1
|
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.
Collapse
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
| |
Collapse
|
2
|
Dubé K, Morton T, Fox L, Dee L, Palm D, Villa TJ, Freshwater W, Taylor J, Graham G, Carter WB, Sauceda JA, Peluso MJ, Rid A. A partner protection package for HIV cure-related trials involving analytical treatment interruptions. THE LANCET. INFECTIOUS DISEASES 2023; 23:e418-e430. [PMID: 37295453 PMCID: PMC10543569 DOI: 10.1016/s1473-3099(23)00267-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 06/12/2023]
Abstract
Analytical treatment interruptions (ATIs) have become a key methodological approach to evaluate the effects of experimental HIV cure-related research interventions. During ATIs, sex partners of trial participants might be at risk of acquiring HIV. This risk raises both ethical and feasibility concerns about ATI trials. We propose a partner protection package (P3) approach to address these concerns. A P3 approach would provide guidance to investigators, sponsors, and those who are designing and implementing context-specific partner protections in HIV cure-related trials involving ATIs. The approach would also help assure institutional review boards, trial participants, and communities that ATI trials with a P3 would provide appropriate partner protections. We offer a prototype P3 framework that delineates three basic considerations for protecting participants' sex partners during ATI trials: (1) ensuring the scientific and social value of the ATI and the trial, (2) reducing the likelihood of unintended HIV transmission, and (3) ensuring prompt management of any acquired HIV infection. We outline possible ways of implementing these basic considerations.
Collapse
Affiliation(s)
- Karine Dubé
- Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA; University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
| | - Tia Morton
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Rockville, MD, USA
| | - Lawrence Fox
- Division of AIDS, National Institute of Allergy and Infectious Diseases, Rockville, MD, USA
| | - Lynda Dee
- Delaney AIDS Research Enterprise Community Engagement and Community Advisory Board University of California San Francisco, Department of Medicine, HIV, ID and Global Medicine, San Francisco, CA, USA; AIDS Action Baltimore, Baltimore, MD, USA
| | - David Palm
- AIDS Clinical Trials Group Global Community Advisory Board, Chapel Hill, NC, USA; Institute of Global Health and Infectious Diseases Clinical Trials Unit, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Thomas J Villa
- HIV Obstruction by Programmed Epigenetics Delaney Collaboratory Community Advisory Board, Gladstone Institutes, San Francisco, CA, USA; National HIV & Aging Advocacy Network, National Minority AIDS Council, Washington, DC, USA; Reversing Immune Dysfunction HIV Delaney Collaboratory Community Advisory Board, Scripps Research, La Jolla, CA, USA; Rockville, MD, USA
| | | | - Jeff Taylor
- Delaney AIDS Research Enterprise Community Engagement and Community Advisory Board University of California San Francisco, Department of Medicine, HIV, ID and Global Medicine, San Francisco, CA, USA; Reversing Immune Dysfunction HIV Delaney Collaboratory Community Advisory Board, Scripps Research, La Jolla, CA, USA; Palm Springs, CA, USA; HIV + Aging Research Project, Palm Springs, CA, USA
| | | | - William B Carter
- Baltimore, MD, USA; BEAT-HIV Collaboratory Delaney Community Advisory Board, Wistar Institute, Philadelphia, PA, USA
| | - John A Sauceda
- Center for AIDS Prevention Studies, Division of Prevention Sciences, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Michael J Peluso
- Department of Medicine, Division of HIV, Infectious Diseases, and Global Medicine, San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Annette Rid
- Department of Bioethics, NIH Clinical Center, Bethesda, MD, USA
| |
Collapse
|
3
|
Bonney EY, Lamptey H, Kyei GB. HIV cure: an acceptability scientific agenda. Curr Opin HIV AIDS 2023; 18:12-17. [PMID: 36503877 PMCID: PMC9757853 DOI: 10.1097/coh.0000000000000771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Recent years have seen major investments into HIV cure research, seeking a permanent cure or remission. The purpose of this review is to consider how this important research agenda could be broadened to include issues of acceptability and appropriateness for different populations. RECENT FINDINGS We discuss how the definitions of cure such as functional cure (remission) or complete cure (viral elimination) could be interpreted differently by various populations. We also discuss the different methods of cure and the importance of including Africa in cure research to ensure that emerging remedies could be trialled and utilized on the continent that bears the brunt of the AIDS pandemic. SUMMARY We propose that the social science research of HIV cure acceptability should be done concurrently with the basic and clinical sciences, to ensure that cure methods consider stakeholder preferences.
