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Boakye DS, Kumah E, Adjorlolo S. Policies and Practices Facilitating Access to and Uptake of HIV Testing Services among Adolescents in Sub-Sahara Africa: A Narrative Review. Curr HIV/AIDS Rep 2024:10.1007/s11904-024-00701-4. [PMID: 38814361 DOI: 10.1007/s11904-024-00701-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE OF REVIEW Expanding access to HIV testing services and linking newly diagnosed positive adolescents to antiretroviral therapy is critical to epidemic control. However, testing coverage and treatment initiation rates continue to lag behind adult counterparts. This article synthesizes evidence on facilitative policies and service delivery practices focused on adolescents to inform programming. RECENT FINDINGS Our narrative review found that national policies are growing more adolescent-inclusive but barriers around the age of consent, waiver frameworks and dissemination constrain translate into practice. Facility-based provider-initiated testing through integrated sexual health services and dedicated youth centres demonstrates uptake effectiveness if confidentiality and youth-friendly adaptations are assured. Supportive policies, youth-responsive adaptations across testing models and strengthening age-disaggregated monitoring are vital to improving adolescents' engagement across the HIV testing and treatment cascade. Further implementation research is imperative to expand the reach of adolescent HIV testing in sub-Saharan Africa.
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Affiliation(s)
- Dorothy Serwaa Boakye
- Department of Health Administration and Education, University of Education, Winneba, Ghana, P.O. Box 25, South Campus.
| | - Emmanuel Kumah
- Department of Health Administration and Education, University of Education, Winneba, Ghana, P.O. Box 25, South Campus
| | - Samuel Adjorlolo
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Accra, Ghana
- Research and Grant Institute of Ghana, Legon, Ghana
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Munung NS, Nembaware V, Osei-Tutu L, Treadwell M, Chide OE, Bukini D, Tutuba H, Wonkam A. Assent, parental consent and reconsent for health research in Africa: thematic analysis of national guidelines and lessons from the SickleInAfrica registry. BMC Med Ethics 2022; 23:130. [PMID: 36482457 PMCID: PMC9730625 DOI: 10.1186/s12910-022-00843-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 10/18/2022] [Indexed: 12/13/2022] Open
Abstract
The enrolment of children and adolescents in health research requires that attention to be paid to specific assent and consent requirements such as the age range for seeking assent; conditions for parental consent (and waivers); the age group required to provide written assent; content of assent forms; if separate assent and parental consent forms should be used, consent from emancipated young adults; reconsent at the age of adulthood when a waiver of assent requirements may be appropriate and the conditions for waiving assent requirements. There is however very little available information for researchers and ethics committees on how to navigate these different issues. To provide guidance to research initiatives, the SickleInAfrica consortium conducted a thematic analysis of a sample of research ethics guidelines and procedures in African countries, to identify guidance for assent requirements in health research. The thematic analysis revealed that 12 of 24 African countries specified the age group for which assent is required. The minimum age for written assent varied across the countries. Five countries, Algeria, Botswana, Cameroon, Nigeria and The Democratic Republic of Congo require consent from both parents/family council in certain circumstances. Botswana, Nigeria, South Africa and Uganda have specific assent/consent requirements for research with emancipated minors. South Africa and Algeria requires re-consent at onset of adulthood. Five countries (Botswana, Cameroon, Nigeria, South Africa and Tanzania) specified conditions for waiving assent requirements. The CIOMS and the ICH-GCP guidelines had the most comprehensive information on assent requirements compared to other international guidelines. An interactive map with assent requirements for different African countries is provided. The results show a major gap in national regulations for the inclusion of minors in health research. The SickleInAfrica experience in setting up a multi-country SCD registry in Africa highlights the need for developing and harmonising national and international guidelines on assent and consent requirements for research involving minors. Harmonisation of assent requirements will help facilitate collaborative research across countries.
