Browsing by Author "Singh, Jerome Amir."

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The abandoned trials of pre-exposure prophylaxis for HIV : what went wrong?
(Plos., 2005) Singh, Jerome Amir.; Mills, Edward J.
Discusses the impact of irresponsible reporting and activism against the use of the oral antiretroviral drug tenofovir as a pre-exposure prophylaxis (PREP) for HIV/AIDS. Protests against trials of PREP; Concerns of the protestors; Threats to PREP trials.
Addressing ethical, social, and cultural issues in global health research.
(Plos., 2013) Lavery, James V.; Green, Shane K.; Bandewar, Sunita V. S.; Bhan, Anant.; Daar, Abdallah S.; Emerson, Claudia I.; Masum, Hassan.; Randazzo, Filippo M.; Singh, Jerome Amir.; Upshur, Ross Edward Grant.; Singer, Peter A.
The purpose of this paper is to encourage reflection among the global health research community and the research ethics community about how a wide range of ethical, social, and cultural (ESC) influences on the conduct, success, and impact of global health research can best be addressed by consultation services in research ethics (CSRE). We draw on lessons we have learned during our experiences with the ESC Program of the Grand Challenges in Global Health initiative to propose key features of CSRE that may prove useful for those designing or implementing similar programs.
Balancing efficiency, equity and feasibility of HIV treatment in South Africa – development of programmatic guidance.
(BioMed Central., 2013) Baltussen, Rob.; Mikkelsen, Evelinn.; Tromp, Noor.; Hurtig, AnneKarin.; Byskov, Jens.; Olsen, Oystein.; Baeroe, Kristine.; Hontelez, Jan A.; Singh, Jerome Amir.; Norheim, Ole F.
South Africa, the country with the largest HIV epidemic worldwide, has been scaling up treatment since 2003 and is rapidly expanding its eligibility criteria. The HIV treatment programme has achieved significant results, and had 1.8 million people on treatment per 2011. Despite these achievements, it is now facing major concerns regarding (i) efficiency: alternative treatment policies may save more lives for the same budget; (ii) equity: there are large inequalities in who receives treatment; (iii) feasibility: still only 52% of the eligible population receives treatment. Hence, decisions on the design of the present HIV treatment programme in South Africa can be considered suboptimal. We argue there are two fundamental reasons to this. First, while there is a rapidly growing evidence-base to guide priority setting decisions on HIV treatment, its included studies typically consider only one criterion at a time and thus fail to capture the broad range of values that stakeholders have. Second, priority setting on HIV treatment is a highly political process but it seems no adequate participatory processes are in place to incorporate stakeholders’ views and evidences of all sorts. We propose an alternative approach that provides a better evidence base and outlines a fair policy process to improve priority setting in HIV treatment. The approach integrates two increasingly important frameworks on health care priority setting: accountability for reasonableness (A4R) to foster procedural fairness, and multi-criteria decision analysis (MCDA) to construct an evidence-base on the feasibility, efficiency, and equity of programme options including trade-offs. The approach provides programmatic guidance on the choice of treatment strategies at various decisions levels based on a sound conceptual framework, and holds large potential to improve HIV priority setting in South Africa.
Bigotry and oppressive laws in Africa drive HIV in men who have sex with men.
(Plos., 2013) Singh, Jerome Amir.
No abstract available.
The challenge of discharging research ethics duties in resource-constrained settings.
(Plos, 2011) Singh, Jerome Amir.
No abstract available.
Enrolling adolescents in research on HIV and other sensitive Issues: lessons from South Africa.
(Plos., 2006) Singh, Jerome Amir.; Abdool Karim, Salim Safurdeen.; Abdool Karim, Quarraisha.; Mlisana, Koleka Patience.; Williamson, Carolyn.; Gray, Clive M.; Govender, Michele.; Gray, Andrew Lofts.
