Consent Challenges and Psychosocial Distress in the Scale-up of Voluntary Medical Male Circumcision Among Adolescents in Western Kenya

Luseno, Winnie K.; Field, Samuel; Iritani, Bonita J.; Rennie, Stuart; Gilbertson, Adam; Odongo, Fredrick; Kwaro, Daniel; Ongili, Barrack; Hallfors, Denise Dion

doi:10.1007/s10461-019-02620-7

Cited by 15 publications

(14 citation statements)

References 30 publications

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“…Depressive symptoms were also measured in the context of VMMC service uptake and parental consent among circumcised and uncircumcised adolescents [61]. Circumcision without parental consent was associated with being an orphan, out of school, probable clinical depression (CES‐D score >16), and poorer quality of life.…”

Section: Resultsmentioning

confidence: 99%

“…HIV programme implementers must also consider how the social vulnerabilities of adolescents may increase the risk of coercive participation in HIV prevention or may indirectly create barriers to interventions (e.g. VMMC), and consequently, greater emotional stressors for young people [61].…”

Section: The Relationship Between Mental Health and Hiv Prevention Behavioursmentioning

confidence: 99%

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Intervening for HIV prevention and mental health: a review of global literature

et al. 2021

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Introduction Numerous effective HIV prevention options exist, including behaviour change interventions, condom promotion and biomedical interventions, like voluntary medical male circumcision and pre‐exposure prophylaxis. However, populations at risk of HIV also face overlapping vulnerabilities to common mental disorders and severe mental illness. Mental health status can affect engagement in HIV risk behaviours and HIV prevention programmes. We conducted a narrative review of the literature on HIV prevention among key populations and other groups vulnerable to HIV infection to understand the relationship between mental health conditions and HIV prevention outcomes and summarize existing evidence on integrated approaches to HIV prevention and mental healthcare. Methods We searched five databases for studies published from January 2015 to August 2020, focused on HIV prevention and mental health conditions among key populations and individuals with serious mental illness. Studies were included if they evaluated an HIV prevention intervention or assessed correlates of HIV risk reduction and included assessment of mental health conditions or a mental health intervention. Results and discussion We identified 50 studies meeting our inclusion criteria, of which 26 were randomized controlled trials or other experimental designs of an HIV prevention intervention with or without a mental health component. Behaviour change interventions were the most common HIV prevention approach. A majority of studies recruited men who have sex with men and adolescents. Two studies provided distinct approaches to integrated HIV prevention and mental health service delivery. Overall, a majority of included studies showed that symptoms of mental disorder or distress are associated with HIV prevention outcomes (e.g. increased risky sexual behaviour, poor engagement in HIV prevention behaviours). In addition, several studies conducted among groups at high risk of poor mental health found that integrating a mental health component into a behaviour change intervention or linking mental health services to combination prevention activities significantly reduced risk behaviour and mental distress and improved access to mental healthcare. Conclusions Evidence suggests that mental health conditions are associated with poorer HIV prevention outcomes, and tailored integrated approaches are urgently needed to address overlapping vulnerabilities among key populations and other individuals at risk.

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Section: Resultsmentioning

confidence: 99%

Section: The Relationship Between Mental Health and Hiv Prevention Behavioursmentioning

confidence: 99%

Intervening for HIV prevention and mental health: a review of global literature

et al. 2021

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“…The history of global health research holds far too many examples of researchers violating the core principles of medical ethics-autonomy, beneficence, non-maleficence and justice-when recruiting human subjects in developing world communities. [22][23][24][25] Since novel pathogens often emerge-and are particularly devastating in-contexts of limited health systems capacity, there is a pronounced risk that the harms of an unethical secondary vaccine trial would disproportionately affect populations in lower-income countries, thereby creating the conditions for vulnerability laid out by Schroeder and Gefenas. 21 Finally, pursuing a randomised controlled trial of a novel vaccine during an active outbreak may be at odds with epidemic control efforts.…”

Section: The Prima Facie Argument Against Secondary Vaccine Trialsmentioning

confidence: 99%

Ethical considerations for epidemic vaccine trials

Monrad

2020

J Med Ethics

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Vaccines are a powerful measure to protect the health of individuals and to combat outbreaks such as the COVID-19 pandemic. An ethical dilemma arises when one effective vaccine has been successfully developed against an epidemic disease and researchers seek to test the efficacy of another vaccine for the same pathogen in clinical trials involving human subjects. On the one hand, there are compelling reasons why it would be unethical to trial a novel vaccine when an effective product exists already. First, it is a firm principle of medical ethics that an effective treatment or vaccine should not be withheld from patients if their life may depend on it. Second, since epidemic outbreaks often emerge in settings with less-resourced health systems, there is a pronounced risk that any trial withholding an effective vaccine would disproportionately affect the vulnerable populations that historically have been exploited for biomedical research. Third, clinical trials for novel vaccines may be at odds with efforts to control active outbreaks. On the other hand, it may be justified to conduct a trial for a candidate vaccine if it is expected to have certain advantages compared with the existing product. This essay discusses key factors for comparing vaccines against epidemic pathogens, including immunological, logistical and economic considerations. Alongside a case study of the development of vaccines for Ebola, the essay seeks to establish a general framework that should be expanded and populated by immunologists, epidemiologists, economists and bioethicists, and ultimately could be applied to the case of COVID-19 vaccines.

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“…They also suggest more input from local VMMC providers, mobilizers, and implementing partners should be considered for target setting and call for strengthened adherence to standards for responsible conduct of VMMC. Lastly, in the push to reach all potential VMMC clients at a rapid pace, another study identified issues in consent verification among adolescent Kenyan VMMC clients [42], further calling for reconsideration of the direct linkage between VMMC target achievement to program success.…”

Section: Discussionmentioning

confidence: 99%

Balancing competing priorities: Quantity versus quality within a routine, voluntary medical male circumcision program operating at scale in Zimbabwe

Feldacker

Murenje²,

Makunike-Chikwinya³

et al. 2020

PLoS ONE

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Background Since 2013, the ZAZIC consortium supported the Zimbabwe Ministry of Health and Child Care (MOHCC) to implement a high quality, integrated voluntary medical male circumcision (VMMC) program in 13 districts. With the aim of significantly lowering global HIV rates, prevention programs like VMMC make every effort to achieve ambitious targets at an increasingly reduced cost. This has the potential to threaten VMMC program quality. Two measures of program quality are follow-up and adverse event (AE) rates. To inform further VMMC program improvement, ZAZIC conducted a quality assurance (QA) activity to assess if pressure to do more with less influenced program quality. Methods Key informant interviews (KIIs) were conducted at 9 sites with 7 site-based VMMC program officers and 9 ZAZIC roving team members. Confidentiality was ensured to encourage candid conversation on adherence to VMMC standards, methods to increase productivity, challenges to target achievement, and suggestions for program modification. Interviews were recorded, transcribed and analyzed using Atlas.ti 6. Results VMMC teams work long hours in diverse community settings to reach ambitious targets. Rotating, large teams of trained VMMC providers ensures meeting demand. Service providers prioritize VMMC safety procedures and implement additional QA measures to prevent

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Consent Challenges and Psychosocial Distress in the Scale-up of Voluntary Medical Male Circumcision Among Adolescents in Western Kenya

Cited by 15 publications

References 30 publications

Intervening for HIV prevention and mental health: a review of global literature

Intervening for HIV prevention and mental health: a review of global literature

Ethical considerations for epidemic vaccine trials

Balancing competing priorities: Quantity versus quality within a routine, voluntary medical male circumcision program operating at scale in Zimbabwe

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