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Developing and Implementing new TB Technologies: Key Informants’ Perspectives on the Ethical Challenges

  • Symposium: Pharmaceutical Ethics
  • Published:
Journal of Bioethical Inquiry Aims and scope Submit manuscript

Abstract

Objective

To identify the ethical challenges associated with the development and implementation of new tuberculosis (TB) drugs and diagnostics.

Methods

Twenty-three semi-structured qualitative interviews conducted between December 2015 and September 2016 with programme administrators, healthcare workers, advocates, policymakers, and funders based in the Americas, Europe, and Africa. Interviews were analysed using thematic analysis.

Results

Divergent interests and responsibilities, coupled with power imbalances, are a primary source of ethical challenges; the uncertain risk profiles of new drugs present an additional one. Although this challenge can be partially mitigated through stringent pharmacovigilance, respondents highlighted that high-burden countries tend to lack the resources to facilitate safe implementation. Increased advocacy and community engagement are considered an ethical imperative for future TB development and implementation.

Conclusions

This project helps identify some of the ethical challenges of new TB technologies. It demonstrates that investigating ethical challenges through qualitative research is one way to apprehend the difficulty of implementing new TB technologies. Addressing this difficulty will require that those in positions of power reconsider their interests in relation to disempowered communities.

Policy implications

Efforts to build consensus regarding what values should underpin the global governance of TB research, prevention, and care are essential to facilitate the ethical implementation of new TB technologies.

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References

  • Albert, H., R.R. Nathavitharana, C. Isaacs, M. Pai, C.M. Denkinger, and C.C. Boehme. 2016. Development, roll-out and impact of Xpert MTB/RIF for tuberculosis: What lessons have we learnt and how can we do better? European Respiratory Journal 48(2): 516–525.

    PubMed  Google Scholar 

  • Boulanger, R.F., S. Seidel, E. Lessem, et al. 2013. Engaging communities in tuberculosis research. Lancet Infectious Diseases 13(6): 540–545.

    PubMed  Google Scholar 

  • Braun, V., and V. Clarke. 2006. Using thematic analysis in psychology. Qualitative Research in Psychology 3(2): 77–101.

    Google Scholar 

  • Churchyard, G.J., W.S. Stevens, L.D. Mametja, et al. 2015. Xpert MTB/RIF versus sputum microscopy as the initial diagnostic test for tuberculosis: A cluster-randomised trial embedded in South African roll-out of Xpert MTB/RIF. Lancet Global Health 3(8): e450-e457.

    PubMed  Google Scholar 

  • Clayden, P., S. Collins, M. Frick, et al. 2016. The 2016 Pipeline Report: HIV and Tuberculosis (TB) drugs, diagnostics, vaccines, preventive technologies, research towards a cure, and immune-based and gene therapies in development. London/New York: Treatment Action Group.

    Google Scholar 

  • Davids, A., K. Dheda, N.P. Pai, D. Cogill, M. Pai, and N. Engel. 2015. A survey on use of rapid tests and tuberculosis diagnostic practices by primary health care providers in South Africa: Implications for the development of new point-of-care tests. PLoS One 10(10): e0141453

    PubMed  PubMed Central  Google Scholar 

  • Degeling, C., C. Mayes, W. Lipworth, I. Kerridge, and R.E.G. Upshur. 2015. The political and ethical challenge of multi-drug resistant tuberculosis. Journal of Bioethical Inquiry 12(1): 107–113.

    PubMed  Google Scholar 

  • DeLuca, A., E. Lessem, D. Wegener, L.R. Mingote, M. Frick, and D. Von Delft. 2014. The evolving role of advocacy in tuberculosis. Lancet Respiratory Medicine 2(4): 258–259.

    PubMed  Google Scholar 

  • Dickert, N., and J. Sugarman. 2005. Ethical goals of community consultation in research. American Journal of Public Health 95(7): 1123–1127.

    PubMed  PubMed Central  Google Scholar 

  • Engel, N., J. Kenneth, and M. Pai. 2012. TB diagnostics in India: Creating an ecosystem for innovation. Expert Review of Molecular Diagnostics 12(1): 21–24.

    PubMed  Google Scholar 

  • Engel, N., and M. Pai. 2013. Tuberculosis diagnostics: Why we need more qualitative research. Journal of Epidemiology and Global Health 3(3): 119–121.

    PubMed  Google Scholar 

  • Free, M. 2004. Achieving appropriate design and widespread use of health care technologies in the developing world. Overcoming obstacles that impede the adaptation and diffusion of priority technologies for primary health care. International Journal of Gynaecology and Obstetrics 85(Supplement 1): S3-13.

