Predictors of Adolescent Decision Making Regarding HIV Vaccine Trial Participation
Methods: As part of a larger educational intervention study, 4 The Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) sites recruited 120 sexually active adolescents (60 males & 60 females) who have sex with males. Participants were aged 16-19 years and were predominantly African American (n=74), White (Non-Hispanic) (n=17), and Hispanic/Latino (n=25). Adolescents who indicated that they might consider enrolling in an HIV vaccine clinical trial were given a standard HIV vaccine trial consent form, which was reviewed with them by research staff, and completed interviewer administered surveys. Surveys included measures of health beliefs: perceived benefits of trial participation to self and others (5 items; alpha=.80), fear of shots (4 items; alpha=.87), and worry about future HIV infection (3 items, alpha=.80). We also measured knowledge of HIV vaccine clinical trials, a subjective numeracy, and health literacy. The outcome of interest, WTP, was measured via a summed scale composed of 3 items (alpha=.80), with potential scores ranging from 3-15.
Results: The mean WTP score was 9.9 (SD=2.9). Pearson correlations for the whole sample indicated that Perceived Benefits was the only significant predictor of WTP (r=.44). Multiple linear regression analyses conducted separately by gender indicated that Perceived Benefits (standardized beta=.48) and Fear of Shots (standardized beta=-.39) were significant independent predictors of WTP for females (R2=.34, p<.001). For males, Perceived Benefits remained as the sole predictor of WTP (standardized beta=.43; R2=.20, p<.01).
Conclusions: After a careful review of an HIV vaccine trial consent form, many adolescents indicated a willingness to participate in a preventive HIV vaccine clinical trial. Not surprisingly, perceiving benefits from HIV vaccine trial participation predicted strong WTP. For females only, fear of shots was associated with Low WTP. It is notable that knowledge about HIV vaccine clinical trials, health literacy, and numeracy were not associated with WTP, suggesting that adolescents who are less informed about the risks and benefits of participation may be just as willing to participate as those who are well informed. This set of findings indicates an important focus for future research around evaluation of adolescents’ capacity to understand key aspects of HIV vaccine clinical trials and approaches to ensuring that all adolescents who are recruited for such trials understand the risks and benefits associated with participation. For adolescents who are fearful of shots, behavioral approaches for managing this kind of anxiety may be helpful.
Support: NICHD with supplemental funding from NIDA and NIMH (5 U01 HD 40533 & 5 U01 HD 40474), LEAH training grant (HRSA/MCHB T7100008).