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Koricha ZB, Abraha YG, Ababulgu SA, Abraham G, Morankar S. Community engagement in research addressing infectious diseases of poverty in sub-Saharan Africa: A qualitative systematic review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003167. [PMID: 39008476 PMCID: PMC11249264 DOI: 10.1371/journal.pgph.0003167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 04/05/2024] [Indexed: 07/17/2024]
Abstract
Though engaging communities in research processes has several advantages and implications, research efforts are poorly embedded in and linked with communities, especially in low- and middle-income countries (LMICs). There is also a need for more empirical evidence on effectively engaging communities in research in LMICs, specifically in Sub-Saharan Africa (SSA). Thus, there is an urgent need to synthesize existing evidence on community engagement experiences in research in SSA. Therefore, this review aimed to synthesize the existing community engagement experiences and related barriers to engaging communities in health research focusing on infectious diseases of poverty in SSA. The systematic review was conducted following the JBI methodology for qualitative systematic reviews. The review included both published and unpublished studies. A thematic analysis approach was used for data synthesis. A total of 40 studies were included in the review. Community engagement in the conceptualization of the research project, analysis, dissemination, and interpretation of the result was rare. On top of this, almost all the research projects engaged the community at a lower level of engagement (i.e., informing or consulting the community at some point in the research process), suggesting the importance of integrating communities in the entire research cycle. The lack of shared control over the research by the community was one of the significant challenges mentioned. This review uncovered that community engagement in the research process is minimal. Nevertheless, the review generated valuable evidence that can inform researchers and research stakeholders to promote effective community engagement in the research process addressing infectious diseases of poverty. Despite these, it requires rigorous primary studies to examine the applicability and usefulness of community engagement, including developing valid metrics of engagement, standardizations of reporting community engagements, and views and understandings of communities and stakeholders on the values, expectations, and concepts of community engagement in research.
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Affiliation(s)
- Zewdie Birhanu Koricha
- Public Health Faculty, Department of Health, Behaviour and Society, Jimma University, Jimma, Ethiopia
- Ethiopian Evidence-Based Healthcare and Development Centre: a JBI Centre of Excellence, Jimma University, Jimma, Ethiopia
| | - Yosef Gebreyohannes Abraha
- Public Health Faculty, Department of Health, Behaviour and Society, Jimma University, Jimma, Ethiopia
- Ethiopian Public Health Institute, Knowledge Translation Directorate, Addis Ababa, Ethiopia
- The Ethiopian Public Health Institute, Ethiopian Knowledge Translation Group for Health: a JBI Affiliated Group, Addis Ababa, Ethiopia
| | - Sabit Ababor Ababulgu
- Public Health Faculty, Department of Health, Behaviour and Society, Jimma University, Jimma, Ethiopia
- Ethiopian Public Health Institute, Knowledge Translation Directorate, Addis Ababa, Ethiopia
- The Ethiopian Public Health Institute, Ethiopian Knowledge Translation Group for Health: a JBI Affiliated Group, Addis Ababa, Ethiopia
| | - Gelila Abraham
- Public Health Faculty, Department of Health, Behaviour and Society, Jimma University, Jimma, Ethiopia
- Ethiopian Evidence-Based Healthcare and Development Centre: a JBI Centre of Excellence, Jimma University, Jimma, Ethiopia
- Health Policy & Management Department, Jimma Institute of Health, Jimma University, Jimma, Ethiopia
| | - Sudhakar Morankar
- Public Health Faculty, Department of Health, Behaviour and Society, Jimma University, Jimma, Ethiopia
- Ethiopian Evidence-Based Healthcare and Development Centre: a JBI Centre of Excellence, Jimma University, Jimma, Ethiopia
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Appiah R, Raviola G, Weobong B. Balancing Ethics and Culture: A Scoping Review of Ethico-Cultural and Implementation Challenges of the Individual-Based Consent Model in African Research. J Empir Res Hum Res Ethics 2024; 19:143-172. [PMID: 38497301 PMCID: PMC11298123 DOI: 10.1177/15562646241237669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/19/2024]
Abstract
Objective: This review explores the ethico-cultural and implementation challenges associated with the individual-based informed consent (IC) model in the relatively collectivistic African context and examines suggested approaches to manage them. Methods: We searched four databases for peer-reviewed studies published in English between 2000 to 2023 that examined the ethico-cultural and implementation challenges associated with the IC model in Africa. Results: Findings suggest that the individual-based IC model largely misaligns with certain African social values and ethos and subverts the authority and functions of community gatekeepers. Three recommendations were proffered to manage these challenges, that researchers should: adopt a multi-step approach to IC, conduct a rapid ethical assessment, and generate an African-centered IC model. Conclusions: A pluriversal, context-specific, multi-step IC model that critically harmonizes the cultural values of the local population and the general principles of IC can minimize ethics dumping, safeguard the integrity of the research process, and promote respectful engagement.
