Posted: Mar 6, 2017
Knowledge and attitudes towards HIV vaccines among Soweto adolescents
Background: To explore adolescent HIV risk perception, HIV vaccine knowledge, willingness to participate in future HIV vaccine clinical trials, and the factors that influence willingness to participate among high school students in Soweto, South Africa, we recruited school-going youth through randomly selected local high schools. All pupils within the selected schools from whom parental consent and child assent could be obtained were eligible for participation. A self-administered, facilitated questionnaire was completed by all participants.
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Findings: Perception of adolescent HIV risk was high. Some misconceptions regarding vaccine research were common, particularly regarding placebo and potential eligibility criteria for prophylactic vaccine trials. Of 240 responses to the willingness item, 84 (35%) indicated they were “probably willing” and 126 (52.5%) that they were “definitely willing to participate”. There were no significant differences in willingness by gender, age, school grade, or institution. Factors that were rated as “very important” in determining willingness included receiving current information about HIV research [n = 201 (88.9%)], doing something to honour people who have HIV or have died of AIDS [n = 168 (70.9%)], getting free counselling and testing [n = 167 (70.5)], that participants may receive some protection against HIV infection from the vaccine [n = 160 (70.2%)], and improving motivation to avoid risky behaviour [n = 134 (59%)].
Conclusion: Soweto school-going youth report high degrees of willingness to participate in HIV vaccine trials. This may be related to the high levels of adolescent HIV risk perception. Whether hypothetical willingness translates to participation will await data from adolescent HIV vaccine trials.
De Bruyn, Guy et al. “Knowledge and Attitudes towards HIV Vaccines among Soweto Adolescents.” BMC Research Notes 1 (2008): 76. PMC. Web. 6 Mar. 2017.
Posted: Mar 6, 2017
Scientific justification for the participation of children and adolescents in HIV-1 vaccine trials in South Africa
UNAIDS estimates that there were 4.9 million new HIV infections in the year 2004, and that 640 000 of these infections occurred in children less than 15 years old. The first national population-based survey conducted in South Africa in 20022 showed that 9.3% of persons between the ages of 15 and 24 years of age were HIV-positive and that female youth were more likely to be HIV-infected than male youth (Table I). In South Africa sexual debut is at an early age,3 with 50% of adolescents sexually active by the age of 15. Transgenerational sex, transactional sex and non-consensual sex put adolescent girls at high risk for acquiring HIV infection.
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JASPAN, H. B., GRAY, G. E., ROBINSON, A. K., COOVADIA, H. M. & BEKKER, L. G. 2005. Scientific justification for the participation of children and adolescents in HIV-1 vaccine trials in South Africa. S Afr Med J, 95, 685-7.
Posted: Mar 6, 2017
Adolescent and Adult Participation in an HIV Vaccine Trial Preparedness Cohort in South Africa
Purpose: The importance of involving adolescents in HIV prevention trials has been recognized, but there have been few experiences reported from sub-Saharan Africa. We analyzed adult and adolescent data from a cohort study conducted to assess the feasibility of involving adolescents and adults in HIV vaccine-related studies.
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Methods: Two hundred HIV-negative participants aged 16 to 40 years were enrolled, including 86 (43%) adolescents. At baseline, sexual risk behavior and willingness to participate (WTP) in future HIV vaccine trials questionnaires were administered. Three monthly HIV counseling, pregnancy, HIV and syphilis tests were performed. Risk questionnaires were repeated at 6 months and WTP at 12 months. Results: No signiﬁcant difference in retention between adults (83%) and adolescents (87%) was noted (p .58). Initially, more adults (40%) reported WTP compared to adolescents (13%) (p .001). At the end of the study both groups reported higher levels of WTP; increasing to 40% among adolescents. HIV incidence during the study was 9.2 infections per 100 person-years (95% conﬁdence interval [CI]: 4.4–19.2) among adolescents compared to 5.8 (95% CI 2.6–12.9) in adults (p .42). Conclusions: Retention of high-risk HIV-negative adolescents in a cohort study is feasible. Following education, adolescents reported improved WTP. The high HIV incidence rate in adolescents highlights the importance of including this group in prevention trials. © 2008 Society for Adolescent Medicine. All rights reserved.
MIDDELKOOP, K., MYER, L., MARK, D., MTHIMUNYE, S. P., SMIT, J., WOOD, R. & BEKKER, L. G. 2008. Adolescent and adult participation in an HIV vaccine trial preparedness cohort in South Africa. J Adolesc Health, 43, 8-14.
Posted: Mar 6, 2017
Enrolling adolescents in HIV vaccine trials: reflections on legal complexities from South Africa
Background: South Africa is likely to be the first country in the world to host an adolescent HIV vaccine trial. Adolescents may be enrolled in late 2007. In the development and review of adolescent HIV vaccine trial protocols there are many complexities to consider, and much work to be done if these important trials are to become a reality.
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Discussion: This article sets out essential requirements for the lawful conduct of adolescent research in South Africa including compliance with consent requirements, child protection laws, and processes for the ethical and regulatory approval of research.
Summary: This article outlines likely complexities for researchers and research ethics committees, including determining that trial interventions meet current risk standards for child research. Explicit recommendations are made for role-players in other jurisdictions who may also be planning such trials. This article concludes with concrete steps for implementing these important trials in South Africa and other jurisdictions, including planning for consent processes; delineating privacy rights; compiling information necessary for ethics committees to assess risks to child participants; training trial site staff to recognize when disclosures trig mandatory reporting response; networking among relevant ethics commitees; and lobbying the National Regulatory Authority for guidance.
SLACK, C., STRODE, A., FLEISCHER, T., GRAY, G. & RANCHOD, C. 2007. Enrolling adolescents in HIV vaccine trials: reflections on legal complexities from South Africa. BMC Med Ethics, 8, 5.
Posted: Mar 6, 2017
Adolescent HIV Prevalence, Sexual Risk, and Willingness to Participate in HIV Vaccine Trials
Purpose: To determine human immunodeﬁciency virus (HIV) prevalence, sexual risk behaviors, and attitudes toward HIV vaccine trials among 11–19 year-olds in a peri-urban community near Cape Town, South Africa.
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Methods: We performed HIV antibody testing on oral transudate, and assessed sexual risk behaviors and willingness to participate in HIV vaccine trials using self-administered questionnaires. Results: Of the 510 adolescents selected, 356 (73%) participated. The HIV prevalence of the group was 10.6% (95% conﬁdence interval [CI] 7.5–14.4). One-third of adolescents had experienced sexual debut, with a mean age of 14.6 years. Number of lifetime sexual partners was independently associated with HIV infection (odds ratio [OR] 1.62; 95% CI 1.1–2.3). In a multivariate analysis, increasing age, female gender, and attending school were independently associated with having had sex. The majority of adolescents (79%) were willing to participate in an HIV vaccine trial. Increasing age and length of residence in the community were signiﬁcantly associated with willingness to participate (OR 1.19; 95% CI 1.01–1.4 and OR 1.14; 95% CI 1.03–1.26, respectively).
Conclusions: The prevalence of HIV and risk behavior among adolescents in this community is high. HIV vaccines are required that target preadolescents. HIV vaccine trials in adolescents in this setting will be facilitated by their willingness to participate. © 2006 Society for Adolescent Medicine. All rights reserved.
JASPAN, H. B., BERWICK, J. R., MYER, L., MATHEWS, C., FLISHER, A. J., WOOD, R. & BEKKER, L. G. 2006. Adolescent HIV prevalence, sexual risk, and willingness to participate in HIV vaccine trials. J Adolesc Health, 39, 642-8.