Collapse
Affiliation(s)
- Evelyn Y. Bonney
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Helena Lamptey
- Departments of Medicine and Molecular Microbiology, Washington University School of Medicine in St Louis, Missouri, USA
| | - George B. Kyei
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
- Departments of Medicine and Molecular Microbiology, Washington University School of Medicine in St Louis, Missouri, USA
- Medical and Scientific Research Center, University of Ghana Medical Center, Accra, Ghana
| |
Collapse
|
4
|
Sylla L, Patel H, Louella M, Simoni J, Dubé K. Community HIV clinicians' perceptions about HIV cure-related research in the Northwestern United States. HIV Res Clin Pract 2022; 23:61-75. [PMID: 35904107 PMCID: PMC9836364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background: Research on stakeholder perspectives of HIV cure research has involved people with HIV (PWH), who generally cite the importance of HIV clinician advice in making decisions about trial participation. However, there has been little exploration of non-researcher community HIV clinician perspectives, which are clearly critical to the success of HIV cure-related research.Objective: We aimed to learn how community HIV clinicians perceive HIV cure research and identify factors that would lead them to support or discourage HIV cure trial participation by their patients.Methods: We recruited a purposive sample of 12 community HIV clinicians in metro-Seattle, WA to participate in structured interviews. We completed 11 interviews via teleconference and received one written response. We used conventional content analysis to analyze the data.Results: Overall, community HIV clinicians were supportive of patient participation in HIV cure trials. Factors affecting support included knowledge of local trials, ease of referral, patient immune function and health stability, study risks and benefits, burden of study requirements, patient characteristics, patient life stability, potential impact on engagement in care, study communication plans, and beliefs that patients should have the autonomy to decide to participate. Participants had concerns about trials requiring treatment delays or interruptions and HIV transmission risk. While their knowledge of the field was limited, they were interested in learning more about open HIV cure trials.Conclusions: It would benefit the HIV cure research community if those leading HIV cure trials make stronger efforts to engage community clinicians who care for PWH, but are not active researchers, early in the trial design process. Such engagement prior to launching HIV cure trials will improve trial designs, leading to better enrollment and retention within these important studies.
Collapse
Affiliation(s)
- Laurie Sylla
- defeatHIV Collaboratory, 1100 Fairview Avenue North, E5-110, Seattle, WA, 98109, USA,University of Washington, School of Medicine, Division of Allergy and Infectious Diseases, Mountain West AIDS Education & Training Center, Mailstop 359932, Seattle, WA 98104
| | - Hursch Patel
- University of North Carolina Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC, 27599, USA
| | - Michael Louella
- defeatHIV Collaboratory, 1100 Fairview Avenue North, E5-110, Seattle, WA, 98109, USA
| | - Jane Simoni
- University of Washington, Departments of Psychology and Global Health, 3909 Stevens Way CE, Box 351525, Seattle, WA, USA
| | - Karine Dubé
- University of North Carolina Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC, 27599, USA
| |
Collapse
|
5
|
Dubé K, Kanazawa J, Taylor J, Dee L, Jones N, Roebuck C, Sylla L, Louella M, Kosmyna J, Kelly D, Clanton O, Palm D, Campbell DM, Onaiwu MG, Patel H, Ndukwe S, Henley L, Johnson MO, Saberi P, Brown B, Sauceda JA, Sugarman J. Ethics of HIV cure research: an unfinished agenda. BMC Med Ethics 2021; 22:83. [PMID: 34193141 PMCID: PMC8243312 DOI: 10.1186/s12910-021-00651-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 06/23/2021] [Indexed: 02/07/2023] Open
Abstract