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Affiliation(s)
- Richard Appiah
- Department of Psychology, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
- Center for African Studies, Harvard University, Cambridge, MA, USA
- College of Health Sciences, University of Ghana, Accra, Ghana
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa
| | - Giuseppe Raviola
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Benedict Weobong
- College of Health Sciences, University of Ghana, Accra, Ghana
- School of Global Health, Faculty of Health, York University, Toronto, ON, Canada
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Day S, Tahlil KM, Shah SJ, Fidelak L, Wilson EC, Shah SK, Nwaozuru U, Chima K, Obiezu-Umeh C, Chikwari CD, Mwaturura T, Phiri N, Babatunde AO, Gbajabiamila T, Rennie S, Iwelunmor J, Ezechi O, Tucker JD. The HI V O pen Call on I nformed C onsent and E thics in Research (VOICE) for Adolescents and Young Adults: A Digital Crowdsourcing Open Call in Low- and Middle-Income Countries. Sex Transm Dis 2024; 51:359-366. [PMID: 38346417 PMCID: PMC11018461 DOI: 10.1097/olq.0000000000001949] [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: 02/22/2024]
Abstract
BACKGROUND Many adolescents and young adults (AYAs; 10-24 years old) are excluded from HIV research because of social, ethical, and legal challenges with informed consent, resulting in limited AYA-focused data. We use a participatory approach to identify strategies for improving AYA consent processes in HIV research in low- and middle-income countries (LMICs). METHODS We conducted a digital crowdsourcing open call for ideas to improve AYA consent to HIV research in LMICs. Crowdsourcing involves engaging a group of people in problem-solving, then sharing emergent solutions. Submissions were evaluated by 3 independent judges using predefined criteria, with exceptional strategies receiving prizes. Demographic data were collected, and textual data were qualitatively analyzed for emergent themes in barriers and facilitators for improving AYA consent in HIV research, guided by a socioecological model. RESULTS We received 110 strategies total; 65 were eligible for evaluation, 25 of which were identified as finalists. Fifty-eight participants from 10 LMICs submitted the 65 eligible submissions, of which 30 (52%) were 18 to 24 years old. Thematic analysis identified 10 barriers to AYA consent, including HIV stigma, limited education, and legal/regulatory barriers. Strategies for improving AYA consent processes revealed 7 potential facilitators: enhancing AYA engagement in research, involving parents/guardians, improving education/awareness, improving institutional practices/policy, making research participation more AYA-friendly, enhancing engagement of other key communities of interest, and empowering AYA. CONCLUSIONS Diverse communities of interest in LMICs developed compelling strategies to enhance informed consent that may improve AYA inclusion in HIV research. These data will be used to develop practical guidance on improving AYA consent processes.
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Affiliation(s)
- Suzanne Day
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kadija M. Tahlil
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Sonam J. Shah
- Institute of Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Lauren Fidelak
- Current undergraduate student (degree not yet granted) in the Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Erin C. Wilson
- San Francisco Department of Public Health, San Francisco, California, USA
| | - Seema K. Shah
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Ucheoma Nwaozuru
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Kelechi Chima
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Chisom Obiezu-Umeh
- Department of Behavioral Science & Health Education, College for Public Health and Social Justice, St. Louis University, St. Louis, Missouri, USA
| | - Chido Dziva Chikwari
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | - Nomsa Phiri
- Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | | | - Titilola Gbajabiamila
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
- Department of Behavioral Science & Health Education, College for Public Health and Social Justice, St. Louis University, St. Louis, Missouri, USA
| | - Stuart Rennie
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- UNC Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Juliet Iwelunmor
- Department of Behavioral Science & Health Education, College for Public Health and Social Justice, St. Louis University, St. Louis, Missouri, USA
| | - Oliver Ezechi
- Clinical Sciences Department, Nigerian Institute of Medical Research, Lagos, Nigeria
| | - Joseph D. Tucker
- Department of Medicine, Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
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Ciptaningtyas VR, Sumekar TA, de Mast Q, de Jonge MI, Margawati A. Parental engagement in research on paediatric lower respiratory tract infections in Indonesia. BMC Pediatr 2024; 24:165. [PMID: 38459462 PMCID: PMC10921691 DOI: 10.1186/s12887-024-04648-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/15/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Lower respiratory tract infections (LRTIs) in children are a major concern in Indonesia as it is the leading cause of morbidity and mortality. Therefore, research on LRTIs is crucial to improve children's health. However, clinical research in children is challenging due to parental concerns. This study aims to understand parental considerations for taking part in clinical studies on LRTI in the Indonesian context. METHODS A cross-sectional study using a validated online questionnaire was conducted from November 2021 to March 2022. This study included parents from two public elementary schools and two private primary schools in Semarang, Indonesia. A total of 1236 responses were analysed. RESULTS There was a significant association between educational attainment and willingness to participate in general health and LRTI-related research requiring specimen collection; respondents with an advanced educational level were more likely to refuse participation in research. A similar pattern was observed among respondents with smaller families and younger children against participation in LRTI research. Most respondents who indicated not to participate explained that they did not perceive the necessity to take part and expressed their concerns about endangering their child's health as a consequence of the specimen collection. Most respondents expected a personal benefit and prioritized access to the study results for their child. CONCLUSION Parents' educational background and family composition are important determinants of parental engagement in research on LRTI in Indonesia. Notably, parents with a lower educational level, having large families, and older children were more inclined to participate. The emphasis on concerns about potential harm and personal benefit underscores the need for a targeted communication strategy.
