Rethinking the practice of community engagement in health research: the case of the tenofovir trials in Cambodia and Cameroon.

Masters Degree. University of KwaZulu-Natal, Pietermaritzburg.Recent developments in the governance of research have recognised the part that communities can and should play in emergent and inventive research. It is now widely agreed that community engagement is essential in certain kinds of research – indeed, an ethical prerequisite – and that it is indispensable to the success of many health research projects. Unfortunately, as an ethical requirement, community engagement has sometimes been seen as a hurdle to jump over rather than as an integral part of the research process. At times, inadequate attention has been paid to how and when community engagement should be implemented and on the need to engage the community meaningfully and genuinely throughout the research process. This is concerning given that researchers and sponsors invest large sums of money in the development of a product, training on clinical procedures, facility designing and building, etc., and yet seem to have repeatedly ignored the importance of meaningful community engagement processes, often at great cost. The aim of this study was to demonstrate, using the tenofovir trials that were stopped in both Cameroon and Cambodia in 2005, that inadequate community engagement might lead to significant scientific losses, whereas early, sustained and meaningful community engagement could prevent this from occurring. The study involved no human participants and used a case study design approach that was based on the secondary data analysis. The cases (Cameroon and Cambodia) for the study were chosen for a number of reasons, but perhaps most significant of these was that the Good Participatory Practice (GPP/AVAC) guidelines which set standard practices for stakeholder’s engagement in HIV vaccine trials, were established in response to the premature ending of the tenofovir trials in these two countries. Several lessons were learned from this study: one of the major ones was that it is not sufficient for researchers to maintain high ethical and scientific standards in a study; in many cases, it is equally important and necessary for them to work very closely with the communities through various flexible mechanisms. Examples of such mechanisms include the community advisory boards (CABs), as well as the local ethical review boards (ERBs). In cases where community engagement is relevant, participation should commence from the very start of the protocol development. Participation should focus on the methodology, participant selection, the procedures for the study results disseminations at different points of the research and finally on enhancing informed participation. Any consultation with the community after the protocol is developed may be regarded as cosmetic rather than as genuine community engagement

Responding to the COVID-19 Pandemic in Cameroon: A statement from the Cameroon Bioethics Initiative

The ongoing COVID-19 pandemic has caused devastating consequences across economies in the world, with substantial effects on lives and livelihoods. Cameroon has been one of the countries in sub-Saharan Africa with an increasing number of cases and fatalities from the disease. In an effort to support the government’s response to the epidemic, the Cameroon Bioethics Initiative (CAMBIN); a not-for-profit, non-governmental, non-political, non-discriminatory, multidisciplinary association issued a statement on COVID-19, primarily targeting the government and the general public. In this article, we situate the context within which the statement was issued and present the statement in its entirety

Research priorities for accelerating the achievement of three 95 HIV goals in Cameroon: a consensus statement from the Cameroon HIV Research Forum (CAM-HERO)

Introduction: the Treat-All remains the globally endorsed approach to attain the 95-95-95 targets and end the AIDS pandemic by 2030, but requires some country-level contextualization. In Cameroon, the specific research agenda to inform strategies for improving HIV policy was yet to be defined. Methods: under the patronage of the Cameroon Ministry of health, researchers, policy makers, implementing partners, and clinicians from 13 institutions, used the Delphi method to arrive at a consensus of HIV research priorities. The process had five steps: 1) independent literature scan by 5 working groups; 2) review of the initial priority list; 3) appraisal of priorities list in a larger group; 4) refinement and consolidation by a consensus group; 5) rating of top research priorities. Results: five research priorities and corresponding research approaches, resulted from the process. These include: 1) effectiveness, safety and active toxicity monitoring of new and old antiretrovirals; 2) outcomes of Antiretroviral Therapy (ART) with focus in children and adolescents; 3) impact of HIV and ART on aging and major chronic diseases; 4) ART dispensation models and impact on adherence and retention; 5) evaluations of HIV treatment and prevention programs. Conclusion: the research priorities resulted from a consensus amongst a multidisciplinary team and were based on current data about the pandemic and science to prevent, treat, and ultimately cure HIV. These priorities highlighted critical areas of investigation with potential relevance for the country, funders, and regulatory bodies

Outcomes of the first meeting of the CAMEROON HIV RESEARCH FORUM (CAM-HERO)

Research is a vital component for the development of any country. In Cameroon, HIV Operational research is rapidly growing, however, it faces some intractable problems which can only be solved through an urgent, strategic, efficient, and collaborative approach involving key stakeholders. The Kribi meeting (09 and 10th December 2020) brought together under the auspices of the Ministry of Public Health leading HIV research organisations and connected HIV researchers and actors from different sectors. These actors disseminated and discussed recent research findings and worked out mechanisms to advance HIV research development, developed new ideas and identified priority research areas, with emphasis on translational research. The official launching and consolidation of Cam-HERO was a critical step and it is hoped that these synergistic efforts will catalyse attainment of the 95-95-95 goals in Cameroon