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Odera DO, Tuju J, Mwai K, Nkumama IN, Fürle K, Chege T, Kimathi R, Diehl S, Musasia FK, Rosenkranz M, Njuguna P, Hamaluba M, Kapulu MC, Frank R, Osier FHA, Abdi AI, Chi PC, de Laurent Z, Jao I, Kamuya D, Kamuyu G, Makale J, Murungi L, Musyoki J, Muthui M, Mwacharo J, Kariuki S, Mwanga D, Mwongeli J, Ndungu F, Njue M, Nyangweso G, Kimani D, Ngoi JM, Musembi J, Ngoto O, Otieno E, Ooko M, Shangala J, Wambua J, Mohammed KS, Omuoyo D, Mosobo M, Kibinge N, Kinyanjui S, Bejon P, Lowe B, Marsh K, Marsh V, Abebe Y, Billingsley PF, Sim BKL, Hoffman SL, James ER, Richie TL, Audi A, Olewe F, Oloo J, Ongecha J, Ongas MO, Koskei N, Bull PC, Hodgson SH, Kivisi C, Imwong M, Murphy SC, Ogutu B, Tarning J, Winterberg M, Williams TN. Anti-merozoite antibodies induce natural killer cell effector function and are associated with immunity against malaria. Sci Transl Med 2023; 15:eabn5993. [PMID: 36753561 DOI: 10.1126/scitranslmed.abn5993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Natural killer (NK) cells are potent immune effectors that can be activated via antibody-mediated Fc receptor engagement. Using multiparameter flow cytometry, we found that NK cells degranulate and release IFN-γ upon stimulation with antibody-opsonized Plasmodium falciparum merozoites. Antibody-dependent NK (Ab-NK) activity was largely strain transcending and enhanced invasion inhibition into erythrocytes. Ab-NK was associated with the successful control of parasitemia after experimental malaria challenge in African adults. In an independent cohort study in children, Ab-NK increased with age, was boosted by concurrent P. falciparum infections, and was associated with a lower risk of clinical episodes of malaria. Nine of the 14 vaccine candidates tested induced Ab-NK, including some less well-characterized antigens: P41, P113, MSP11, RHOPH3, and Pf_11363200. These data highlight an important role of Ab-NK activity in immunity against malaria and provide a potential mechanism for evaluating vaccine candidates.
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Affiliation(s)
- Dennis O Odera
- Centre of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany.,Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - James Tuju
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Kennedy Mwai
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.,Epidemiology and Biostatistics Division, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Irene N Nkumama
- Centre of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Kristin Fürle
- Centre of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Timothy Chege
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Rinter Kimathi
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Stefan Diehl
- Centre of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Fauzia K Musasia
- Centre of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Micha Rosenkranz
- Centre of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Patricia Njuguna
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Mainga Hamaluba
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Melissa C Kapulu
- Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Roland Frank
- Centre of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Faith H A Osier
- Centre of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany.,Centre for Geographic Medicine Research (Coast), Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya.,Department of Life Sciences, Imperial College London, UK
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de Jong BC, Gaye BM, Luyten J, van Buitenen B, André E, Meehan CJ, O'Siochain C, Tomsu K, Urbain J, Grietens KP, Njue M, Pinxten W, Gehre F, Nyan O, Buvé A, Roca A, Ravinetto R, Antonio M. Ethical Considerations for Movement Mapping to Identify Disease Transmission Hotspots. Emerg Infect Dis 2019; 25. [PMID: 31211938 PMCID: PMC6590736 DOI: 10.3201/eid2507.181421] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Traditional public health methods for detecting infectious disease transmission, such as contact tracing and molecular epidemiology, are time-consuming and costly. Information and communication technologies, such as global positioning systems, smartphones, and mobile phones, offer opportunities for novel approaches to identifying transmission hotspots. However, mapping the movements of potentially infected persons comes with ethical challenges. During an interdisciplinary meeting of researchers, ethicists, data security specialists, information and communication technology experts, epidemiologists, microbiologists, and others, we arrived at suggestions to mitigate the ethical concerns of movement mapping. These suggestions include a template Data Protection Impact Assessment that follows European Union General Data Protection Regulations.