The article discusses the challenge of enrolling adolescents in HIV studies in South Africa. It is practically impossible in some instances to seek parental consent or to determine who, if anyone, is the legal guardian to authorize an adolescent's participation in research. The South African Medical Research Council research ethics guidelines prescribe 14 years of age as the autonomous age of consent for therapeutic research but not observational studies.
The ethical and legal implications of performing involuntary sterilization on mentally incompetent adolescent woman.
(2014) Bhajan, Serisha.; Singh, Jerome Amir.
No abstract available.
The ethical dilemmas of critical care specialists encountered in the admission of patients with HIV infection to intensive care.
(2012) Naidoo, Kantharuben.; Lalloo, Umesh Gangaram.; Singh, Jerome Amir.
South Africa has one of the fastest growing HIV epidemics in the world with 5.6 million people living with HIV/AIDS. As a consequence of the delayed implementation of the ARV rollout and failure to control the epidemic, the number of people living with HIV/AIDS who seek or need intensive care places a huge burden on precious, expensive and sparse intensive care unit facilities. Critical care specialists are faced with complex challenges when making decisions about the provision of such care. Aim: The aim of the study was to develop best practice criteria for admitting HIV-infected patients to intensive care. Methods: The study was done utilising: 1. A comprehensive literature review of the legal and ethical framework governing such decisions in South Africa and compared with that in different countries, both developed and developing. Further, legal precedents and clinical best practice that could inform policy and practice in South Africa were applied to the decision making process. 2. An audit of ICU beds in South Africa by first making a comprehensive and contemporary review of critical care facilities in South Africa, to place in context the ethical dilemmas faced by critical care specialists in the admission of HIV/AIDS infected patients to intensive care in a resource limited environment. 3. Critical care practitioners’ response to a standardised questionnaire regarding ethical decisions and provision of intensive care to five hypothetical clinical case scenarios. Results: The study showed that: The ICU bed availability in South Africa is limited and the problem is worse in the public sector with widespread variations across the provinces. The lack of skilled staff for ICU is insufficient for our needs in the public sector. For people living with HIV/AIDS, specific variables influence their survival in intensive care. The benefits of anti-retroviral treatment in intensive care are still being debated. Clinical prediction tools should be considered as an aid to clinical judgment on decisions about whom to admit to intensive care. Rational decision making should include central questions such as ‘ whether the patient too ill or too well for ICU care’ and whether there is a reasonable prospect of ‘reversibility of organ-dysfunction’? Non-invasive ventilation using a continuous positive airway pressure (CPAP) ventilation mask is showing promise for patients with Pneumocystis jeroveci pneumonia (PJP), especially in a resource-constrained environment. Further studies need to validate this. People living with HIV/AIDS are not discriminated against on admissions to ICU and are not subjected to medical futility decisions. Discussion: The shortage of ICU beds results in critical care specialists being under pressure to deliberate on resource allocation decisions for competing patients. Strong regulatory and ethical frameworks exist to protect the rights of people living with HIV/AIDS and access to intensive care. The ‘Limitation Clause’ of the South African Constitution, as canvassed by the courts resulting in the refusal of renal dialysis in the case of Mr. Subramoney, a utilitarian judgment, would not be justiciable for people living with HIV/AIDS and access to intensive care. The National Health Insurance Plan envisages making more ICU beds available through a public-private sector partnership. There is a compelling need for regionalisation of intensive care services in the country. Respiratory failure in HIV/AIDS patients remains the commonest indication for intensive care unit admissions, and other diagnosis such as non-PCP pneumonia, sepsis, cardiac, gastrointestinal, and renal diseases, are becoming more common. The ART era has seen an improvement in ICU to ward survival rates of 70% (similar to that of the general medical population) as well as the three month and long-term survival outcomes post-ICU discharge. ICU prognostic systems should be regarded as an aid to clinical judgment. Daniels ‘accountability for reasonableness’ provides a moral framework for ethical decision-making and priority setting. In its determined efforts to control the pandemic of HIV/AIDS, some countries, notably Botswana and South Africa are accused of violating international treaties. Conclusion: South Africa has made many legal provisions to protect the rights of its HIV infected patients. People living with HIV/AIDS are neither discriminated against in admission to intensive care units, nor being subjected to medical futility decisions. With the advent of HAART, people living with HIV/AIDS admitted to ICUs, have similar outcomes to that of the general population. Admission guidelines for ICU as advised by the professional bodies for use by the general population should be equally applicable to people living with HIV/AIDS, i.e. is the patient too ill or too well to warrant ICU admission, and is there a realistic prospective of 'reversibility of organ dysfunction'?
