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Implementing post-trial access plans for HIV prevention research
  1. Amy Paul1,
  2. Maria W Merritt1,2,
  3. Jeremy Sugarman1,3
  1. 1 Berman Institute of Bioethics, Johns Hopkins University, Baltimore, Maryland, USA
  2. 2 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
  3. 3 Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
  1. Correspondence to Dr Amy Paul, Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD 21205, USA; apaul7{at}jhu.edu

Abstract

Ethics guidance increasingly recognises that researchers and sponsors have obligations to consider provisions for post-trial access (PTA) to interventions that are found to be beneficial in research. Yet, there is little information regarding whether and how such plans can actually be implemented. Understanding practical experiences of developing and implementing these plans is critical to both optimising their implementation and informing conceptual work related to PTA. This viewpoint is informed by experiences with developing and implementing PTA plans for six large-scale multicentre HIV prevention trials supported by the HIV Prevention Trials Network. These experiences suggest that planning and implementing PTA often involve challenges of planning under uncertainty and confronting practical barriers to accessing healthcare systems. Even in relatively favourable circumstances where a tested intervention medication is approved and available in the local healthcare system, system-level barriers can threaten the viability of PTA plans. The aggregate experience across these HIV prevention trials suggests that simply referring participants to local healthcare systems for PTA will not necessarily result in continued access to beneficial interventions for trial participants. Serious commitments to PTA will require additional efforts to learn from future approaches, measuring the success of PTA plans with dedicated follow-up and further developing normative guidance to help research stakeholders navigate the complex practical challenges of realising PTA.

  • research ethics
  • HIV infection and AIDS
  • clinical trials

https://doi.org/10.1136/medethics-2017-104637

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    Footnotes

    • Contributors AP contributed to conceptualisation of the paper, drafted the follow-up interview guide, conducted follow-up interviews with key stakeholders and drafted and revised the paper. JS conceptualised the paper, participated in the initial large group discusssion on PTA, reviewed and revised the follow-up interview guide and critically reviewed and revised the paper. MWM contributed to conceptualisation of the study, reviewed and revised the follow-up interview guide and critically reviewed and revised the paper.

    • Funding This work was supported by the Hecht-Levi Fellowship Program in Bioethics at the Johns Hopkins Berman Institute of Bioethics; the Johns Hopkins University Center for AIDS Research (P30AI094189); and the HIV Prevention Trials Network (HPTN). Overall support for the HPTN is provided by the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institutes of Health (NIH) under Award Numbers UM1AI068619 (HPTN Leadership and Operations Center), UM1AI068617 (HPTN Statistical and Data Management Center), and UM1AI068613 (HPTN Laboratory Center).

    • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Allergy and Infectious Diseases or the National Institutes of Health.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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