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Affiliation(s)
- Vincentia Rizke Ciptaningtyas
- Department of Microbiology, Faculty of Medicine, Universitas Diponegoro, Jl. Prof. H. Soedarto, Semarang, SH, Tembalang, Semarang, 50275, Indonesia.
- Diponegoro National Hospital, Semarang, Indonesia.
- Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Tanjung Ayu Sumekar
- Diponegoro National Hospital, Semarang, Indonesia
- Department of Psychiatry, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
- Center for Biomedical Research, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
| | - Quirijn de Mast
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marinus Isaäk de Jonge
- Department of Laboratory Medicine, Laboratory of Medical Immunology, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ani Margawati
- Department of Public Health, Faculty of Medicine, Universitas Diponegoro, Semarang, Indonesia
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Gillette E, Nyandiko W, Chory A, Scanlon M, Aluoch J, Choudhury N, Lagat D, Ashimosi C, Biegon W, Munyoro D, Lidweye J, Nyagaya J, Wilets I, DeLong A, Kantor R, Vreeman R, Naanyu V. Ethical Considerations for Engaging Children and Adolescents Living with HIV in Research in African Countries: A Systematic Review. J Empir Res Hum Res Ethics 2023; 18:346-362. [PMID: 37872659 PMCID: PMC11325447 DOI: 10.1177/15562646231208991] [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: 10/25/2023]
Abstract
Research engaging children and adolescents living with HIV (CALWH) is critical for youth-friendly services and HIV care, and researchers need to ensure that such engagement is ethical. We conducted a systematic review to identify key ethical considerations for the engagement of CALWH in research. The review focused on primary research articles conducted in African countries that examined ethical issues in CALWH engaged in research. Ten studies met the inclusion criteria; the following seven key domains were extracted: 1) justifications for engaging CALWH in research; 2) community involvement; 3) informed consent/assent; 4) caregiver involvement; 5) perceptions of benefits; 6) perception of the risks of involvement; and 7) confidentiality. These domains can inform the ethical engagement of CALWH in research.
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Affiliation(s)
- Emma Gillette
- Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Winstone Nyandiko
- Moi University College of Health Sciences, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ashley Chory
- Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Scanlon
- Indiana University Center for Global Health, Indianapolis, Indiana, USA
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Nandini Choudhury
- Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Daniel Lagat
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | | | - Whitney Biegon
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Dennis Munyoro
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Janet Lidweye
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jack Nyagaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ilene Wilets
- Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Rachel Vreeman
- Department of Global Health and Health Systems Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Violet Naanyu
- Moi University College of Health Sciences, Eldoret, Kenya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
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MacDonald KR, Enane LA, McHenry MS, Davis NL, Whipple EC, Ott MA. Ethical Aspects of Involving Adolescents in HIV Research: A Systematic Review of the Empiric Literature. J Pediatr 2023; 262:113589. [PMID: 37399918 PMCID: PMC11119419 DOI: 10.1016/j.jpeds.2023.113589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To evaluate the ethics of involving adolescents in HIV research, we conducted a systematic review of the empiric literature. METHODS Electronic databases Ovid Medline, Embase, and CINAHL were systematically searched using controlled vocabulary terms related to ethics, HIV, specified age groups, and empiric research studies. We reviewed titles and abstracts, including studies that collected qualitative or quantitative data, evaluated ethical issues in HIV research, and included adolescents. Studies were appraised for quality, data were extracted, and studies were analyzed using narrative synthesis. RESULTS We included 41 studies: 24 qualitative, 11 quantitative, 6 mixed methods; 22 from high-income countries (HIC), 18 from low- or middle-income countries (LMIC), and 1 from both HIC and LMIC. Adolescent, parent, and community perspectives assert the benefits of involving minors in HIV research. Participants in LMIC expressed mixed views regarding parental consent requirements and confidentiality, given adolescents' both increasing autonomy and continued need for adult support. In studies in HIC, sexual or gender minority youth would not participate in research if parental consent were required or if there were confidentiality concerns. There was variation in the comprehension of research concepts, but adolescents generally demonstrated good comprehension of informed consent. Informed consent processes can be improved to increase comprehension and study accessibility. Vulnerable participants face complex social barriers that should be considered in study design. CONCLUSIONS Data support the inclusion of adolescents in HIV research. Empiric research can inform consent processes and procedural safeguards to ensure appropriate access.
