In it for health, not money

Wits researchers have found that participants in drug trials may be genuinely concerned about their health, rather than taking part just for the promise of payment.

Until now, researchers have raised concerns that participation in clinical trials related to HIV may be mainly motivated by compensation, or that women in these studies would abuse reimbursements, share drugs with other people or dump the drugs.

But according to a study published by researchers at the Wits Reproductive Health and HIV Institute last week, none of these concerns was found to be true after interviewing women who took part in such a trial.

The women were positive for HIV and Herpes Simplex Virus 2, both sexually transmitted infections (STIs). The risk of spreading HIV is three times higher when a person is infected with both viruses. The women had participated in a trial which tested how efficient an anti-herpes drug was at reducing the risk of spreading HIV.

The women were asked how well they kept to the rules of the trial and what motivated them to do so. For a clinical trial to work, participants have to visit the clinic regularly for medication and check-ups. They also have to take the drugs at certain times and change some of their behaviour. For example, they were required to use condoms and avoid vaginal douching.

The women followed these rules about 90% of the time, and they said they were motivated by concerns for their health. Co-author of the paper, Dr Catherine MacPhail, said this was significant because the health system was not perceived as adequate or user-friendly.

“The thing that made me decide to participate in the study was I started to see symptoms that I did not understand, like I had discharge and I was always sick so then I decided to go and find out about my status,” said one participant.

The women also welcomed the free health care that came with the trial, even though they knew some of the drugs were placebos, or sugar pills.

A major factor that encouraged women to visit the clinic regularly was staff support. “I think it [staff attitude] helped me because when I thought about coming to the clinic I knew that I am going to be laughing and talking to people who care about me and I loved to come to the clinic,” said another participant.

Researchers said the study also showed that people in low and middle-income countries, characterised by poverty and social deprivation, could be trusted to take medication as prescribed.

The paper was published in Dove Press, an open access medical journal. It was authored by Dr Catherine MacPhail and Dr Sinead Delany-Moretlwe from Wits, and Prof Philippe Mayaud from the Faculty of Infectious and Tropical Diseases, at the London School of Hygiene and Tropical Medicine.