    Google Scholar 

  • Guglielmetti, L., C. Hewison, Z. Avaliani, et al. 2017. Examples of bedaquiline introduction for the management of multidrug-resistant tuberculosis in five countries. International Journal of Tuberculosis and Lung Disease 21(2): 167–174.

    CAS  PubMed  Google Scholar 

  • Keshavjee, S., and P.E. Farmer. 2010. Picking up the pace—Scale-up of MDR tuberculosis treatment programs. New England Journal of Medicine 363(19): 1781–1784.

    CAS  PubMed  Google Scholar 

  • ———. 2012. Tuberculosis, drug resistance, and the history of modern medicine. New England Journal of Medicine. 367(10): 931–936.

    CAS  PubMed  Google Scholar 

  • Leese, M. 2017. Holding the project accountable: Research governance, ethics, and democracy. Science and Engineering Ethics 23(6): 1597–1616.

    PubMed  Google Scholar 

  • MacQueen, K.M., N.T. Eley, M. Frick, et al. 2016. Developing a framework for evaluating ethical outcomes of good participatory practices in TB clinical drug trials. Journal of Empirical Research on Human Research Ethics 11(3): 203–213.

    PubMed  PubMed Central  Google Scholar 

  • Mason, P.H., T. Oni, M.M.J.W. van Herpen, and A.K. Coussens. 2016. Tuberculosis prevention must integrate technological and basic care innovation. European Respiratory Journal 48(5): 1529–1531.

    PubMed  Google Scholar 

  • Mason, P.H., A. Roy, and P. Singh. 2017. Reciprocity-building and the importance of interdisciplinary collaboration in tuberculosis research. Journal of Biosocial Science 49(4): 559–562.

    CAS  PubMed  Google Scholar 

  • Natoli, L., R.J. Guy, M. Shephard, et al. 2015. “I do feel like a scientist at times”: A qualitative study of the acceptability of molecular point-of-care testing for chlamydia and gonorrhoea to primary care professionals in a remote high STI burden setting. PLoS One 10(12): e0145993.

    PubMed  PubMed Central  Google Scholar 

  • Patton, M.Q. 2002. Qualitative research and evaluation methods. Thousand Oaks, CA: 3rd Sage Publications.

  • Piot, P. 2012. Innovation and technology for global public health. Global Public Health 7(sup1): S46-S53.

    PubMed  Google Scholar 

  • Silva, D.S., A. Dawson, and R.E.G. Upshur. 2016. Reciprocity and ethical tuberculosis treatment and control. Journal of Bioethical Inquiry 13(1): 75–86.

    PubMed  PubMed Central  Google Scholar 

  • Selgelid, M.J. 2005. Ethics and infectious disease. Bioethics 19(3): 272–289.

    PubMed  Google Scholar 

  • ———. 2008. Ethics, tuberculosis and globalization. Public Health Ethics 1(1): 10–20.

    Google Scholar 

  • World Health Organization. 2014. The end TB strategy: Global strategy and targets for tuberculosis prevention, care and control after 2015. Geneva: World Health Organization.

    Google Scholar 

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Funding

This project was funded through grant courtesy of the Canadian Institutes of Health Research (grant no. 136732).

Author information

Authors and Affiliations

  1. Centre for Applied Ethics, McGill University Health Centre, 2155 Guy Street, 2nd floor, Montreal, Quebec, H3H 2R9, Canada

    Renaud F. Boulanger

  2. Leslie Dan Faculty of Pharmacy & Joint Centre for Bioethics, University of Toronto, 144 College Street, Toronto, Ontario, M5S 3M2, Canada

    Ana Komparic

  3. Sydney Health Ethics & Marie Bashir Institute for Infectious Diseases and Biosecurity, Level 1, Medical Foundation Building, The University of Sydney, Sydney, NSW, 2006, Australia

    Angus Dawson & Diego S. Silva

  4. Dalla Lana School of Public Health & Joint Centre for Bioethics, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada

    Ross E. G. Upshur

Authors
  1. Renaud F. Boulanger
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  2. Ana Komparic
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  3. Angus Dawson
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  4. Ross E. G. Upshur
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  5. Diego S. Silva
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Corresponding author

Correspondence to Diego S. Silva.

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Human Participant Protection

This study was reviewed and approved by the research ethics board at Simon Fraser University. Informed consent was obtained from each participant prior to their respective interview. Limited information about the respondents whom we quote is provided so as to protect confidentiality. While the whole data set cannot be made available for the same reason, authors may be contacted for additional details.

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Boulanger, R.F., Komparic, A., Dawson, A. et al. Developing and Implementing new TB Technologies: Key Informants’ Perspectives on the Ethical Challenges. Bioethical Inquiry 17, 65–73 (2020). https://doi.org/10.1007/s11673-019-09954-w

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  • DOI: https://doi.org/10.1007/s11673-019-09954-w

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