Oral Abstract Session 01 - Global HIV Vaccine Enterprise

POSTERS
Posters
Topic 4: Clinical Vaccine Trials and Trial Site Challenges
P04.03
Motivators to Participation in HIV Vaccine Trials and
Cancer Trials: The Application of Personal and Social
Categorization
S. Dhalla 1 , G. Poole 2
1 University of British Columbia, Vancouver, Canada; 2 School of
Population and Public Health, University of British Columbia,
Vancouver, Canada
Background: The Health Belief Model provides a framework to
understand motivators for volunteering for medical research.
Motivators can take the form of social benefits, including
macrosocial (pertaining to one’s greater society), mesosocial
(pertaining to one’s larger social world), and microsocial
(pertaining to one’s immediate social network). Personal benefits
can be sub-divided into psychological, physical, and financial wellbeing.
In this systematic review of review articles, we extend our
conceptual framework from motivators regarding participation
in HIV vaccine trials to another life-threatening disease, cancer.
Methods: In 2012, two people independently searched the
Cochrane Database for Systematic Reviews, Pubmed, Embase,
and Google Scholar to identify review articles examining cancer
trial motivators to participation. Search terms were: “cancer”,
“oncology”, “cancer trials”, “oncology trials”, “clinical trials”,
“medical research”, “willingness to participate”, “motivators”,
“incentives”. Review articles were also retrieved from our search
examining barriers to participation in cancer research and from
bibliographic references.
Results: We retrieved 12 review articles from 2000-2012 examining
motivators to participation in cancer trials. Personal benefits were
most often psychological such as “coping with symptoms”. Social
benefits included “advancing research”, “helping other cancer
patients”, and “for their family”. These categories also apply well
in HIV vaccine trials. Personal/psychological benefits are most
commonly cited as motivators for both types of research. In cancer
research, “coping with symptoms” and “extending life expectancy”
were motivators; in HIV vaccine trials, it was to “reduce the risk of
becoming HIV positive”.
Conclusion: While specific motivators vary between considerations
of cancer research and HIV vaccine trials, these motivators fall into
similar categories at similar frequencies. Personal / psychological
benefits are most common in each. Altruistic factors found at a
macrosocial level outnumber factors relevant to more proximal
levels, such as family and other patients. Participant recruitment
must be mindful of these categories of motivators for both HIV
vaccine and cancer research.
150
AIDS Vaccine 2012
P04.04
A Social Ecological Model of Willingness to
Participate in HIV Vaccine Trials Among Men Who
Have Sex with Men in Chennai and Mumbai, India
V. Chakrapani 1 , P.A. Newman 2 , J. Jerajani 3 , M. Shanmugam 1 ,
N. Singhal 3
1 Centre for Sexuality and Health Research and Policy;
Humsafar Trust, Chennai and Mumbai, India; 2 University of
Toronto, Toronto, Canada; 3 The Humsafar Trust, Mumbai, India
Background: Recruitment of low- and middle-income country
volunteers from most-at-risk-populations in HIV vaccine trials is
essential to vaccine development. In India, men who have sex
with men (MSM), at 20-fold higher risk for HIV infection than
the general population, are a crucial population for recruitment.
Research on willingness to participate (WTP) in HIV vaccine trials
has focused predominantly on individual-level determinants
(e.g., safety concerns, mistrust, altruism) in high-income
countries. We used a social ecological framework to explore
multi-level determinants of WTP among MSM in India.
Methods: We conducted 9 focus groups (n=49) with low
socioeconomic MSM (aged 20-46 years, mean=28), including
peer outreach workers, in Chennai (in Tamil) and Mumbai (in
Marathi/Hindi), and 7 key informant interviews with MSM
community leaders and healthcare professionals. Focus groups/
interviews were recorded, transcribed and translated into
English. Two independent bilingual investigators conducted
narrative thematic analysis using line-by-line coding and a
constant comparative method, with member-checking by
community representatives.
Results: Structural-level determinants of WTP included poverty,
compensation for trial-related harms and having financiallydependent
family members. Community-level factors were
negative societal attitudes about same-sex sexuality and
community engagement in HIV vaccine research. Interpersonal
factors included anticipated peer and familial reactions and
perceived HIV stigma. Individual-level determinants of WTP
included knowledge about vaccines, openness about one’s
sexuality and altruistic beliefs.
Conclusion: WTP in HIV vaccine trials among MSM in India is
associated with multi-level factors. Ubiquitous interpersonal
and community-level concerns characteristic of the sociocultural
context may complicate individual-focused conceptualizations of
WTP. Interventions to reduce stigma and discrimination against
MSM and PLHIV, capacity-building of MSM service organizations,
and sustained and transparent communications tailored to the
knowledge, concerns and educational level of local communities
may support meaningful engagement of MSM in HIV vaccine
trial preparedness. Attention to providing fair yet non-coercive
compensation and healthcare benefits are warranted to support
ethical conduct of trials.