to HIV research prior to undergoing MAiD at our institution. Going forward, we hope this will help provide support to individuals in their decisions around tissue donation following MAiD, while highlighting how healthcare providers, by complying with such wishes, can affect patient satisfaction in the last days of life.
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Affiliation(s)
- Teslin S Sandstrom
- Ottawa Hospital Research Institute.,Department of Biochemistry, Microbiology & Immunology, University of Ottawa
| | | | - Jonathan B Angel
- Ottawa Hospital Research Institute.,Department of Biochemistry, Microbiology & Immunology, University of Ottawa.,Division of Infectious Diseases, Ottawa Hospital-General Campus, Canada
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14
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Rawlings SA, Layman L, Smith D, Scott B, Ignacio C, Porrachia M, Concha-Garcia S, Hendrickx S, Kaytes A, Taylor J, Gianella S. Performing rapid autopsy for the interrogation of HIV reservoirs. AIDS 2020; 34:1089-1092. [PMID: 32287073 PMCID: PMC7780881 DOI: 10.1097/qad.0000000000002546] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
: Rapid autopsy at the end of life in people with HIV (PWH) permits the preservation of valuable tissue specimens for subsequent study of HIV reservoirs. At our institution, we have developed a cohort of PWH who consent to a rapid autopsy to gather a wide range of fluids and tissues with the goal of advancing HIV cure research. The protocol for successfully performing these autopsies has required careful thought and development over months and years. We have now successfully performed six rapid autopsies and detail here our steps to build the study cohort, train and staff a team of more than a dozen personnel, and process and preserve hundreds of samples from each autopsy.
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Affiliation(s)
- Stephen A. Rawlings
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, Stein Clinical Research Building
| | - Laura Layman
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, Stein Clinical Research Building
| | - Davey Smith
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, Stein Clinical Research Building
- Veterans Affairs Viral Research Laboratory
| | - Brianna Scott
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, Stein Clinical Research Building
| | - Caroline Ignacio
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, Stein Clinical Research Building
| | | | - Susanna Concha-Garcia
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, Stein Clinical Research Building
| | - Steven Hendrickx
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, Stein Clinical Research Building
| | - Andy Kaytes
- Antiviral Research Center Community Advisory Board, University of California, San Diego, San Diego
| | - Jeff Taylor
- Antiviral Research Center Community Advisory Board, University of California, San Diego, San Diego
- HIV and Aging Research Project – Palm Springs (HARP-PS), Palm Springs, California, USA
| | - Sara Gianella
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, Stein Clinical Research Building
- Veterans Affairs Viral Research Laboratory
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15
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Steel R. Reconceptualising risk-benefit analyses: the case of HIV cure research. JOURNAL OF MEDICAL ETHICS 2020; 46:212-219. [PMID: 31732681 DOI: 10.1136/medethics-2019-105548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/25/2019] [Accepted: 10/08/2019] [Indexed: 06/10/2023]
Abstract
Modern antiretroviral therapies (ART) are capable of suppressing HIV in the bloodstream to undetectable levels. Nonetheless, people living with HIV must maintain lifelong adherence to ART to avoid the re-emergence of the infection. So despite the existence and efficacy of ART, there is still substantial interest in development of a cure. But HIV cure trials can be risky, their success is as of yet unlikely, and the medical gain of being cured is limited against a baseline of ART access. The medical prospect associated with participation in cure research thus look poor. Are the risks and burdens that HIV cure research places on participants so high that it is unethical, at present, to conduct it? In this paper, I answer 'no'. I start my argument by describing a foundational way of thinking about the ethical justification for regulatory limits on research risk; I then apply this way of thinking to HIV cure trials. In offering this analysis, I confine my attention to studies enrolling competent adults and I also do not consider risks research may pose to third parties or society. Rather, my concern is to engage with the thought that some trials are so risky that performing them is an ethically unacceptable way to treat the participants themselves. I reject this thought and instead argue that there is no level of risk, no matter how high, that inherently mistreats a participant.