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Affiliation(s)
- Katherine R MacDonald
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, University of North Carolina School of Medicine, Chapel Hill, NC.
| | - Leslie A Enane
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN
| | - Megan S McHenry
- Department of Pediatrics, Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University School of Medicine, Indianapolis, IN
| | - Neilkant L Davis
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Elizabeth C Whipple
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, IN
| | - Mary A Ott
- Department of Pediatrics, Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN
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Strode A, Essack Z. Parental waivers to enable adolescent participation in certain forms of health research: lessons from a South African case study. BMC Med Ethics 2022; 23:98. [PMID: 36153500 PMCID: PMC9509649 DOI: 10.1186/s12910-022-00833-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 09/07/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The South African legal framework requires mandatory parental/legal guardian consent for all research with children. Ethics guidelines provide some reprieve by allowing RECs to grant waivers of parental or guardianship consent in certain defined circumstances. In the first instance, consent may be provided by a proxy when parents or guardians are unavailable, for example with orphaned children. In the second instance, guidelines permit adolescent self-consent when the nature of the study justifies this approach, for example, research on sensitive issues like sexual behaviour or substance use.
Discussion
South African guidelines set several conditions that must be met for waivers to be granted. These norms overlap with those in international guidelines. However, the ethical norms, especially related to self-consent are sometimes vague. This article critically evaluates the consent norms in the national ethics guidelines and makes recommendations for reform to ethics guidelines in a way that recognises the value of child participation in research, their evolving decision-making capacity and their best interests.
Conclusion
Recommendations are made to harmonise ethics guidelines and law in a way that promotes child participation in research, to ensure additional protections for adolescents when self-consent is allowed, and to withdraw procedural requirements for the community endorsement of self-consent strategies.
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Day S, Kapogiannis BG, Shah SK, Wilson EC, Ruel TD, Conserve DF, Strode A, Donenberg GR, Kohler P, Slack C, Ezechi O, Tucker JD. Adolescent participation in HIV research: consortium experience in low and middle-income countries and scoping review. Lancet HIV 2020; 7:e844-e852. [PMID: 33275917 PMCID: PMC8491773 DOI: 10.1016/s2352-3018(20)30269-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/10/2020] [Accepted: 09/07/2020] [Indexed: 01/09/2023]
Abstract
Adolescents in low and middle-income countries (LMICs) have a high prevalence of HIV, therefore, it is important that they are included in HIV research. However, ethical challenges regarding consent can hinder adolescent research participation. We examined examples from the Prevention and Treatment Through a Comprehensive Care Continuum for HIV-affected Adolescents in Resource Constrained Settings (PATC3H) research consortium, which investigates adolescent HIV prevention and treatment in seven LMICs: Brazil, Kenya, Mozambique, Nigeria, South Africa, Uganda, and Zambia. PATC3H researchers were asked to identify ethical and practical challenges of adolescent consent to research participation in these countries. We also did a scoping review of strategies that could improve adolescent participation in LMIC HIV studies. Examples from PATC3H research highlighted many ethical challenges that affect adolescent participation, including inconsistent or absent consent guidance, guidelines that fail to account for the full array of adolescents' lives, and variation in how ethical review committees assess adolescent studies. Our scoping review identified three consent-related strategies to expand adolescent inclusion: waiving parental consent requirements, allowing adolescents to independently consent, and implementing surrogate decision making. Our analyses suggest that these strategies should be further explored and incorporated into ethical and legal research guidance to increase adolescent inclusion in LMIC HIV research.
