Abstract
BackgroundThis paper presents findings from a qualitative investigation of ethical and participatory issues related to the conduct of biomedical HIV prevention trials among marginalized populations in Thailand. This research was deemed important to conduct, as several large-scale biomedical HIV prevention trials among marginalized populations had closed prematurely in other countries, and a better understanding of how to prevent similar trial closures from occurring in the future was desired.MethodsIn-depth key informant interviews were held in Bangkok and Chiang Mai, Thailand. Interviews were audio recorded, transcribed, translated and thematically analyzed. The Good Participatory Practice Guidelines for Biomedical HIV Prevention Trials (GPP) guided this work.ResultsFourteen interviews were conducted: 10 with policymakers, academic and community-based researchers and trial staff and four with representatives of non-governmental organizations (NGOs). Suggested ways to improve ethical and participatory practice centered on standards of HIV prevention, informed consent, communication and human rights. In particular, the need to overcome language and literacy differences was identified. Key informants felt communication was the basis of ethical understanding and trust within biomedical HIV prevention trial contexts, and thus fundamental to trial participants' ability to exercise free will.DiscussionBiomedical HIV prevention trials present opportunities for inclusive and productive ethical and participatory practice. Key informants suggested that efforts to improve practice could result in better relationships between research stakeholders and research investigative teams and by extension, better, more ethical participatory trials. This research took place in Thailand and its findings apply primarily to Thailand. However, given the universality of many ethical considerations, the results of this study can inform the improvement of ethical and participatory practice in other parts of the world where biomedical HIV prevention trials occur, and where clinical trials in marginalized populations continue.
Highlights
This paper presents findings from a qualitative investigation of ethical and participatory issues related to the conduct of biomedical HIV prevention trials among marginalized populations in Thailand
This paper aims to contribute to efforts to improve ethical and participatory practice for marginalized populations in biomedical HIV prevention trials
These trials sought to test the efficacy of Tenofovir (Viread) as pre-exposure prophylaxis (PrEP) for HIV prevention in locations as diverse as Thailand, Cambodia, Malawi, Nigeria, Ghana and Cameroon [1]
Summary
In the 2000s, several large-scale biomedical HIV prevention trials among marginalized populations prematurely closed in a number of countries in Africa and Asia. These trials sought to test the efficacy of Tenofovir (Viread) as pre-exposure prophylaxis (PrEP) for HIV prevention in locations as diverse as Thailand, Cambodia, Malawi, Nigeria, Ghana and Cameroon [1]. The closure of these trials acted to prevent or in some cases slow the development of other biomedical HIV prevention trials in marginalized populations across these regions. The role of ethical and participatory practice in these trial stoppages has received substantial attention [6–10]
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