Views among Malawian women about joining HIV prevention clinical trials when pregnant

被引:10
作者
Sullivan, Kristen [1 ,2 ]
Mtande, Tiwonge [3 ]
Jaffe, Elana [1 ,2 ]
Rosenberg, Nora [4 ]
Zimba, Chifundo [3 ]
Hoffman, Irving [5 ]
Little, Maggie [6 ]
Faden, Ruth [7 ]
Lyerly, Anne Drapkin [1 ,2 ]
机构
[1] Univ North Carolina Chapel Hill, Ctr Bioeth, 333 S Columbia St,Campus Box 7240, Chapel Hill, NC 27599 USA
[2] Univ North Carolina Chapel Hill, Dept Social Med, 333 S Columbia St,Campus Box 7240, Chapel Hill, NC 27599 USA
[3] Tidziwe Ctr, UNC Project Malawi, Private Bag A-104, Lilongwe, Malawi
[4] Univ North Carolina Chapel Hill, UNC Gillings Sch Global Publ Hlth, Dept Hlth Behav, 170 Rosenau Hall,135 Dauer Dr, Chapel Hill, NC 27599 USA
[5] Univ North Carolina Chapel Hill, Inst Global Hlth & Infect Dis, Bioinformat Bldg,130 Mason Farm Rd, Chapel Hill, NC 27599 USA
[6] Georgetown Univ, Kennedy Inst Eth, 3700 O St Northwest, Washington, DC 20057 USA
[7] Johns Hopkins Univ, Berman Inst Bioeth, 1809 Ashland Ave, Baltimore, MD 21205 USA
基金
美国国家卫生研究院;
关键词
Pregnancy; Women's views; HIV prevention; Clinical trials; Qualitative methods; Research ethics; PREEXPOSURE PROPHYLAXIS; PERINATAL TRANSMISSION; UNDUE INDUCEMENT; ANCILLARY CARE; PARTICIPATION; INFECTION; COUNTRIES;
D O I
10.1186/s12981-020-00271-6
中图分类号
R51 [传染病];
学科分类号
100401 ;
摘要
Background The pressing need to expand the biomedical HIV prevention evidence base during pregnancy is now increasingly recognized. Women's views regarding participation in such trials and initiating PrEP while pregnant are critical to inform evolving policy and best practices aimed at responsibly expanding evidence-based access for this population. Methods We conducted 35 semi-structured interviews with reproductive-aged women in Malawi in the local language, Chichewa. Participants were HIV-negative and purposively sampled to capture a range of experience with research during pregnancy. Women's perspectives on enrolling in three hypothetical HIV prevention trial vignettes while pregnant were explored, testing: (1) oral PrEP (Truvada) (2) a vaginal ring (dapivirine), and (3) a randomized trial comparing the two. The vignettes were read aloud to participants and a simple visual was provided. Interviews were audio-recorded, transcribed, translated, and coded using NVivo 11. Thematic analysis informed the analytic approach. Results A majority of women accepted participation in all trials. Women's views on research participation varied largely based on their assessment of whether participation or nonparticipation would best protect their own health and that of their offspring. Women interested in participating described power dynamics with their partner as fueling their HIV exposure concerns and highlighted health benefits of participation-principally, HIV protection and access to testing/treatment and ancillary care, and perceived potential risks of the vignettes as low. Women who were uninterested in participating highlighted potential maternal and fetal health risks of the trial, challenges of justifying prevention use to their partner, and raised some modality-specific concerns. Women also described ways their social networks, sense of altruism and adherence requirements would influence participation decisions. Conclusions The majority of participants conveyed strong interest in participating in biomedical HIV prevention research during pregnancy, largely motivated by a desire to protect themselves and their offspring. Our results are consistent with other studies that found high acceptance of HIV prevention products during pregnancy, and support the current direction of HIV research policies and practices that are increasingly aimed at protecting the health of pregnant women and their offspring through responsible research, rather than defaulting to their exclusion.
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页数:12
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