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Mbuthia D, Molyneux S, Njue M, Mwalukore S, Marsh V. Kenyan health stakeholder views on individual consent, general notification and governance processes for the re-use of hospital inpatient data to support learning on healthcare systems. BMC Med Ethics 2019; 20:3. [PMID: 30621693 PMCID: PMC6325859 DOI: 10.1186/s12910-018-0343-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 12/26/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Increasing adoption of electronic health records in hospitals provides new opportunities for patient data to support public health advances. Such learning healthcare models have generated ethical debate in high-income countries, including on the role of patient and public consent and engagement. Increasing use of electronic health records in low-middle income countries offers important potential to fast-track healthcare improvements in these settings, where a disproportionate burden of global morbidity occurs. Core ethical issues have been raised around the role and form of information sharing processes for learning healthcare systems, including individual consent and individual and public general notification processes, but little research has focused on this perspective in low-middle income countries. METHODS We conducted a qualitative study on the role of information sharing and governance processes for inpatient data re-use, using in-depth interviews with 34 health stakeholders at two public hospitals on the Kenyan coast, including health managers, providers and researchers. Data were collected between March and July 2016 and analysed using a framework approach, with Nvivo 10 software to support data management. RESULTS Most forms of clinical data re-use were seen as an important public health good. Individual consent and general notification processes were often argued as important, but contingent on interrelated influences of the type of data, use and secondary user. Underlying concerns were linked to issues of patient privacy and autonomy; perceived risks to trust in health systems; and fairness in how data would be used, particularly for non-public sector re-users. Support for engagement often turned on the anticipated outcomes of information-sharing processes, as building or undermining trust in healthcare systems. CONCLUSIONS As reported in high income countries, learning healthcare systems in low-middle counties may generate a core ethical tension between supporting a public good and respecting patient autonomy and privacy, with the maintenance of public trust acting as a core requirement. While more evidence is needed on patient and public perspectives on learning healthcare activities, greater collaboration between public health and research governance systems is likely to support the development of efficient and locally responsive learning healthcare activities in LMICs.
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Affiliation(s)
- Daniel Mbuthia
- Ujamaa Africa, Kenya, 5th Floor, Landmark Plaza, Kamunde Rd, Nairobi, Kenya
| | - Sassy Molyneux
- KEMRI Wellcome Trust Research Programme, Kilifi, 80108 Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, South Parks Road, Oxford University, Oxford, OX1 3SY UK
| | - Maureen Njue
- Institute for Tropical Medicine, Kronenburgstraat 43, 2000 Antwerpen, Belgium
| | - Salim Mwalukore
- KEMRI Wellcome Trust Research Programme, Kilifi, 80108 Kenya
| | - Vicki Marsh
- KEMRI Wellcome Trust Research Programme, Kilifi, 80108 Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, South Parks Road, Oxford University, Oxford, OX1 3SY UK
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Njue M, Njuguna P, Kapulu MC, Sanga G, Bejon P, Marsh V, Molyneux S, Kamuya D. Ethical considerations in Controlled Human Malaria Infection studies in low resource settings: Experiences and perceptions of study participants in a malaria Challenge study in Kenya. Wellcome Open Res 2018; 3:39. [PMID: 29806038 PMCID: PMC5954342 DOI: 10.12688/wellcomeopenres.14439.2] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2018] [Indexed: 01/08/2023] Open
Abstract
Background: The range and amount of volunteer infection studies, known as Controlled Human Infection Model (CHMI) studies, in Low-Middle Income Countries (LMICs) is increasing with rapid technological advancement, world-class laboratory facilities and increasing capacity development initiatives. However, the ethical issues these studies present in LMICs have not been empirically studied. We present findings of a descriptive social science study nested within a malaria volunteer infection study, on-going at the time of writing, at the KEMRI-Wellcome Trust Research Programme (KWTRP) on the Kenyan Coast. Methods: The study included non-participant observations, five group discussions with more than half of the CHMI study participants, two in-depth interviews with study team members, and an exit questionnaire administered to the participants. Results: Participants understood the key elements of the study, including that they would be deliberately infected with malaria parasites and may get malaria as a result, there would be regular blood draws, and they would spend up to 24 days in a residence facility away from their homes. The greatest motivation for participation was the monetary compensation of 20 USD per overnight stay given as a lump-sum at the end of their residency stay. Also appreciated were the health screening tests prior to enrolment and the positive relations with the study team. Concerns raised included the amount and regularity of blood draws experienced, and concerns that this type of research may feed into on-going rumours about research generally. Conclusion: With the increasing range and number of CHMI studies being conducted in LMICs, current ethical guidance are inadequate. This study highlights some of the ethical issues that could emerge in these settings, emphasizing the heavy responsibility placed on research review and regulatory systems, researchers and funders, as well as the importance of carefully tailored community engagement and consent processes.
