Exploring a community’s understanding of HIV vaccine‑induced seropositivity in a South African research setting
DOI:
https://doi.org/10.7196/SAMJ.2023.v113i1.16670Keywords:
HIV, vaccineAbstract
Background. The high HIV prevalence and incidence in South Africa makes it suitable for recruitment of participants for large-scale HIV preventive vaccine trials. However, fear of vaccine-induced seropositivity (VISP) may be a barrier for community acceptability of the trial, for volunteers to participate in HIV preventive vaccine trials and for uptake of an efficacious vaccine. Prior to 2015, when the first phase 1 safety HIV vaccine trial was undertaken at Setshaba Research Centre, Soshanguve, the local community stakeholders and healthcare workers were naive about HIV vaccine research and HIV preventive vaccines.
Objective. To explore knowledge and perceptions regarding VISP among community stakeholders and healthcare workers in peri-urbanb Soshanguve, Tshwane.
Methods. Using a quantitative-qualitative mixed-methods study design, surveys (n=50) and in-depth interviews (n=18) were conducted during July - August 2015. Participants included community stakeholders, community advisory board members and healthcare workers, who were >18 years old and had attended community educational workshops during September 2014 - May 2015. Audio recordings of interviews were transcribed verbatim and coded using content thematic analysis. Data were further analysed by sex, age and educational level.
Results. Of a maximum score of 2 on knowledge on VISP, the 50 survey participants (mean age 33.78 years; 45 females) obtained an
average of 0.88 (44%). Of 17 in-depth interviewees (one interview could not be transcribed; mean age 30.9 years; 12 females), 8 (47%)
displayed some knowledge about VISP, of whom only 5 defined VISP correctly. Women were more knowledgeable about VISP than men; 5 of 12 women (42%) came close to defining VISP correctly, while none of the 5 men did so. The main fear of trial participation expressed by most participants (n=6) was testing HIV-positive as a result of the vaccine. While some participants believed that the community’s perceptions of VISP would negatively affect HIV vaccine trial support and recruitment efforts, others noted that if trial participants understand the concept of VISP and are part of support groups, then they would have the information to combat negative attitudes within their community.
Conclusion. Most participants had an inaccurate and incomplete understanding of VISP. Many feared testing HIV-positive at clinics;
therefore, education on improving a basic understanding of how vaccines work and why VISP occurs is essential. In addition, assessing
participant understanding of HIV testing, transmission and VISP is critical for recruitment of participants into HIV vaccine trials and may improve acceptability of an HIV preventive vaccine.
References
Cooper CJ, Metch B, Dragavon J, Coombs RW, Baden LR, NIAID HIV Vaccine Trials Network (HVTN) Vaccine-Induced Seropositivity (VISP) Task Force. Vaccine-induced HIV seropositivity/ reactivity in noninfected HIV vaccine recipients. JAMA 2010;304(3):275-283. https://doi.org/10.1001/ jama.2010.926
Voronin Y, Zinszner H, Karg C, et al. HIV vaccine-induced sero-reactivity: A challenge for trial participants, researchers, and physicians. Vaccine 2015;33(10):1243-1249. https://doi.org/10.1016/j. vaccine.2014.10.040
Rerks-Ngarm S, Pitisuttithum P, Nitayaphan S, et al. Vaccination with ALVAC and AIDSVAX to Prevent HIV-1 Infection in Thailand. N Engl J Med 2009;361:2209-2220. https://doi.org/10.1056/ NEJMoa0908492
PenezinaO,KruegerNX,Rodriguez-ChavezIR,etal.PerformanceofaredesignedHIVSelectestenzyme- linked immunosorbent assay optimised to minimise vaccine-induced seropositivity in HIV vaccine trial participants. Clin Vaccin Immunol 2014;21(3):391-398. https://doi.org/10.1128/CVI.00748-13
Lavreys L, Vingerhoets J, Colfer A, et al. Vaccine induced seropositivity in participants of the APPROACH study. Madrid: HIV Research for Prevention HIVR4P 2018 Conference, 2018.
Simbayi LC, Zuma K, SABSSM V Team, et al. South African National HIV Prevalence, Incidence, Behaviour and Communications Survey, 2017. Cape Town: HSRC Press, 2019.
