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Developing and Implementing new TB Technologies: Key Informants' Perspectives on the Ethical Challenges.

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Ethical challenges in developing new tuberculosis (TB) drugs and diagnostics stem from conflicting interests and power imbalances. Addressing these requires global consensus on values for TB research, prevention, and care.

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Area of Science:

  • Global Health
  • Medical Ethics
  • Public Health Policy

Background:

  • The development of new tuberculosis (TB) drugs and diagnostics presents unique ethical considerations.
  • Implementation of novel TB technologies requires careful navigation of complex stakeholder interests.

Purpose of the Study:

  • To identify and analyze the ethical challenges encountered during the development and implementation of new tuberculosis (TB) drugs and diagnostics.
  • To explore perspectives on ethical imperatives for future TB technology advancement.

Main Methods:

  • Qualitative study employing 23 semi-structured interviews with diverse stakeholders including programme administrators, healthcare workers, advocates, policymakers, and funders.
  • Interviews were conducted across the Americas, Europe, and Africa between December 2015 and September 2016.
  • Thematic analysis was used to interpret the interview data.

Main Results:

  • Divergent interests, responsibilities, and power imbalances were identified as primary sources of ethical challenges.
  • Uncertain risk profiles of new TB drugs pose additional ethical hurdles, exacerbated by resource limitations in high-burden countries for safe implementation.
  • Stringent pharmacovigilance can mitigate some risks, but increased advocacy and community engagement are deemed essential.

Conclusions:

  • Investigating ethical challenges through qualitative research provides insight into the difficulties of implementing new TB technologies.
  • Addressing these challenges necessitates a re-evaluation of power dynamics and the interests of those in positions of power relative to disempowered communities.
  • Establishing consensus on values for global TB research, prevention, and care governance is crucial for ethical technology implementation.