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Affiliation(s)
- Maureen Njue
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Patricia Njuguna
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- World Health Organisation, Geneva, Switzerland
| | - Melissa C. Kapulu
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University Oxford, Oxford, OX3 7BN, UK
| | - Gladys Sanga
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Philip Bejon
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University Oxford, Oxford, OX3 7BN, UK
| | - Vicki Marsh
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University Oxford, Oxford, OX3 7BN, UK
| | - Sassy Molyneux
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University Oxford, Oxford, OX3 7BN, UK
| | - Dorcas Kamuya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
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Njue M, Njuguna P, Kapulu MC, Sanga G, Bejon P, Marsh V, Molyneux S, Kamuya D. Ethical considerations in Controlled Human Malaria Infection studies in low resource settings: Experiences and perceptions of study participants in a malaria Challenge study in Kenya. Wellcome Open Res 2018; 3:39. [PMID: 29806038 PMCID: PMC5954342 DOI: 10.12688/wellcomeopenres.14439.1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2018] [Indexed: 11/20/2022] Open
Abstract
Background: The range and amount of volunteer infection studies, known as Controlled Human Infection Model (CHMI) studies, in Low-Middle Income Countries (LMICs) is increasing with rapid technological advancement, world-class laboratory facilities and increasing capacity development initiatives. However, the ethical issues these studies present in LMICs have not been empirically studied. We present findings of a descriptive social science study nested within a malaria volunteer infection study, on-going at the time of writing, at the KEMRI-Wellcome Trust Research Programme (KWTRP) on the Kenyan Coast. Methods: The study included non-participant observations, five group discussions with more than half of the CHMI study participants, two in-depth interviews with study team members, and an exit questionnaire administered to the participants. Results: Participants understood the key elements of the study, including that they would be deliberately infected with malaria parasites and may get malaria as a result, there would be regular blood draws, and they would spend up to 24 days in a residence facility away from their homes. The greatest motivation for participation was the monetary compensation of 20 USD per overnight stay given as a lump-sum at the end of their residency stay. Also appreciated were the health screening tests prior to enrolment and the positive relations with the study team. Concerns raised included the amount and regularity of blood draws experienced, and concerns that this type of research may feed into on-going rumours about research generally. Conclusion: With the increasing range and number of CHMI studies being conducted in LMICs, current ethical guidance for more than minimal risk studies is inadequate. This study highlights some of the ethical issues that could emerge in these settings, emphasizing the heavy responsibility placed on research review and regulatory systems, researchers and funders, as well as the importance of carefully tailored community engagement and consent processes.
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Affiliation(s)
- Maureen Njue
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Patricia Njuguna
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- World Health Organisation, Geneva, Switzerland
| | - Melissa C. Kapulu
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University Oxford, Oxford, OX3 7BN, UK
| | - Gladys Sanga
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Philip Bejon
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University Oxford, Oxford, OX3 7BN, UK
| | - Vicki Marsh
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University Oxford, Oxford, OX3 7BN, UK
| | - Sassy Molyneux
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University Oxford, Oxford, OX3 7BN, UK
| | - Dorcas Kamuya
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
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Njue M, Molyneux S, Kombe F, Mwalukore S, Kamuya D, Marsh V. Benefits in cash or in kind? A community consultation on types of benefits in health research on the Kenyan Coast. PLoS One 2015; 10:e0127842. [PMID: 26010783 PMCID: PMC4444261 DOI: 10.1371/journal.pone.0127842] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 03/20/2015] [Indexed: 12/02/2022] Open
Abstract
Background Providing benefits and payments to participants in health research, either in cash or in kind, is a common but ethically controversial practice. While much literature has concentrated on appropriate levels of benefits or payments, this paper focuses on less well explored ethical issues around the nature of study benefits, drawing on views of community members living close to an international health research centre in Kenya. Methods The consultation, including 90 residents purposively chosen to reflect diversity, used a two-stage deliberative process. Five half-day workshops were each followed by between two and four small group discussions, within a two week period (total 16 groups). During workshops and small groups, facilitators used participatory methods to share information, and promote reflection and debate on ethical issues around types of benefits, including cash, goods, medical and community benefits. Data from workshop and field notes, and voice recordings of small group discussions, were managed using Nvivo 10 and analysed using a Framework Analysis approach. Findings and Conclusions The methods generated in-depth discussion with high levels of engagement. Particularly for the most-poor, under-compensation of time in research carries risks of serious harm. Cash payments may best support compensation of costs experienced; while highly valued, goods and medical benefits may be more appropriate as an ‘appreciation’ or incentive for participation. Community benefits were seen as important in supporting but not replacing individual-level benefits, and in building trust in researcher-community relations. Cash payments were seen to have higher risks of undue inducement, commercialising relationships and generating family conflicts than other benefits, particularly where payments are high. Researchers should consider and account for burdens families may experience when children are involved in research. Careful context-specific research planning and skilled and consistent communication about study benefits and payments are important, including in mitigating potential negative effects.