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Affiliation(s)
- Suzanne Day
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Bill G Kapogiannis
- Maternal and Pediatric Infectious Diseases Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Seema K Shah
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Mary Ann and J Milburn Smith Child Health Research, Outreach, and Advocacy Center, Stanley Manne Children's Research Institute, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Erin C Wilson
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Theodore D Ruel
- Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Donaldson F Conserve
- Department of Prevention and Community Health, The George Washington University, Washington, DC, USA
| | - Ann Strode
- School of Law, University of KwaZulu-Natal, University Road, Durban, South Africa
| | - Geri R Donenberg
- Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Pamela Kohler
- Department of Global Health, University of Washington, Seattle, WA, USA; Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA, USA
| | - Catherine Slack
- HIV AIDS Vaccines Ethics Group, School of Applied Human Sciences, University of KwaZulu-Natal, Scottsville, Pietermaritzburg, South Africa
| | - Oliver Ezechi
- Nigerian Institute of Medical Research, Medical Compound, Yaba, Lagos, Nigeria
| | - Joseph D Tucker
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Faculty of Infectious Diseases, London School of Hygiene & Tropical Medicine
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Rennie S, Day S, Mathews A, Gilbertson A, Luseno WK, Tucker JD, Henderson GE. The Role of Inclusion Benefits in Ethics Committee Assessment of Research Studies. Ethics Hum Res 2019; 41:13-22. [PMID: 31108576 DOI: 10.1002/eahr.500015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The relationship between risks and benefits is central to the ethics of research involving human participants. Traditionally, to be ethically justifiable, risks should be reasonable in relation to anticipated benefits (if any) to subjects and to the potential social benefits resulting from research. This calculus is being further complicated by findings from an increasing number of social science studies that reveal that prospective and actual research participants frequently describe various types of inclusion benefits (for example, personal benefits such as access to or improved health care, increased knowledge about their disease or condition, and greater solidarity with the local community) as important to them. What is the ethical significance of such inclusion benefits, particularly those nonmedical in nature, for research ethics committees' risk-benefit assessment of research studies? We argue that, unless participants are clearly mistaken in their perceptions, ethics committees should take these types of inclusion benefits into account, and we suggest a few ways this might look in practice.
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Affiliation(s)
- Stuart Rennie
- Associate professor in the Department of Social Medicine and the Center for Bioethics at the University of North Carolina at Chapel Hill
| | - Suzanne Day
- Postdoctoral researcher in the Department of Social Medicine and the Institute for Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill
| | - Allison Mathews
- Postdoctoral researcher in the Department of Social Medicine and Institute for Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill
| | - Adam Gilbertson
- Postdoctoral researcher in the Department of Social Medicine and the Institute for Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill and an associate research scientist at Pacific Institute for Research and Evaluation
| | - Winfred K Luseno
- Research scientist at the Pacific Institute for Research and Evaluation
| | - Joseph D Tucker
- Associate professor at the Institute for Global Health and Infectious Diseases at the University of North Carolina at Chapel Hill
| | - Gail E Henderson
- Professor in the Department of Social Medicine at the University of North Carolina at Chapel Hill
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Mangochi H, Gooding K, Bennett A, Parker M, Desmond N, Bull S. How should assent to research be sought in low income settings? Perspectives from parents and children in Southern Malawi. BMC Med Ethics 2019; 20:32. [PMID: 31088431 PMCID: PMC6515587 DOI: 10.1186/s12910-019-0369-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 04/22/2019] [Indexed: 11/24/2022] Open
Abstract
Background Paediatric research in low-income countries is essential to tackle high childhood mortality. As with all research, consent is an essential part of ethical practice for paediatric studies. Ethics guidelines recommend that parents or another proxy provide legal consent for children to participate, but that children should be involved in the decision through providing assent. However, there remain uncertainties about how to judge when children are ready to give assent and about appropriate assent processes. Malawi does not yet have detailed guidelines on assent. Understanding perspectives among children and their parents can assist in developing contextually-appropriate assent guidance. Methods Qualitative research was conducted with children and parents in three settings in Southern Malawi (low- and high-income urban and rural), to take account of any variations between socioeconomic and cultural contexts. In each setting, interviews were conducted with parents and their children who had participated in paediatric research to understand their experiences of assent and views on appropriate assent practice. Focus groups were also conducted with children and parents, to understand broader social perspectives. Results We found widespread support for involving children in decisions on research participation. Participants identified a range of factors that affect children’s capacity to give assent, including intellectual capacity, emotional development, life experience and cultural norms. Age was often mentioned as a consideration, but deemed an unreliable sole indicator of capacity to assent. In relation to appropriate assent processes, participants emphasised considerations such as supporting effective understanding and minimizing harms. Views on how to achieve these aims varied; for example, there were different ideas about the appropriate order in which to approach children and parents, and about whose decision to respect in the event of disagreement. Conclusions Parents and children agreed about the value of involving children in decisions on research, and about the need to promote children’s decision-making capacity while respecting parents’ interests in children’s welfare. Developing practical guidance that meets these principles is challenging, particularly given the need for flexible approaches that suit different study types, children’s capacities and family environments. Further discussion within the Malawi research and ethics community will help develop contextually-appropriate guidelines.
