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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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Kanazawa J, Rawlings SA, Hendrickx S, Gianella S, Concha-Garcia S, Taylor J, Kaytes A, Patel H, Ndukwe S, Little SJ, Smith D, Dubé K. Lessons learned from the Last Gift study: ethical and practical challenges faced while conducting HIV cure-related research at the end of life. JOURNAL OF MEDICAL ETHICS 2023; 49:305-310. [PMID: 35732421 PMCID: PMC9772357 DOI: 10.1136/medethics-2021-107512] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/23/2022] [Indexed: 05/03/2023]
Abstract
The Last Gift is an observational HIV cure-related research study conducted with people with HIV at the end of life (EOL) at the University of California San Diego. Participants agree to voluntarily donate blood and other biospecimens while living and their bodies for a rapid research autopsy postmortem to better understand HIV reservoir dynamics throughout the entire body. The Last Gift study was initiated in 2017. Since then, 30 volunteers were enrolled who are either (1) terminally ill with a concomitant condition and have a prognosis of 6 months or less or (2) chronically ill with multiple comorbidities and nearing the EOL.Multiple ethical and logistical challenges have been revealed during this time; here, we share our lessons learnt and ethical analysis. Issues relevant to healthcare research include surrogate informed consent, personal and professional boundaries, challenges posed conducting research in a pandemic, and clinician burnout and emotional support. Issues more specific to EOL and postmortem research include dual roles of clinical care and research teams, communication between research personnel and clinical teams, legally required versus rapid research autopsy, identification of next of kin/loved ones and issues of inclusion. Issues specific to the Last Gift include logistics of body donation and rapid research autopsy, and disposition of the body as a study benefit.We recommend EOL research teams to have clear provisions around surrogate informed consent, rotate personnel to maintain boundaries, limit direct contact with staff associated with clinical care and have a clear plan for legally required versus research autopsies, among other recommendations.
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Affiliation(s)
- John Kanazawa
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Stephen A Rawlings
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Steven Hendrickx
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Sara Gianella
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Susanna Concha-Garcia
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
- HIV Neurobehavioral Research Program (HNRP), California NeuroAIDS Tissue Network (CNTN), University of California San Diego, San Diego, California, USA
| | - Jeff Taylor
- HIV + Aging Research Program - Palm Springs (HARP-PS), Palm Springs, California, USA
- AntiViral Research Center Community Advisory Board, University of California San Diego, La Jolla, California, USA
| | - Andy Kaytes
- AntiViral Research Center Community Advisory Board, University of California San Diego, La Jolla, California, USA
| | - Hursch Patel
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Samuel Ndukwe
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Susan J Little
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Davey Smith
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- AntiViral Research Center, University of California San Diego, San Diego, California, USA
| | - Karine Dubé
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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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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Kanazawa J, Gianella S, Concha-Garcia S, Taylor J, Kaytes A, Christensen C, Patel H, Ndukwe S, Rawlings SA, Hendrickx S, Little S, Brown B, Smith D, Dubé K. Ethical and practical considerations for HIV cure-related research at the end-of-life: a qualitative interview and focus group study in the United States. BMC Med Ethics 2022; 23:2. [PMID: 35012544 PMCID: PMC8748179 DOI: 10.1186/s12910-022-00741-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 12/21/2021] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND One of the next frontiers in HIV research is focused on finding a cure. A new priority includes people with HIV (PWH) with non-AIDS terminal illnesses who are willing to donate their bodies at the end-of-life (EOL) to advance the search towards an HIV cure. We endeavored to understand perceptions of this research and to identify ethical and practical considerations relevant to implementing it. METHODS We conducted 20 in-depth interviews and 3 virtual focus groups among four types of key stakeholders in the United States (PWH, biomedical HIV cure researchers, HIV clinicians, and bioethicists) to obtain triangulated viewpoints because little was known about the ethics of this topic. Each group was queried as to ethical considerations, safeguards, and protections for conducting HIV cure-related research at the EOL to ensure this research remains acceptable. RESULTS All four key stakeholder groups generally supported HIV cure-related research conducted at the EOL because of the history of altruism within the PWH community and the potential for substantial scientific knowledge to be gained. Our informants expressed that: (1) Strong stakeholder and community involvement are integral to the ethical and effective implementation, as well as the social acceptability of this research; (2) PWH approaching the EOL should not inherently be considered a vulnerable class and their autonomy must be respected when choosing to participate in HIV cure-related research at the EOL; (3) Greater diversity among study participants, as well as multi-disciplinary research teams, is necessitated by HIV cure-related research at the EOL; (4) The sensitive nature of this research warrants robust oversight to ensure a favorable risk/benefit balance and to minimize the possibility of therapeutic misconception or undue influence; and (5) Research protocols should remain flexible to accommodate participants' comfort and needs at the EOL. CONCLUSION Because of the ethical issues presented by HIV cure-related research at the EOL, robust ethical safeguards are of utmost importance. The proposed ethical and practical considerations presented herein is a first step in determining the best way to maximize this research's impact and social value. More much inquiry will need to be directed towards understanding context-specific and cultural considerations for implementing EOL HIV cure research in diverse settings.