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Affiliation(s)
- Maureen Njue
- Kenya Medical Research Institute (KEMRI)—Wellcome Trust Research Programme, PO Box 230–80108, Kilifi, Kenya
| | - Sassy Molyneux
- Kenya Medical Research Institute (KEMRI)—Wellcome Trust Research Programme, PO Box 230–80108, Kilifi, Kenya
- Centre for Tropical Medicine, Nuffield Department of Medicine Research Building, Oxford University, Old Road Campus, Headington, Oxford OX3 7FZ, United Kingdom
- Ethox Centre, Nuffield Department of Population Health, Oxford University, Old Road Campus, Headington, Oxford OX3 7LF, United Kingdom
| | - Francis Kombe
- Kenya Medical Research Institute (KEMRI)—Wellcome Trust Research Programme, PO Box 230–80108, Kilifi, Kenya
| | - Salim Mwalukore
- Kenya Medical Research Institute (KEMRI)—Wellcome Trust Research Programme, PO Box 230–80108, Kilifi, Kenya
| | - Dorcas Kamuya
- Kenya Medical Research Institute (KEMRI)—Wellcome Trust Research Programme, PO Box 230–80108, Kilifi, Kenya
- Centre for Tropical Medicine, Nuffield Department of Medicine Research Building, Oxford University, Old Road Campus, Headington, Oxford OX3 7FZ, United Kingdom
- Ethox Centre, Nuffield Department of Population Health, Oxford University, Old Road Campus, Headington, Oxford OX3 7LF, United Kingdom
| | - Vicki Marsh
- Kenya Medical Research Institute (KEMRI)—Wellcome Trust Research Programme, PO Box 230–80108, Kilifi, Kenya
- Centre for Tropical Medicine, Nuffield Department of Medicine Research Building, Oxford University, Old Road Campus, Headington, Oxford OX3 7FZ, United Kingdom
- Ethox Centre, Nuffield Department of Population Health, Oxford University, Old Road Campus, Headington, Oxford OX3 7LF, United Kingdom
- * E-mail:
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Molyneux S, Njue M, Boga M, Akello L, Olupot-Olupot P, Engoru C, Kiguli S, Maitland K. 'The words will pass with the blowing wind': staff and parent views of the deferred consent process, with prior assent, used in an emergency fluids trial in two African hospitals. PLoS One 2013; 8:e54894. [PMID: 23408950 PMCID: PMC3569446 DOI: 10.1371/journal.pone.0054894] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Accepted: 12/17/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To document and explore the views and experiences of key stakeholders regarding the consent procedures of an emergency research clinical trial examining immediate fluid resuscitation strategies, and to discuss the implications for similar trials in future. METHODS A social science sub-study of the FEAST (Fluid Expansion As Supportive Therapy) trial. Interviews were held with trial team members (n = 30), health workers (n = 15) and parents (n = 51) from two purposively selected hospitals in Soroti, Uganda, and Kilifi, Kenya. FINDINGS Overall, deferred consent with prior assent was seen by staff and parents as having the potential to protect the interests of both patients and researchers, and to avoid delays in starting treatment. An important challenge is that the validity of verbal assent is undermined when inadequate initial information is poorly understood. This concern needs to be balanced against the possibility that full prior consent on admission potentially causes harm through introducing delays. Full prior consent also potentially imposes worries on parents that clinicians are uncertain about how to proceed and that clinicians want to absolve themselves of any responsibility for the child's outcome (some parents' interpretation of the need for signed consent). Voluntariness is clearly compromised for both verbal assent and full prior consent in a context of such vulnerability and stress. Further challenges in obtaining verbal assent were: what to do in the absence of the household decision-maker (often the father); and how medical staff handle parents not giving a clear agreement or refusal. CONCLUSION While the challenges identified are faced in all research in low-income settings, they are magnified for emergency trials by the urgency of decision making and treatment needs. Consent options will need to be tailored to particular studies and settings, and might best be informed by consultation with staff members and community representatives using a deliberative approach.
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Affiliation(s)
- Sassy Molyneux
- Health Systems and Social Science Research Group, Kenya Medical Research Institute-ellcome Trust Research Programme, Kilifi, Kenya.
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