Liza Dawson1, Sam Garner2, Chuka Anude3, Paul Ndebele4, Shelly Karuna5, Renee Holt6, Gail Broder5, Jessica Handibode7, Scott M Hammer8, Magdalena E Sobieszczyk8. 1. Division of AIDS, NIH/NIAID, Bethesda, MD, USA dawsonl@niaid.nih.gov. 2. Henry M. Jackson Foundation, Bethesda, MD, USA. 3. AstraZeneca, Gaithersburg, MD, USA. 4. Medical Research Council of Zimbabwe, Harare, Zimbabwe. 5. Fred Hutchinson Cancer Research Center, Seattle, WA, USA. 6. Program for Appropriate Technology in Health (PATH), Seattle, WA, USA. 7. AVAC: Global Advocacy for HIV Prevention, New York, NY, USA. 8. Department of Medicine, Columbia University, New York, NY, USA.
Abstract
BACKGROUND: The field of HIV prevention research has recently experienced some mixed results in efficacy trials of pre-exposure prophylaxis, vaginal microbicides, and HIV vaccines. While there have been positive trial results in some studies, in the near term, no single method will be sufficient to quell the epidemic. Improved HIV prevention methods, choices among methods, and coverage for all at-risk populations will be needed. The emergence of partially effective prevention methods that are not uniformly available raises complex ethical and scientific questions regarding the design of ongoing prevention trials. METHODS: We present here an ethical analysis regarding inclusion of pre-exposure prophylaxis in an ongoing phase IIb vaccine efficacy trial, HVTN 505. This is the first large vaccine efficacy trial to address the issue of pre-exposure prophylaxis, and the decisions made by the protocol team were informed by extensive stakeholder consultations. The key ethical concerns are analyzed here, and the process of stakeholder engagement and decision-making described. DISCUSSION: This discussion and analysis will be useful as current and future research teams grapple with ethical and scientific study design questions emerging with the rapidly expanding evidence base for HIV prevention.
BACKGROUND: The field of HIV prevention research has recently experienced some mixed results in efficacy trials of pre-exposure prophylaxis, vaginal microbicides, and HIV vaccines. While there have been positive trial results in some studies, in the near term, no single method will be sufficient to quell the epidemic. Improved HIV prevention methods, choices among methods, and coverage for all at-risk populations will be needed. The emergence of partially effective prevention methods that are not uniformly available raises complex ethical and scientific questions regarding the design of ongoing prevention trials. METHODS: We present here an ethical analysis regarding inclusion of pre-exposure prophylaxis in an ongoing phase IIb vaccine efficacy trial, HVTN 505. This is the first large vaccine efficacy trial to address the issue of pre-exposure prophylaxis, and the decisions made by the protocol team were informed by extensive stakeholder consultations. The key ethical concerns are analyzed here, and the process of stakeholder engagement and decision-making described. DISCUSSION: This discussion and analysis will be useful as current and future research teams grapple with ethical and scientific study design questions emerging with the rapidly expanding evidence base for HIV prevention.
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