An unclosed loop: Perspectives of community engagement in infectious disease clinical trials in sub-Saharan Africa

Background Community engagement (CE) is pertinent to ethically and scientifically rigorous infectious disease clinical trials in sub-Saharan Africa (SSA). However, there are critiques that CE is not properly embedded in research processes and that there is uncertainty about what CE entails. The aim of this study was to gain an understanding of CE in infectious disease clinical trials in SSA, specifically factors affecting CE and existing strategies for engaging with communities. Methods Semi-structured telephone interviews were conducted with 20 community and clinical trial (CT) stakeholders who worked in SSA. The audio-recorded interviews were transcribed verbatim and analysed inductively using thematic analysis. Results Themes are as follows: 1) Communities are abandoned research-entities —a disconnect between scientific teams and communities was observed and knowledge translation was not prioritised at the community-level. 2 ) Us and them : community engagement teams vs investigators —CE teams expressed that researchers did not account for CE processes and often did not involve CE staff in their planning, and felt that their roles were not valued. 3) Ethical considerations : concerns and gaps— there were concerns that procedures were not standardised and that ethics processes were not adhered to. 4) Opportunities for improved CE practices —training needs were expressed, including for standardised practices, ethics, and for developing a holistic understanding of collaborating with communities. Conclusion CE role players require intensive training to ensure ethical CE and that communities are treated with dignity. This includes 1) using collaborative strategies involving research and CE staff, 2) protocol-adherence that recognises CE as pertinent, 3) viewing communities as complex and building relationships that are sustainable, and 4) ensuring that knowledge translation is considered at a community-level. Further research is necessary to investigate potential training programmes that integrate these elements.