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Affiliation(s)
- Helen Mangochi
- Malawi Liverpool Welcome Trust Clinical Research Programme, P.O. Box 30096, Chichiri, Blantyre, 3, Malawi.
| | - Kate Gooding
- Malawi Liverpool Welcome Trust Clinical Research Programme, P.O. Box 30096, Chichiri, Blantyre, 3, Malawi.,Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L35QA, UK
| | - Aisleen Bennett
- Malawi Liverpool Welcome Trust Clinical Research Programme, P.O. Box 30096, Chichiri, Blantyre, 3, Malawi
| | - Michael Parker
- Ethox Centre and Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX37LF, UK
| | - Nicola Desmond
- Malawi Liverpool Welcome Trust Clinical Research Programme, P.O. Box 30096, Chichiri, Blantyre, 3, Malawi.,Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L35QA, UK
| | - Susan Bull
- Ethox Centre and Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX37LF, UK
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11
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Hejoaka F, Varloteaux M, Desclaux-Sall C, Ndiaye SM, Diop K, Diack A, Niasse F, Cames C. Improving the informed consent process among HIV-infected undisclosed minors participating in a biomedical research: insights from the multicentre nutritional SNACS study in Senegal. Trop Med Int Health 2019; 24:294-303. [PMID: 30624827 DOI: 10.1111/tmi.13202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Providing research information in a manner accessible to minors participating in biomedical research is a major challenge. Guidance is dramatically lacking regarding best practices for seeking informed consent among undisclosed minors enrolled in HIV-related research. We implemented an improved informed consent process (IICP) and identified factors associated with understanding of the information presented to HIV-infected minors prior to their enrolment in a study. METHODS We enrolled study participants attending 12 paediatric HIV clinics in Senegal. Children ≥7 years were provided with standardised research information using the IICP, which involves viewing a video and taking part in extended group discussions. Understanding was assessed by seven basic questions scored 1 or 2 points, with a maximum score of 11 points. A score of 9 or more points was defined as satisfactory understanding. Factors associated with understanding were identified using a stepwise logistic regression model. RESULTS Overall, 112 children, with a median age of 12.9 years (IQR: 10.2-15.0), participated in the IICP, of whom 37% were HIV disclosed. 71% achieved a satisfactory understanding score and all gave consent to participate in the research. HIV-disclosed children were more likely to demonstrate satisfactory understanding than undisclosed children (aOR = 3.2, 95% CI: 1.1-9.6). Age, study setting and education level were not associated with satisfactory understanding. CONCLUSION These findings provide practical guidance for the development of improved and friendly informed consent processes in research involving minors. The implementation of the paediatric HIV research agenda will require a standardised and operational definition of informed consent, integrating the issue of HIV disclosure.
