Feasibility and acceptability of conducting HIV vaccine trials in adolescents in South Africa: : Going beyond willingness to participate towards implementation
- Authors: Chandia, Jimmy
- Date: 2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5498 , vital:44586 , http://www.samj.org.za/index.php/samj/article/view/12260
- Description: Background. HIV/AIDS remains a leading cause of death in adolescents (aged 15 - 25 years), and in sub-Saharan Africa HIV-related deaths continue to rise in this age group despite a decline in both adult and paediatric populations. This is attributable in part to high adolescent infection rates and supports the urgent need for more efficacious prevention strategies. In particular, an even partially effective HIV vaccine, given prior to sexual debut, is predicted to significantly curb adolescent infection rates. While adolescents have indicated willingness to participate in HIV vaccine trials, there are concerns around safety, uptake, adherence, and ethical and logistic issues. Objectives. To initiate a national, multisite project with the aim of identifying obstacles to conducting adolescent HIV vaccine trials in South Africa (SA). Method. A simulated HIV vaccine trial was conducted in adolescents aged 12 - 17 years across five SA research sites, using the already licensed Merck human papillomavirus vaccine Gardasil as a proxy for an HIV vaccine. Adolescents were recruited at community venues and, following a vaccine discussion group, invited to participate in the trial. Consent for trial enrolment was obtained from a parent or legal guardian, and participants aged 16 - 17 years were eligible only if sexually active. Typical vaccine trial procedures were applied during the five study visits, including the administration of vaccination injections at study visits 2, 3 and 4. Results. The median age of participants was 14 years (interquartile range 13 - 15), with 81% between the ages of 12 and 15 years at enrolment. Overall, 98% of screened participants opted to receive the vaccine, 588 participants enrolled, and 524 (89%) attended the final visit. Conclusions. This trial showed that adolescents can be recruited, enrolled and retained in clinical prevention trials with parental support. While promising, these results were tempered by the coupling of sexual-risk eligibility criteria and the requirement for parental/guardian consent, which was probably a barrier to the enrolment of high-risk older adolescents. Further debate around appropriate consent approaches for such adolescents in HIV prevention studies is required.
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- Date Issued: 2018
How good are our guidelines? Four years of experience with the SAMJ’s AGREE II review of submitted clinical practice guidelines
- Authors: Kredo, Tamara , Wiseman, Roger , Gray, Andy , Parrish, Andy , Miot, Jacqui , Jamaloodien, Khadija , Blockman, Marc
- Date: 2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5296 , vital:44431 , http://10.7196/SAMJ.2018.v108i11.13646
- Description: The South African Medical Journal (SAMJ) is an established source of clinical practice guidelines (CPGs) serving the local healthcare community. CPGs link professional societies and clinicians by guiding best practice through the collation and interpretation of the best available evidence. Not only are CPGs important in standardising the quality of patient care, but they also assist with medicine selection and resource allocation decisions, adjudicating medicolegal claims, and promoting equity by influencing medicine access and health system organisation.[1] In 2014, the SAMJ appointed an editorial subcommittee to review CPGs submitted for publication.[2] This was in response to several concerns, including the global shift in CPG quality requirements, the potential effect of poor-quality CPGs on healthcare quality and cost, and the challenges South African (SA) CPG developers face in meeting new standards. This editorial reflects on the SAMJ CPG review subcommittee’s experience over the past 4 years and describes the value of more robust CPG development.
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- Date Issued: 2018
Potential latitudinal variation in orodigestive tract cancers in Africa
- Authors: Adeola, H A , Adefuye, A O , Jimoh, S A
- Date: 2018
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/5280 , vital:44428 , http://www.samj.org.za/index.php/samj/article/view/12259
- Description: Background. Previous studies have alluded to a causal relationship between pathological entities and geographical variations, but there is a paucity of studies from Africa discussing the effect of latitudinal variation on orodigestive cancers in this region. It seems plausible that the burden of orodigestive cancer would differ as a result of variations in diet, cultural habits, climate and environmental conditions down the length of Africa. Objectives. To analyse regional variations in prevalence, incidence and mortality data in the global cancer statistics database (GLOBOCAN 2012) curated by the World Health Organization and the International Agency for Research on Cancer. Basic descriptive statistical tools were used to depict regional variations in cancer morbidity and mortality. Methods. Data on 13 African countries between longitude 20⁰ and 30⁰ east and latitude 35⁰ north and 35⁰ south were examined for variation in age-standardised orodigestive cancer prevalence, incidence and mortality. Possible regional causes for orodigestive tract cancer development were investigated. Data on lip and oral cavity, oesophageal, gastric, colorectal, liver, gallbladder and pancreatic cancers in the 13 countries were compared. Results. Our empirical findings from this preliminary study support the notion that the incidence and prevalence of orodigestive cancers vary within Africa. This effect may be due to environmental, economic, political and possibly genetic factors. Conclusions. Considering the heterogeneity of the above factors across Africa, disbursement of funding for cancer research and therapy in Africa should be focused in terms of regional variations to make best use of the fiscal allocation by African governments, non-governmental organisations and international agencies.
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- Date Issued: 2018