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Affiliation(s)
- Robert Steel
- Clinical Center Department of Bioethics, National Institutes of Health Clinical Center, Bethesda, MD 20892, USA
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16
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Schwarzer R, Gramatica A, Greene WC. Reduce and Control: A Combinatorial Strategy for Achieving Sustained HIV Remissions in the Absence of Antiretroviral Therapy. Viruses 2020; 12:v12020188. [PMID: 32046251 PMCID: PMC7077203 DOI: 10.3390/v12020188] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/05/2020] [Accepted: 02/05/2020] [Indexed: 12/23/2022] Open
Abstract
Human immunodeficiency virus (HIV-1) indefinitely persists, despite effective antiretroviral therapy (ART), within a small pool of latently infected cells. These cells often display markers of immunologic memory and harbor both replication-competent and -incompetent proviruses at approximately a 1:100 ratio. Although complete HIV eradication is a highly desirable goal, this likely represents a bridge too far for our current and foreseeable technologies. A more tractable goal involves engineering a sustained viral remission in the absence of ART––a “functional cure.” In this setting, HIV remains detectable during remission, but the size of the reservoir is small and the residual virus is effectively controlled by an engineered immune response or other intervention. Biological precedence for such an approach is found in the post-treatment controllers (PTCs), a rare group of HIV-infected individuals who, following ART withdrawal, do not experience viral rebound. PTCs are characterized by a small reservoir, greatly reduced inflammation, and the presence of a poorly understood immune response that limits viral rebound. Our goal is to devise a safe and effective means for replicating durable post-treatment control on a global scale. This requires devising methods to reduce the size of the reservoir and to control replication of this residual virus. In the following sections, we will review many of the approaches and tools that likely will be important for implementing such a “reduce and control” strategy and for achieving a PTC-like sustained HIV remission in the absence of ART.
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‘Be the match’. Predictors of decisions concerning registration in potential bone marrow donor registry in a group of Polish young adults as an example of prosocial behaviour. CURRENT PSYCHOLOGY 2019. [DOI: 10.1007/s12144-019-00319-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Highlights from the Fourth Biennial Strategies for an HIV Cure Meeting, 10–12 October 2018, Bethesda, MD, USA. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30280-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Kuo L, Lawrence D, McDonald D, Refsland E, Bridges S, Smiley S, Tressler RL, Beaubien C, Salzwedel K. Highlights from the Fourth Biennial Strategies for an HIV Cure Meeting, 10-12 October 2018, Bethesda, MD, USA. J Virus Erad 2019; 5:50-59. [PMID: 30800428 PMCID: PMC6362907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The National Institute of Allergy and Infectious Diseases (NIAID) organised the Strategies for an HIV Cure 2018 meeting focused on research to develop innovative strategies for eradicating or achieving long-term remission of HIV infection. The purpose was to bring together researchers studying HIV persistence and cure strategies, including the six National Institutes of Health (NIH)-funded Martin Delaney Collaboratories for HIV Cure Research (MDCs), as well as industry and community partners, to share scientific results and stimulate active discussion among all stakeholders about the merits of various approaches under investigation. These discussions were intended to stimulate new collaborations and ideas for future research. The meeting covered a comprehensive range of topics spanning basic and translational research, drug discovery and development, and clinical research. Aside from the oral presentations described here, the meeting also included 130 poster presentations. Each of the three days of presentations is available for viewing via the NIH VideoCast website at: https://videocast.nih.gov/PastEvents.asp.
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Affiliation(s)
- Lillian Kuo
- Division of AIDS,
National Institute of Allergy and Infectious Diseases,
Bethesda,
MD,
USA
| | - Diane Lawrence
- Division of AIDS,
National Institute of Allergy and Infectious Diseases,
Bethesda,
MD,
USA
| | - David McDonald
- Division of AIDS,
National Institute of Allergy and Infectious Diseases,
Bethesda,
MD,
USA
| | - Eric Refsland
- Division of AIDS,
National Institute of Allergy and Infectious Diseases,
Bethesda,
MD,
USA
| | - Sandra Bridges
- Division of AIDS,
National Institute of Allergy and Infectious Diseases,
Bethesda,
MD,
USA
| | - Stephen Smiley
- Division of AIDS,
National Institute of Allergy and Infectious Diseases,
Bethesda,
MD,
USA
| | - Randall L Tressler
- Division of AIDS,
National Institute of Allergy and Infectious Diseases,
Bethesda,
MD,
USA
| | - Candice Beaubien
- Division of AIDS,
National Institute of Allergy and Infectious Diseases,