Background The pursuit of a cure for HIV is a high priority for researchers, funding agencies, governments and people living with HIV (PLWH). To date, over 250 biomedical studies worldwide are or have been related to discovering a safe, effective, and scalable HIV cure, most of which are early translational research and experimental medicine. As HIV cure research increases, it is critical to identify and address the ethical challenges posed by this research. Methods We conducted a scoping review of the growing HIV cure research ethics literature, focusing on articles published in English peer-reviewed journals from 2013 to 2021. We extracted and summarized key developments in the ethics of HIV cure research. Twelve community advocates actively engaged in HIV cure research provided input on this summary and suggested areas warranting further ethical inquiry and foresight via email exchange and video conferencing. Discussion Despite substantial scholarship related to the ethics of HIV cure research, additional attention should focus on emerging issues in six categories of ethical issues: (1) social value (ongoing and emerging biomedical research and scalability considerations); (2) scientific validity (study design issues, such as the use of analytical treatment interruptions and placebos); (3) fair selection of participants (equity and justice considerations); (4) favorable benefit/risk balance (early phase research, benefit-risk balance, risk perception, psychological risks, and pediatric research); (5) informed consent (attention to language, decision-making, informed consent processes and scientific uncertainty); and (6) respect for enrolled participants and community (perspectives of people living with HIV and affected communities and representation). Conclusion HIV cure research ethics has an unfinished agenda. Scientific research and bioethics should work in tandem to advance ethical HIV cure research. Because the science of HIV cure research will continue to rapidly advance, ethical considerations of the major themes we identified will need to be revisited and refined over time.
Collapse
Affiliation(s)
- Karine Dubé
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC, 27599-7469, USA.
| | - John Kanazawa
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC, 27599-7469, USA
| | - Jeff Taylor
- HIV + Aging Research Project - Palm Springs (HARP-PS), Palm Springs, CA, USA.,AntiViral Research Center (AVRC) Community Advisory Board (CAB), San Diego, CA, USA.,Collaboratory of AIDS Researchers for Eradication (CARE) CAB, Chapel Hill, NC, USA
| | - Lynda Dee
- AIDS Action Baltimore, Baltimore, MD, USA.,Delaney AIDS Research Enterprise (DARE) Community Advisory Board (CAB), San Francisco, CA, USA
| | - Nora Jones
- BEAT-HIV Collaboratory CAB, Philadelphia, PA, USA
| | | | | | | | - Jan Kosmyna
- AIDS Clinical Trials Group (ACTG) Community Scientific Subcommittee (CSS) Ethics Working Group, Nationwide, USA
| | - David Kelly
- AIDS Clinical Trials Group (ACTG) Community Scientific Subcommittee (CSS) Ethics Working Group, Nationwide, USA
| | - Orbit Clanton
- AIDS Clinical Trials Group Global CAB, Washington, D.C., USA
| | - David Palm
- Collaboratory of AIDS Researchers for Eradication (CARE) CAB, Chapel Hill, NC, USA.,Institute of Global Health and Infectious Diseases HIV Treatment and Prevention CAB, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Danielle M Campbell
- Delaney AIDS Research Enterprise (DARE) Community Advisory Board (CAB), San Francisco, CA, USA.,Charles R. Drew College of Medicine and Science, Los Angeles, CA, USA
| | - Morénike Giwa Onaiwu
- AIDS Clinical Trials Group (ACTG) Community Scientific Subcommittee (CSS) Ethics Working Group, Nationwide, USA.,Center for the Study of Women, Gender, and Sexuality (School of Humanities), Rice University, Houston, TX, USA
| | - Hursch Patel
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC, 27599-7469, USA
| | - Samuel Ndukwe
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC, 27599-7469, USA
| | - Laney Henley
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, 4108 McGavran-Greenberg Hall, Chapel Hill, NC, 27599-7469, USA
| | - Mallory O Johnson
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA, USA
| | - Parya Saberi
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA, USA
| | - Brandon Brown
- Department of Social Medicine, Population and Public Health, Center for Healthy Communities, University of California, Riverside, Riverside, CA, USA
| | - John A Sauceda
- Center for AIDS Prevention Studies (CAPS), Division of Prevention Sciences, UCSF, San Francisco, CA, USA
| | - Jeremy Sugarman
- Johns Hopkins Berman Institute for Bioethics, Baltimore, MD, USA
| |
Collapse
|