Inclusion of adolescents in preventive HIV vaccine trials: public health policy and research design at a crossroads.
ABSTRACT The search for a safe effective HIV vaccine has been a centerpiece of HIV research for almost 2 decades. More than 60 clinical HIV vaccine trials have been conducted to date. Several promising candidate HIV vaccines are in advanced clinical development. To date, however, no trial has included adolescents, one of the most important target groups for any preventive HIV vaccine. To license a vaccine for use in this age group, efficacy data or, at a minimum, bridging safety and immunogenicity data in this population are needed. To accomplish this, several critical issues and special challenges in the development and implementation of HIV vaccine trials in adolescents must be addressed, including regulatory considerations, potential differentials in safety and immunogenicity, alternative trial design strategies, recruitment and retention challenges, community involvement models, and approaches to informed consent/assent. This article examines these issues and proposes specific next steps to facilitate the routine inclusion of this high-priority population in preventive HIV vaccine trials as early and seamlessly as possible.
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ABSTRACT: Adolescents globally are at high risk for HIV acquisition and are the targets of HIV prevention interventions such as HIV vaccines. In order to understand stakeholders' attitudes towards the ethical issues of adolescent involvement in HIV vaccine trials, we conducted focus group discussions with key members of a semi-urban, informal Cape Town community with high HIV prevalence in which HIV vaccine trials are taking place. Themes were identified from focus group transcripts by four researchers, and included necessity of guardian consent, age of independent consent, and confidentiality of in-trial medical results. In general, ethical adolescent HIV vaccine trials will be feasible in this community.Vaccine 10/2008; 26(45):5679-83. DOI:10.1016/j.vaccine.2008.08.033 · 3.62 Impact Factor
Chapter: HIV/AIDS vaccine research[Show abstract] [Hide abstract]
ABSTRACT: The scale of the HIV epidemic in the last 25 years has been staggering: today there are 39.5 million people living with HIV, with more than 4 million new infections occurring every year (UNAIDS, 2006). The majority of new HIV infections worldwide occur in developing countries, where the brunt of the epidemic lies and one in four people are infected in the most severely affected regions. Many of them are young adults in their economically most productive years (UNAIDS, 2006). Here the scale of the pandemic threatens the very fabric of society.12/2008: pages 85-114;
Article: Adolescents in Clinical Trials[Show abstract] [Hide abstract]
ABSTRACT: Drug development is a lengthy, costly, and complex process, with clinical trials essential for characterizing dosing, safety, and efficacy in treated populations. After regulatory approval, aggressive marketing ensures that most drugs are used by a broad spectrum of ages, genders, races, and ethnic groups. Unfortunately, not all groups are adequately represented in clinical trials; adolescents are commonly overlooked. This commentary explores how adolescents are considered during drug development, with a special focus on the influence of inherent psychosocial, biological, ethical, and regulatory issues in their recruitment and participation in clinical studies leading to drug licensing.Clinical Pharmacology & Therapeutics 01/2009; 84(6):655-9. DOI:10.1038/clpt.2008.191 · 7.90 Impact Factor