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Background

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Background

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  1. Background • As effective new HIV-prevention tools are developed, researchers face ethical and logistical questions about how and when to include them in the prevention package provided to trial participants in ongoing and future HIV-prevention trials. Current UNAIDS/WHO guidance recommends that decisions about adding new tools to the prevention package be made in consultation with “all relevant stakeholders” but leaves open questions of process and implementation. • In March 2009, GCM, UNAIDS, and CDC convened an international consultation to develop practical approaches to key questions related to the standard of prevention in individual trials and the overall context of HIV-prevention research: • 1. When and under what circumstances are researchers ethically obligated to make a new prevention tool available to study participants in a future trial? • 2. Under what circumstances would it be necessary to stop or modify an ongoing trial because a method has been shown to be effective in another trial? • 3. What impact will adding new prevention modalities have on the ability of future trials to evaluate the efficacy of the HIV-prevention tools they are testing? • 4. How can the field balance obligations to trial participants with the urgent need for new HIV-prevention methods? Recommendations Participants at the consultation – nearly 60 people working in HIV prevention research, advocacy and policymaking -- developed points of agreement and developed a set of specific criteria to inform decision making around adding new prevention methods to the prevention package in trials. Some of the key recommendations are listed below. • Existing Guidance • UNAIDS/WHO (2007) Guidance Point 13 • Researchers, research staff, and trial sponsors should ensure ….that appropriate counseling and access to all state-of-the-art HIV-risk-reduction methods are provided to participants • New HIV risk reduction methods should be added, based on consultation among all research stakeholders including the community, as they are scientifically validated or as they are approved by relevant authorities • Outstanding Questions • Definition • state of the art • proven • established • validated • approved by relevant authorities • Implementation • stakeholder consultation • negotiation • conflict resolution How Much is Enough? Standards of Prevention in HIV Prevention Trials Consultation report and recommendationsSean Philpott1,5, Elizabeth McGrory*2, Catherine Hankins3, Lynn Paxton4, Lori Heise1,6, the Participants in the 2009 GCM/CDC/UNAIDS Consultation on Standards of Prevention in HIV Prevention Trials 1Global Campaign for Microbicides; 2Consultant to GCM; 3 Joint United Nations Programme on HIV/AIDS (UNAIDS); United States Centers for Disease Control and Prevention (CDC), 5 Union Graduate College-Mt. Sinai School of Medicine Bioethics Program; 6Gender Violence & Health Centre, London School of Hygiene & Tropical Medicine For more information on the Consultation on Standards of Prevention in HIV Prevention Trials please visit www.Global-Campaign.org

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