Bethesda,
MD,
USA
| | - Karl Salzwedel
- Division of AIDS,
National Institute of Allergy and Infectious Diseases,
Bethesda,
MD,
USA
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Dubé K, Gianella S, Concha-Garcia S, Little SJ, Kaytes A, Taylor J, Mathur K, Javadi S, Nathan A, Patel H, Luter S, Philpott-Jones S, Brown B, Smith D. Ethical considerations for HIV cure-related research at the end of life. BMC Med Ethics 2018; 19:83. [PMID: 30342507 PMCID: PMC6196016 DOI: 10.1186/s12910-018-0321-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 10/02/2018] [Indexed: 12/25/2022] Open
Abstract
Background The U.S. National Institute of Allergies and Infectious Diseases (NIAID) and the National Institute of Mental Health (NIMH) have a new research priority: inclusion of terminally ill persons living with HIV (PLWHIV) in HIV cure-related research. For example, the Last Gift is a clinical research study at the University of California San Diego (UCSD) for PLWHIV who have a terminal illness, with a prognosis of less than 6 months. Discussion As end-of-life (EOL) HIV cure research is relatively new, the scientific community has a timely opportunity to examine the related ethical challenges. Following an extensive review of the EOL and HIV cure research ethics literature, combined with deliberation from various stakeholders (biomedical researchers, PLWHIV, bioethicists, and socio-behavioral scientists) and our experience with the Last Gift study to date, we outline considerations to ensure that such research with terminally ill PLWHIV remains ethical, focusing on five topics: 1) protecting autonomy through informed consent, 2) avoiding exploitation and fostering altruism, 3) maintaining a favorable benefits/risks balance, 4) safeguarding against vulnerability through patient-participant centeredness, and 5) ensuring the acceptance of next-of-kin/loved ones and community stakeholders. Conclusion EOL HIV cure-related research can be performed ethically and effectively by anticipating key issues that may arise. While not unique to the fields of EOL or HIV cure-related research, the considerations highlighted can help us support a new research approach. We must honor the lives of PLWHIV whose involvement in research can provide the knowledge needed to achieve the dream of making HIV infection curable.
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Affiliation(s)
- Karine Dubé
- Gillings School of Global Public Health, University of North Carolina, 4108 McGavran-Greenberg Hall, Chapel Hill, North Carolina, USA.
| | - Sara Gianella
- Division of Infectious Diseases and Global Public Health, University of California San Diego, Stein Clinical Research Building, La Jolla, California, USA.,AntiViral Research Center (AVRC), University of California San Diego, 220 Dickinson Street, Suite A, San Diego, California, USA
| | - Susan Concha-Garcia
- Division of Infectious Diseases and Global Public Health, University of California San Diego, Stein Clinical Research Building, La Jolla, California, USA.,AntiViral Research Center (AVRC), University of California San Diego, 220 Dickinson Street, Suite A, San Diego, California, USA
| | - Susan J Little
- Division of Infectious Diseases and Global Public Health, University of California San Diego, Stein Clinical Research Building, La Jolla, California, USA
| | - Andy Kaytes
- AVRC Community Advisory Board, University of California San Diego, 220 Dickinson Street, Suite A, San Diego, California, USA
| | - Jeff Taylor
- AVRC Community Advisory Board, University of California San Diego, 220 Dickinson Street, Suite A, San Diego, California, USA.,HIV and Aging Research Project - Palm Springs (HARP-PS), 1775 East Palm Canyon Drive, Suite 110-349, Palm Springs, California, USA
| | - Kushagra Mathur
- AntiViral Research Center (AVRC), University of California San Diego, 220 Dickinson Street, Suite A, San Diego, California, USA
| | - Sogol Javadi
- AntiViral Research Center (AVRC), University of California San Diego, 220 Dickinson Street, Suite A, San Diego, California, USA
| | - Anshula Nathan
- Gillings School of Global Public Health, University of North Carolina, 4108 McGavran-Greenberg Hall, Chapel Hill, North Carolina, USA
| | - Hursch Patel
- Gillings School of Global Public Health, University of North Carolina, 4108 McGavran-Greenberg Hall, Chapel Hill, North Carolina, USA
| | - Stuart Luter
- Gillings School of Global Public Health, University of North Carolina, 4108 McGavran-Greenberg Hall, Chapel Hill, North Carolina, USA
| | - Sean Philpott-Jones
- Department of Bioethics, Clarkson University, 80 Nott Terrace, Schenectady, New York, USA
| | - Brandon Brown
- Center for Healthy Communities, Department of Social Medicine, Population, and Public Health, University of California Riverside School of Medicine, 3333 14th Street, Riverside, California, USA
| | - Davey Smith
- Division of Infectious Diseases and Global Public Health, University of California San Diego, Stein Clinical Research Building, La Jolla, California, USA.,AntiViral Research Center (AVRC), University of California San Diego, 220 Dickinson Street, Suite A, San Diego, California, USA
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