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Affiliation(s)
- Nchangwi Syntia Munung
- grid.7836.a0000 0004 1937 1151Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | - Victoria Nembaware
- grid.7836.a0000 0004 1937 1151Division of Human Genetics, University of Cape Town, Cape Town, South Africa
| | | | - Marsha Treadwell
- grid.266102.10000 0001 2297 6811Department of Pediatrics, School of Medicine, University of California San Francisco, San Francisco, CA USA
| | - Okocha Emmanuel Chide
- grid.470111.20000 0004 1783 5514Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra Nigeria
| | - Daima Bukini
- grid.25867.3e0000 0001 1481 7466Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Hilda Tutuba
- grid.25867.3e0000 0001 1481 7466Sickle Cell Program, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | | | - Ambroise Wonkam
- grid.7836.a0000 0004 1937 1151Division of Human Genetics, University of Cape Town, Cape Town, South Africa ,grid.469474.c0000 0000 8617 4175McKusick-Nathans Institute and Department of Genetic Medicine, Johns Hopkins Medicine, Baltimore, MD USA
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Folayan MO, Conway M, Russo C, Diniz N, Jafta LP, Sam-Agudu NA, Bernays S, Santana VM, Epps C, Turner MA. Health Equity in Pediatric Drug Development: Translating Aspiration into Operation. Ther Innov Regul Sci 2022; 56:991-1003. [PMID: 35596108 PMCID: PMC9122543 DOI: 10.1007/s43441-022-00410-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 04/07/2022] [Indexed: 01/01/2023]
Abstract
The concept of health equity—the attainment of the highest possible level of health for all members of society—requires equitable access to all aspects of healthcare, including pediatric drug development. However, many communities are under-represented in pediatric drug development programs. Barriers to participation include geographic, economic, racial/ethnic bias, legal, cultural, linguistic, and other factors. While there is no “one size fits all” approach to addressing these barriers, community engagement and collaboration is recognized by the Centers for Disease Control, the World Health Organization, and other global health organizations as a cornerstone for building a more equitable healthcare system. In this article, we will present case studies of stakeholder and community engagement in clinical research for rare diseases and other areas of healthcare, as examples of strategies and practices for actively involving under-represented communities and fostering their participation in pediatric drug development programs. These studies may serve as templates for facilitating equity in pediatric drug development from aspiration into operation.
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Affiliation(s)
| | | | - Carolyn Russo
- Department of Hematology, St. Jude Children's Research Hospital and Comprehensive Cancer Center, Memphis, TN, USA
| | - Nilza Diniz
- Biology Department, Biological Sciences Center, State University of Londrina, Londrina, PR, 86057-970, Brazil
| | | | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria.,Institute of Human Virology and Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA.,Department of Pediatrics and Child Health, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
| | - Sarah Bernays
- School of Public Health, University of Sydney, Sydney, Australia.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Victor M Santana
- Departments of Oncology and Global Pediatric Medicine, St. Jude Children's Research Hospital and Comprehensive Cancer Center, Memphis, TN, USA
| | - Carla Epps
- Office of Pediatric Therapeutics, Food and Drug Administration, Silver Spring, MD, USA
| | - Mark A Turner
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool Health Partners, Liverpool, UK. .,Neonatal Unit, Liverpool Women's NHS Foundation Trust, Crown Street, Liverpool, L8 7SS, UK.
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Transparent reporting of recruitment and informed consent approaches in clinical trials recruiting children with minor parents in sub-Saharan Africa: a secondary analysis based on a systematic review. BMC Public Health 2021; 21:1473. [PMID: 34320934 PMCID: PMC8318049 DOI: 10.1186/s12889-021-11079-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 05/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background Standardised checklists of items to be addressed in clinical study protocols and publications are promoting transparency in research. However, particular specifications for exceptional cases, such as children with minor parents are missing. This study aimed to examine the level of transparency regarding recruitment and informed consent approaches in publications of clinical trials recruiting children with minor parents in sub-Saharan Africa. We thereby focused particularly on the transparency about consenting persons (i.e. proxy decision-makers) and assessed the need to expand reporting guidelines for such exceptional cases. Methods We conducted a secondary analysis of clinical trial publications previously identified through a systematic review. Multiple scientific databases were searched up to March 2019. Clinical trial publications addressing consent and potentially recruiting children with minor parents in sub-Saharan Africa were included. 44 of the in total 4382 screened articles met our inclusion criteria. A descriptive analysis was performed. Results None of the included articles provided full evidence on whether any recruited children had minor parents and how consent was obtained for them. Four proxy decision-maker types were identified (parents; parents or guardians; guardians; or caregivers), with further descriptions provided rarely and mostly in referenced clinical trial registrations or protocols. Also, terminology describing proxy decision-makers was often used inconsistently. Conclusions Reporting the minimum maternal age alongside maternal data provided in baseline demographics can increase transparency on the recruitment of children with minor mothers. The CONSORT checklist should require clinical trial publications to state or reference exceptional informed consent procedures applied for special population groups. A standardized definition of proxy decision-maker types in international clinical trial guidelines would facilitate correct and transparent informed consent for children and children with minor parents. Study registration CRD42018074220. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11079-y.
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