"Should researchers return individual pharmacogenomics results to participants?" A descriptive qualitative study on stakeholder perspectives involved in HIV/AIDS research and treatment in Uganda.

Abstract

The return of individual pharmacogenomic research results is increasingly recognized as an ethical obligation, reflecting participants' right to information and researchers' duty of care. However, implementing this in low-resource settings poses significant ethical and logistical challenges. We explored stakeholders' attitudes and challenges to the process of returning individual pharmacogenomics research results in Uganda. Between September 2021 and February 2022, we conducted 54 qualitative interviews. These included five focus group discussions with 30 community representatives across five HIV research institutions, 12 key informant interviews with researchers, and 12 in-depth interviews with ethics committee members. A thematic approach was used to interpret the results. Four themes emerged from this data. These included (i) attitudes towards returning individual pharmacogenomics results to people living with HIV; (ii) social and ethical implications of returning results; (iii) perceived challenges to the return of results; and (iv) proposed recommendations to overcome the challenges. Returning results reflects principles of reciprocity and equity, and is a source of hope to many people living with chronic illnesses. However, stakeholders raised challenges, including low literacy levels and absence of direct translation of genetic terms, which may lead to misinterpretation of the results; depression and anxiety; stigma and discrimination that could result from breach of confidentiality and privacy. Stakeholders highlighted the need to sensitize the public about the role of genes in an individual's body. Returning pharmacogenomic results to vulnerable populations is ethically important, but must be approached with caution due to implications that may extend beyond the individual. Stakeholders emphasized the need for national guidelines and institutional standard operating procedures to ensure results are communicated safely and sensitively.