Contributions of Community Advisory Board and Experience of Study Participants in TB/MDR-TB Clinical Trial Management in Addis Ababa, Ethiopia: A Qualitative Study

Abstract

Community Advisory Boards (CABs), as a form of community engagement, provide an important mechanism to ensure that research aligns with community needs and priorities by representing broader community interests and guiding research accordingly. Tuberculosis (TB) and multidrug-resistant tuberculosis (MDR-TB) remain significant public health concerns, particularly due to resistance to key first-line anti-TB medications, and individuals affected by these conditions often face stigma and discrimination that hinder timely diagnosis and treatment adherence. Addressing these challenges requires community-driven strategies and improved access to health services, with CABs serving a central role in bridging gaps between researchers, healthcare providers, and affected communities. This study explored the contributions of CAB members in supporting TB/MDR-TB clinical trials, the challenges experienced by trial participants, and the strategies employed to address these challenges. Using an exploratory qualitative design, in-depth interviews were conducted with 17 stakeholders involved in TB/MDR-TB clinical trials, and data were analyzed using deductive thematic analysis. The findings highlight persistent stigma and discrimination, limited understanding of the role and functions of CABs, inconsistent budget allocation, reduced participation, and diminished CAB influence throughout the research process. The study underscores the essential role of CABs in enhancing community engagement in TB/MDR-TB clinical trials and emphasizes the need for greater awareness, advocacy, and institutional support to strengthen their contributions. Adequate and sustained funding, along with systematic planning and implementation, is critical for reinforcing CAB roles and promoting more ethical, inclusive, and responsive public health research practices in Ethiopia and other low- and middle-income countries.