Allen MA, La Salvia T, Tjugum B, Gulakowski RJ, Murguía M. Assessing the attitudes, knowledge, and awareness of HIV vaccine research among adults in the United States. J Acquir Immune Defic Syndr 2005;40(5):617-624. https://doi.org/10.1097/01.qai.0000174655.63653.38
Buchbinder SP, Metch B, Holte SE, Scheer S, Vittinghoff CA. Determinants of enrollment in a preventive HIV vaccine trial: Hypothetical versus actual willingness and barriers to participation. J Acquir Immune Defic Syndr 2004:36(1):604-612. https://doi.org/10.1097/00126334-200405010-00009
Jackson DJ, Martin HL Jr, Bwayo JJ, et al. Acceptability of HIV vaccine trials in high-risk heterosexual cohorts in Mombasa, Kenya. AIDS 1995;9(11):1279-1284. https://doi.org/10.1097/00002030-199511000- 00010
Kakinami L, Newman PA, Lee SJ, Duand N. Differences in HIV vaccine acceptability between genders. AIDS Care 2008:20(5):542-546. https://doi.org/10.1080/09540120701867180
Koblin BA, Heagerty P, Sheon A, et al. Readiness of high‐risk populations in the HIV Network for Prevention Trials to participate in HIV vaccine efficacy trials in the United States. Aids 1998;12(7):785- 793. https://doi.org/10.1097/00002030-199807000-00015
Koblin BA, Holte S, Lenderking B, Heagerty P. Readiness for HIV vaccine trials: Changes in willingness and knowledge among high-risk populations in the HIV Network for Prevention Trials. J Acquir Immune Defic Syndr 2000;24(5):451-457. https://doi.org/10.1097/00126334-200008150-00010
Lesch A, Kafaar Z, Kagee A, Swartz L. Community members’ perceptions of enablers and inhibitors to participation in HIV vaccine trials. S Afr J Psychol 2006;36(4):734-761. https://doi. org/10.1177/008124630603600406
Newman PA, Duan N, Rudy ET, Roberts KJ, Swendeman D. Posttrial HIV vaccine adoption: Concerns, motivators, and intentions among persons at risk for HIV. J Acquir Immune Defic Syndr 2004;37(3):1393-1403. https://doi.org/10.1097/01.qai.0000127064.84325.ad
Dhalla S. An update on human immunodeficiency virus vaccine preparedness studies. J Med Microbiol 2015;64(7):731-738. https://doi.org/10.1099/jmm.0.000073
Laher F, Bekker L, Garrett N, Lazarus EM, Gray GE. Review of preventative HIV vaccine clinical trials in South Africa. Arch Virol 2020;165(11):2439-2452. https://doi.org/10.1007%2Fs00705-020-04777-2
Vindrola-Padros C, Johnson GA. Rapid techniques in qualitative research: A critical review of the
literature. Qual Health Res 2020;30(10):1596-1604. https://doi.org/10.1177/1049732320921835
Strauss RP, Sengupta S, Kegeles S, et al. Willingness to volunteer in future preventive HIV vaccine trials: Issues and perspectives from three US communities. J Acquir Immune Defic Syndr 1999;26(1):63-71.
Karg C, Wecker M. VISP and the HVTN’s commitment to poststudy HIV testing. HVTNews, 2 March 2012. http://hvtnews.wordpress.com/2012/03/02/visp-and-the-hvtns-commitment-to-poststudy-hiv- testing/#more-560/ (accessed 1 December 2022).
Downloads
Published
Issue
Section
License
Copyright (c) 2022 M Malahleha, A Dilraj, J Jean, NS Morar, JJ Dietrich, M Ross, E Mbatsane, MC Keefer, K Ahmed
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Licensing Information
The SAMJ is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
Publishing Rights
Authors grant the Publisher the exclusive right to publish, display, reproduce and/or distribute the Work in print and electronic format and in any medium known or hereafter developed, including for commercial use. The Author also agrees that the Publisher may retain in print or electronic format more than one copy of the Work for the purpose of preservation, security and back-up.
