Randomized, Controlled Evaluation of a Prototype Informed Consent Process for HIV Vaccine Efficacy Trials

Procedures must be developed to ensure that valid informed consent is obtained from participants in HIV vaccine efficacy trials. A prototype informed consent process was evaluated among 4,892 persons at high risk for HIV infection in the HIV Network for Prevention Trials Vaccine Preparedness Study (VPS), a prospective cohort study of HIV seroincidence in eight U.S. metropolitan areas. Twenty percent of VPS participants were selected at random to undergo the prototype informed consent process at VPS month 3. Participants' knowledge of 10 key HIV vaccine trial concepts and willingness to participate in HIV vaccine efficacy trials were assessed and compared at baseline and semiannually thereafter for 18 months. Knowledge of HIV vaccine trial concepts was low at baseline. Participation in the prototype process was associated with substantial and sustained increases in knowledge (relative risks for the 10 items, 1.04–2.26), which were of similar magnitude across HIV risk groups, race/ethnicity, and educational levels. It is recommended that the prototype informed consent process be adopted for future HIV vaccine efficacy trials as well as for clinical trials in other research areas.

[1]  R. Y. Nishimi,et al.  From the Office of Technology Assessment. , 1993, JAMA.

[2]  D. DeMets,et al.  How informed is informed consent?: The BHAT experience , 1981 .

[3]  L. Lasagna,et al.  OBTAINING INFORMED CONSENT: FORM OR SUBSTANCE , 1970 .

[4]  F. E. Freeberg,et al.  Informed consent documents: increasing comprehension by reducing reading level. , 1990, IRB.

[5]  J. Kahn,et al.  Risk behavior for HIV infection in participants in preventive HIV vaccine trials: a cautionary note. , 1997, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[6]  Barry T Peterson,et al.  Improving readability of consent forms: what the computers may not tell you. , 1992, IRB.

[7]  W. Mackillop,et al.  Ethical problems in clinical research: the need for empirical studies of the clinical trials process. , 1986, Journal of chronic diseases.

[8]  C. M. Collins Sustaining Support for Domestic HIV Vaccine Research: Social Issues Over the Long Haul of Human Trials , 1996 .

[9]  Informed consent: ethical, legal, and medical implications for doctors and patients who participate in randomised clinical trials. , 1983, British medical journal.

[10]  G. Barbour,et al.  Videotape aids informed consent decision. , 1978, JAMA.

[11]  J E Sieber,et al.  Empirical studies of ethical issues in research. A research agenda. , 1987, The American psychologist.

[12]  P. Lurie,et al.  Ethical, behavioral, and social aspects of HIV vaccine trials in developing countries. , 1994, JAMA.

[13]  M. Keefer,et al.  Preventing discrimination against volunteers in prophylactic HIV vaccine trials: lessons from a phase II trial. , 1998, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[14]  A. Sheon Preventing Discrimination against Volunteers in Preventive HIV Vaccine Efficacy Trials: Conference Summary , 1995 .

[15]  D. Vlahov,et al.  Medical eligibility, comprehension of the consent process, and retention of injection drug users recruited for an HIV vaccine trial. , 1995, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[16]  H. Taub Comprehension of informed consent for research: issues and directions for future study. , 1986, IRB.

[17]  N. Lynöe,et al.  Informed consent: study of quality of information given to participants in a clinical trial. , 1991, BMJ.

[18]  N. Rader,et al.  Informing the Elderly: A Comparison of Four Methods , 1986, Journal of the American Geriatrics Society.

[19]  Bennett Cerf,et al.  At Random , 1977 .

[20]  C. Spurr,et al.  Written informed consent in patients with breast cancer , 1979, Cancer.

[21]  L. Temoshok Behavioral research contributions to planning and conducting HIV vaccine efficacy studies. , 1994, AIDS research and human retroviruses.

[22]  S. Vermund,et al.  Preparing for HIV vaccine efficacy trials: Partnerships and challenges , 1993 .

[23]  P S Appelbaum,et al.  False hopes and best data: consent to research and the therapeutic misconception. , 1987, The Hastings Center report.

[24]  R. Simes,et al.  Randomised comparison of procedures for obtaining informed consent in clinical trials of treatment for cancer. , 1986, British medical journal.

[25]  G. Morrow,et al.  A simple technique for increasing cancer patients' knowledge of informed consent to treatment , 1978, Cancer.

[26]  S. Zeger,et al.  Longitudinal data analysis using generalized linear models , 1986 .

[27]  J. Ensinck,et al.  ARE RESEARCH SUBJECTS REALLY INFORMED? , 1975, The Western journal of medicine.

[28]  C. Turner,et al.  Behavioral studies relevant to vaccine trial preparation: an introduction. , 1994, AIDS research and human retroviruses.

[29]  S. Reiser Human subjects in medical experimentation: by Bradford H. Gray. John Wiley, New York, 1975. 298 pp. $13.50 , 1977 .

[30]  R. Hoff,et al.  Trial objectives and end points for measuring the efficacy of HIV vaccines. , 1995, Infectious agents and disease.

[31]  M. Silva,et al.  Enhancing comprehension of information for informed consent: a review of empirical research. , 1988, IRB.

[32]  C. Grady The Search for an AIDS Vaccine: Ethical Issues in the Development and Testing of a Preventive HIV Vaccine , 1995 .

[33]  T. Fleming,et al.  Intermediate-size trials for the evaluation of HIV vaccine candidates: a workshop summary. , 1997, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[34]  S. Self,et al.  Safety and immunogenicity of a canarypox-vectored human immunodeficiency virus Type 1 vaccine with or without gp120: a phase 2 study in higher- and lower-risk volunteers. , 2001, The Journal of infectious diseases.

[35]  L. Roth,et al.  Informed consent in psychiatric research: preliminary findings from an ongoing investigation. , 1985, Social science & medicine.