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Affiliation(s)
- John Kanazawa
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 4108 McGavran-Greenberg Hall, Chapel Hill, NC USA
| | - Sara Gianella
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA USA
| | - Susanna Concha-Garcia
- AntiViral Research Center (AVRC), University of California at San Diego, 220 Dickinson Street, Suite A, San Diego, CA USA
- HIV Neurobehavioral Research Program (HNRP), California NeuroAIDS Tissue Network, University of California San Diego, 220 Dickson Street, Suite B, San Diego, CA USA
| | - Jeff Taylor
- AVRC Community Advisory Board, University of California San Diego, 220 Dickinson Street, Suite A, San Diego, CA USA
- HIV + Aging Research Project – Palm Springs (HARP-PS), 1775 Palm Canyon Drive, Suite 110-349, Palm Springs, CA USA
| | - Andy Kaytes
- AVRC Community Advisory Board, University of California San Diego, 220 Dickinson Street, Suite A, San Diego, CA USA
| | - Christopher Christensen
- HIV + Aging Research Project – Palm Springs (HARP-PS), 1775 Palm Canyon Drive, Suite 110-349, Palm Springs, CA USA
| | - Hursch Patel
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 4108 McGavran-Greenberg Hall, Chapel Hill, NC USA
| | - Samuel Ndukwe
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 4108 McGavran-Greenberg Hall, Chapel Hill, NC USA
| | - Stephen A. Rawlings
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA USA
- AntiViral Research Center (AVRC), University of California at San Diego, 220 Dickinson Street, Suite A, San Diego, CA USA
| | - Steven Hendrickx
- AntiViral Research Center (AVRC), University of California at San Diego, 220 Dickinson Street, Suite A, San Diego, CA USA
| | - Susan Little
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA USA
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside, 3333 14th Street, Riverside, CA USA
| | - Davey Smith
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA USA
- AntiViral Research Center (AVRC), University of California at San Diego, 220 Dickinson Street, Suite A, San Diego, CA USA
| | - Karine Dubé
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 4108 McGavran-Greenberg Hall, Chapel Hill, NC USA
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Kanazawa J, Gianella S, Concha-Garcia S, Taylor J, Kaytes A, Christensen C, Patel H, Ndukwe S, Rawlings S, Hendrickx S, Little S, Brown B, Smith D, Dubé K. Ethical and practical considerations for interventional HIV cure-related research at the end-of-life: A qualitative study with key stakeholders in the United States. PLoS One 2021; 16:e0254148. [PMID: 34270612 PMCID: PMC8284787 DOI: 10.1371/journal.pone.0254148] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/18/2021] [Indexed: 12/19/2022] Open
Abstract
Background A unique window of opportunity currently exists to generate ethical and practical considerations presented by interventional HIV cure-related research at the end-of-life (EOL). Because participants would enroll in these studies for almost completely altruistic reasons, they are owed the highest ethical standards, safeguards, and protections. This qualitative empirical ethics study sought to identify ethical and practical considerations for interventional HIV cure-related research at the EOL. Methods and findings We conducted 20 in-depth interviews and three virtual focus groups (N = 36) with four key stakeholder groups in the United States: 1) bioethicists, 2) people with HIV, 3) HIV care providers, and 4) HIV cure researchers. This study produced six key themes to guide the ethical implementation of interventional HIV cure-related research at the EOL: 1) all stakeholder groups supported this research conditioned upon a clearly delineated respect for participant contribution and autonomy, participant understanding and comprehension of the risks associated with the specific intervention(s) to be tested, and broad community support for testing of the proposed intervention(s); 2) to ensure acceptable benefit-risk profiles, researchers should focus on limiting the risks of unintended effects and minimizing undue pain and suffering at the EOL; 3) only well-vetted interventions that are supported by solid pre-clinical data should be tested in the EOL translational research model; 4) the informed consent process must be robust and include process consent; 5) research protocols should be flexible and adopt a patient/participant centered approach to minimize burdens and ensure their overall comfort and safety; and 6) a participant’s next-of-kin/loved ones should be a major focus of EOL research but only if the participant consents to such involvement. Conclusions To our knowledge, this empirical ethics study generated the first ethical and practical considerations for interventional HIV cure-related research at the EOL. The ethical complexities of such research must be considered now. We must navigate this ethical conundrum so that we are good stewards of the participants’ extremely altruistic gifts by maximizing the impact and social value of this research. We hope that this study will serve as the foundation for future research and discussion on this topic.
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Affiliation(s)
- John Kanazawa
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Sara Gianella
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Susanna Concha-Garcia
- HIV Neurobehavioral Research Program (HNRP), California NeuroAIDS Tissue Network, University of California San Diego, San Diego, California, United States of America
| | - Jeff Taylor
- AVRC Community Advisory Board, University of California San Diego, San Diego, California, United States of America
- HIV + Aging Research Project–Palm Springs (HARP-PS), Palm Springs, California, United States of America
| | - Andy Kaytes
- AVRC Community Advisory Board, University of California San Diego, San Diego, California, United States of America
| | - Christopher Christensen
- HIV + Aging Research Project–Palm Springs (HARP-PS), Palm Springs, California, United States of America
| | - Hursch Patel
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Samuel Ndukwe
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Stephen Rawlings
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States of America
- AntiViral Research Center (AVRC), University of California at San Diego, San Diego, California, United States of America
| | - Steven Hendrickx
- AntiViral Research Center (AVRC), University of California at San Diego, San Diego, California, United States of America
| | - Susan Little
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside, Riverside, California, United States of America
| | - Davey Smith
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States of America
- AntiViral Research Center (AVRC), University of California at San Diego, San Diego, California, United States of America
| | - Karine Dubé
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
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