Preparedness for international AIDS vaccine trials: Lessons learned from a multi-site study of knowledge, attitudes, and willingness to participate (Thailand, China, India)

Background. Multi-site AIDS vaccine trials are efficient ways of addressing the genetic diversity and geographic distribution of HIV and gaining information about applicability of candidate vaccines in a variety of study populations and settings. AIDS vaccine preparedness studies involving comparative assessments of knowledge, attitudes, and willingness to participate are paramount to the preparedness, planning, and implementation of multi-site AIDS vaccine trials in the international arena.; Methods. The AIDS Vaccine Preparedness Survey, a 20-question instrument was used to examine knowledge, attitudes, and factors relating to willingness to participate in AIDS vaccine trials. This survey was administered to various at-risk populations at potential AIDS vaccine trial sites in Thailand, China, India, Baltimore, Maryland (USA), and Washington, DC (USA). Populations included injection drug users (IDUs) in Thailand, China, and Baltimore, Maryland (USA), clients of a Sexually Transmitted Diseases clinic in India, clients of an HIV Counseling and Testing Center in Washington, DC, and college students attending a Historically Black College and University (HBCU) in Baltimore, Maryland, (USA).; Results. Overall willingness to participate in AIDS vaccine trials ranged from 14% among students in Baltimore, Maryland to 67% of STD clinic attendees in India. Multivariate analyses revealed distinctly different profiles of willingness to participate in AIDS vaccine trials by study location. Among students at the HBCU, increased willingness to participate was associated with higher education level, smoking, condom use, awareness of the AIDS vaccine effort, personal importance of an AIDS vaccine, research conducted by minority investigators, and a belief that research has the best interests of participants in mind. Among IDUs in Thailand, China, and Baltimore, Maryland, predictors of higher knowledge levels included the belief that an AIDS vaccine can prevent HIV in the future, holding the opinion that those who are infected with HIV are discriminated against in society, and being concerned about side-effects due to AIDS vaccine trial participation.; Conclusions. Knowledge, attitudes, and willingness to participate in an AIDS vaccine trial depends on the social and cultural milieu of the study location. Assessing site-specific predictors is critical to the development of tailored educational, recruitment and retention efforts for multi-site, international AIDS vaccine trials.