Collateral benefits: how the practical application of Good Participatory Practice can strengthen HIV research in sub‐Saharan Africa

Abstract

IntroductionThe Good Participatory Practice (GPP): Guidelines for Biomedical HIV Prevention Trials, second edition (2011) were developed to provide clinical trial sponsors and implementers with a formal stakeholder engagement framework. As one of the largest African research institutes, Wits Reproductive Health and HIV Institute (Wits RHI) became an early adopter of GPP by implementing its principles within large‐scale national and regional clinical trials. This article examines Wits RHI's lessons learned from implementing GPP, its ongoing efforts to institutionalize GPP, and the yet to be realized potential in creating fully sustainable structures for meaningful stakeholder engagement in HIV prevention research, implementation science and beyond.DiscussionFor the past seven years, Wits RHI has undertaken both centralized leadership roles in implementing GPP across multi‐party regional research consortia as well as overseeing GPP for smaller investigator‐driven trials. Through this iterative roll‐out of GPP, key lessons have emerged. Obtaining upfront funding to support GPP activities throughout and between the research life cycle, and a trained multi‐disciplinary team of GPP practitioners have helped facilitate an enabling environment for GPP implementation. We further recommend formally integrating stakeholder engagement into study documents, including monitoring and evaluation plans with indicators and performance metrics, to assist teams to track and refine their GPP strategies. Finally, institutionalizing resources and supporting organization‐wide GPP along with ongoing support can help build efficiencies and maximize economies of scale toward a pragmatic and innovative application of the GPP Guidelines.ConclusionsThanks to a growing global network of GPP practitioners and a burgeoning GPP Community of Practice, there has been substantive progress in making GPP an integral component of clinical HIV prevention research. The Wits RHI experience highlights the possibilities and the challenges to translating the GPP principles into concrete practices within specific clinical trials and across a research institute. Realizing the full potential of GPP, including direct and indirect – ‘collateral benefits’ will require the collective buy‐in and support from sponsors, implementers and community stakeholders across the research field. As the HIV prevention research field expands, however, a more conscious and systematic implementation of GPP is timely.

Youth engagement in HIV prevention intervention research in sub‐Saharan Africa: a scoping review

“…Engagement activities identified were then categorized and independently coded once for each intervention as per the modified Hart’s ladder described above. We used the University of Witwatersrand Reproductive Health and HIV Institute (Wits RHI) Good Participatory Practice Implementation Model, adapted from the UNAIDS Good Participatory Practice Guidelines to categorize the timing of engagement activities as pre‐intervention, intervention or post‐intervention research phases [7,17]. Pre‐intervention phase referred to planning and readiness activities, including stakeholder advisory mechanisms, protocol development, ethical approval, field testing and related formative research activities.…”

It is not just about “the trial”: the critical role of effective engagement and participatory practices for moving the HIV research field forward

“…Another aspect of community and stakeholder engagement that has received little attention in the literature is the set of challenges faced by research sites conducting multiple trials with multiple sponsors or other partners. Baron and colleagues present a unique case study highlighting lessons learned from a leading South African research institute in this regard . Their analysis goes beyond assessing GPP implementation in the context of a single clinical trial, and documents the experience of implementing it on an institution‐wide level.…”

Why ethics guidance needs to be updated for contemporary HIV prevention research

“…In addition, ethicists and others increasingly emphasize the importance of addressing research questions that are relevant to local populations and responsive to host communities’ health priorities [5‐8], but which can complicate conventional approaches to selecting research sites that may have simply relied upon HIV incidence data within a particular locality. While community engagement and capacity building have long been part of much HIV prevention research, many guidance documents articulate specifications for robustly engaging communities and strengthening local capacity beyond health care and performing research [9‐17], making explicit a broad range of responsibilities for HIV prevention researchers that necessitate careful attention.…”