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Affiliation(s)
- Fabienne Hejoaka
- Institut de recherche pour le développement, UMI233 TransVIHmi, U1175 INSERM, Université de Montpellier, Montpellier, France
| | - Marie Varloteaux
- Institut de recherche pour le développement, UMI233 TransVIHmi, U1175 INSERM, Université de Montpellier, Montpellier, France
| | - Caroline Desclaux-Sall
- Institut de recherche pour le développement, UMI233 TransVIHmi, U1175 INSERM, Université de Montpellier, Montpellier, France
| | - Sidy Mokhtar Ndiaye
- Centre régional de recherche et de formation à la prise en charge clinique, Dakar, Sénégal
| | - Karim Diop
- Centre régional de recherche et de formation à la prise en charge clinique, Dakar, Sénégal.,Division de lutte contre le sida et les IST/Ministère de la santé et de l'action sociale, Dakar, Sénégal
| | - Aminata Diack
- Centre hospitalier national d'enfants Albert Royer, Dakar, Sénégal
| | - Fatou Niasse
- Conseil national de lutte contre le sida, Dakar, Sénégal
| | - Cécile Cames
- Institut de recherche pour le développement, UMI233 TransVIHmi, U1175 INSERM, Université de Montpellier, Montpellier, France
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12
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Colom M, Rohloff P. Cultural considerations for informed consent in paediatric research in low/middle-income countries: a scoping review. BMJ Paediatr Open 2018; 2:e000298. [PMID: 30613801 PMCID: PMC6307601 DOI: 10.1136/bmjpo-2018-000298] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 10/24/2018] [Accepted: 10/25/2018] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Conducting research with children in low/middle-income countries (LMIC) requires consideration of socioeconomic inequalities and cultural and linguistic differences. Our objective was to survey the literature on informed consent in paediatric LMIC research, assessing for practical guidance for culturally and linguistically appropriate procedures. METHODS We conducted a scoping review on informed consent in paediatric LMIC research searching the PubMed, Web of Science and PsycINFO databases. Eligible articles were published in English, from any date range, of any study design or format. RESULTS The search identified 2027 references, of which 50 were included in the analysis following full-text review. Reviewed guidelines emphasised individual, informed and voluntary consent from parents and caregivers. Reviewed articles provided detailed practical guidance on adapting these guiding principles to LMIC settings, including considerations for community engagement, verbal or other alternative consent procedures for low-literacy settings or less commonly spoken languages and guarding against therapeutic misconception by caregivers. There was uncertainty, however, on how to best protect individual autonomy, especially when influenced by gender dynamics, leadership hierarchies or the social status of researchers themselves. There was, furthermore, limited research discussing the special case of research involving adolescents or of procedures for documenting assent by participating children. CONCLUSIONS A scoping review of paediatric research in LMICs revealed substantial guidance on several features of culturally appropriate informed consent. However, additional research and guidance is needed, especially in the areas of gender imbalances, research with adolescents and children's own assent to participate in research.
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Affiliation(s)
- Marcela Colom
- Centre for Research in Indigenous Health, Wuqu’ Kawoq | Maya Health Alliance, Tecpán, Guatemala
| | - Peter Rohloff
- Centre for Research in Indigenous Health, Wuqu’ Kawoq | Maya Health Alliance, Tecpán, Guatemala
- Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, USA
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13
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Scanlon ML, MacNaughton G, Sprague C. Neglected Population, Neglected Right: Children Living with HIV and the Right to Science. Health Hum Rights 2017; 19:169-181. [PMID: 29302174 PMCID: PMC5739368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The laws, language, and tools of human rights have been instrumental in expanding access to lifesaving treatment for people living with HIV. Children, however, remain a neglected population, as evidenced by inadequate child-specific and child-friendly HIV treatment options. In this article, we explore the right to science, a potentially powerful but underdeveloped right in international law, and its application to research and development for pediatric HIV treatment. Drawing on reports of human rights bodies and scholars and applying the human rights typology of state obligations to respect, protect, and fulfill, we argue that states have five core obligations related to research and development for child-specific and child-friendly treatment: (1) adopting a public goods approach to science and science policy; (2) including and protecting children in research activities; (3) adopting legal and policy frameworks to support research and development through public funding and private sector incentives; (4) promoting international cooperation and assistance; and (5) ensuring the participation of marginalized communities in decision-making processes. In concluding, we make a number of recommendations for states, human rights bodies, international organizations, civil society, and private industry to further develop and implement the right to science.
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Affiliation(s)
- Michael L Scanlon
- PhD Student in the Department of Conflict Resolution, Human Security and Global Governance, McCormack Graduate School of Policy and Global Studies at the University of Massachusetts Boston, USA
| | - Gillian MacNaughton
- Assistant professor at the School for Global Inclusion and Social Development at the University of Massachusetts Boston, USA
| | - Courtenay Sprague
- Associate professor in the Department of Conflict Resolution, Human Security and Global Governance, McCormack Graduate School of Policy and Global Studies, and the College of Nursing and Health Sciences, at the University of Massachusetts Boston, USA
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14
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Rennie S, Groves AK, Hallfors DD, Iritani BJ, Odongo FS, Luseno WK. The Significance of Benefit Perceptions for the Ethics of HIV Research Involving Adolescents in Kenya. J Empir Res Hum Res Ethics 2017; 12:269-279. [PMID: 28728497 DOI: 10.1177/1556264617721556] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Assessment of benefits is traditionally regarded as crucial to the ethical evaluation of research involving human participants. We conducted focus group discussions (FGDs) with health and other professionals engaged with adolescents, caregivers/parents, and adolescents in Siaya County, Kenya, to solicit opinions about appropriate ways of conducting HIV research with adolescents. Our data revealed that many focus group participants have a profoundly positive conception of participation in health research, including studies conferring seemingly few benefits. In this article, we identify and analyze five different but interrelated types of benefits as perceived by Kenyan adolescent and adult stakeholders in HIV research, and discuss their ethical significance. Our findings suggest that future empirical and conceptual research should concentrate on factors that may trigger researcher obligations to improve benefit perceptions among research participants.
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Affiliation(s)
- Stuart Rennie
- 1 The University of North Carolina at Chapel Hill, NC, USA
| | | | | | - Bonita J Iritani
- 3 Pacific Institute for Research and Evaluation, Chapel Hill, NC, USA
| | | | - Winnie K Luseno
- 3 Pacific Institute for Research and Evaluation, Chapel Hill, NC, USA
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15
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Randall D, Anderson A, Taylor J. Protecting children in research: Safer ways to research with children who may be experiencing violence or abuse. J Child Health Care 2016; 20:344-53. [PMID: 26105062 DOI: 10.1177/1367493515587060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children participating in research, like other children, may be being maltreated. There is also potential for exposure to abuse during research. Research training, practices and protocols to respond to disclosure and discovery of abuse to protect both researchers and children may not be sufficiently robust. Our aim was to compare and contrast research practices reported in the literature related to protecting children and to recommend safer ways to conduct research. The simultaneous increase in research with children, along with an increased willingness to listen to child victims of abuse, means that researchers must consider the protection of children in the research setting. Twenty-three papers were identified in a literature review. These studies reported a wide variation of ethical considerations, methods, methodology and came from different disciplines. From the 23 papers, two overarching themes were identified: social justice and research and safer research. To make research safer teams should consider training, safety protocols and support for child protection, which includes support to report safeguarding concerns to social care. Further work is required to ensure that training, protocols and support are effective in facilitating researchers to identify and make appropriate child abuse referrals. Ethics practices in abuse research need further debate.
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Affiliation(s)
- Duncan Randall
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Anna Anderson
- University of Edinburgh/NSPCC Child Protection Research Centre, Edinburgh, UK
| | - Julie Taylor
- University of Edinburgh/NSPCC Child Protection Research Centre, Edinburgh, UK
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16
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Embleton L, Ott MA, Wachira J, Naanyu V, Kamanda A, Makori D, Ayuku D, Braitstein P. Adapting ethical guidelines for adolescent health research to street-connected children and youth in low- and middle-income countries: a case study from western Kenya. BMC Med Ethics 2015; 16:89. [PMID: 26687378 PMCID: PMC4684915 DOI: 10.1186/s12910-015-0084-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 12/15/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Street-connected children and youth (SCCY) in low- and middle-income countries (LMIC) have multiple vulnerabilities in relation to participation in research. These require additional considerations that are responsive to their needs and the social, cultural, and economic context, while upholding core ethical principles of respect for persons, beneficence, and justice. The objective of this paper is to describe processes and outcomes of adapting ethical guidelines for SCCY's specific vulnerabilities in LMIC. METHODS As part of three interrelated research projects in western Kenya, we created procedures to address SCCY's vulnerabilities related to research participation within the local context. These consisted of identifying ethical considerations and solutions in relation to community engagement, equitable recruitment, informed consent, vulnerability to coercion, and responsibility to report. RESULTS Substantial community engagement provided input on SCCY's participation in research, recruitment, and consent processes. We designed an assent process to support SCCY to make an informed decision regarding their participation in the research that respected their autonomy and their right to dissent, while safeguarding them in situations where their capacity to make an informed decision was diminished. To address issues related to coercion and access to care, we worked to reduce the unequal power dynamic through street outreach, and provided access to care regardless of research participation. CONCLUSIONS Although a vulnerable population, the specific vulnerabilities of SCCY can to some extent be managed using innovative procedures. Engaging SCCY in ethical research is a matter of justice and will assist in reducing inequities and advancing their health and human dignity.
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Affiliation(s)
- L Embleton
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - M A Ott
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - J Wachira
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
| | - V Naanyu
- College of Health Sciences, Department of Behavioral Sciences, Moi University, Eldoret, Kenya.
| | - A Kamanda
- Moi Teaching and Referral Hospital, Eldoret, Kenya.
| | - D Makori
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
| | - D Ayuku
- College of Health Sciences, Department of Behavioral Sciences, Moi University, Eldoret, Kenya.
| | - P Braitstein
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya.
- Fairbanks School of Public Health, Department of Epidemiology, Indiana University, Indianapolis, IN, USA.
- Regenstrief Institute, Inc., Indianapolis, IN, USA.
- Division of Epidemiology, 155 College Street, Toronto, M5T 3M7, ON, Canada.
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