Genocide: burden of proof and inaction is costing lives in Sudan.
(Elsevier, 2004) Singh, Jerome Amir.
No abstract available.
Grand challenges in global health : community engagement in research in developing countries.
(Plos., 2007) Tindana, Paulina O.; Singh, Jerome Amir.; Tracy, C. Shawn.; Upshur, Ross Edward Grant.; Daar, Abdallah S.; Singer, Peter A.; Fröhlich, Janet Ann.; Lavery, James V.
The authors argue that there have been few systematic attempts to determine the effectiveness of community engagement in research.
Grand challenges in global health : engaging civil society organizations in biomedical research in developing countries.
(Plos., 2007) Bhan, Anant.; Singh, Jerome Amir.; Upshur, Ross Edward Grant.; Singer, Peter A.; Daar, Abdallah S.
The authors discuss the different types of civil society organizations, their role in biomedical research, and the advantages and challenges of working with them.
Grand challenges in global health : ethical, social, and cultural issues based on key informant perspectives.
(Plos., 2007) Berndtson, Kathryn.; Daid, Tina.; Tracy, C. Shawn.; Bhan, Anant.; Cohen, Emma R. M.; Upshur, Ross Edward Grant.; Singh, Jerome Amir.; Lavery, James V.; Singer, Peter A.
The authors interviewed key informants from the developing world and the Grand Challenges investigators to explore their ethical, social, and cultural concerns about the program.
Grand challenges in global health : the ethical, social and cultural program.
(Plos., 2007) Singer, Peter A.; Taylor, Andrew D.; Daar, Abdallah S.; Upshur, Ross Edward Grant.; Singh, Jerome Amir.; Lavery, James V.
The Grand Challenges initiative has 44 projects worldwide aimed at addressing diseases of the poor. What are the ethical, social, and cultural issues that the initiative faces?
Health research and human rights in South Africa.
(Elsevier, 2004) Singh, Jerome Amir.
No abstract available.
HIV/AIDS and admission to intensive care units: A comparison of India, Brazil and South Africa.
(Health and Medical Publishing Group., 2013-03) Naidoo, Kantharuben.; Singh, Jerome Amir.; Lalloo, Umesh Gangaram.
In resource-constrained settings and in the context of HIV-infected patients requiring intensive care, value-laden decisions by critical care specialists are often made in the absence of explicit policies and guidelines. These are often based on individual practitioners’ knowledge and experience, which may be subject to bias. We reviewed published information on legislation and practices related to intensive care unit (ICU) admission in India, Brazil and South Africa, to assess access to critical care services in the context of HIV. Each of these countries has legal instruments in place to provide their citizens with health services, but they differ in their provision of ICU care for HIV-infected persons. In Brazil, some ICUs have no admission criteria, and this decision vests solely on the ‘availability, and the knowledge and the experience’ of the most experienced ICU specialist at the institution. India has few regulatory mechanisms to ensure ICU care for critically ill patients including HIV-infected persons. SA has made concerted efforts towards non-discriminatory criteria for ICU admissions and, despite the shortage of ICU beds, HIV infected patients have relatively greater access to this level of care than in other developing countries in Africa, such as Botswana. Policymakers and clinicians should devise explicit policy frameworks to govern ICU admissions in the context of HIV status.
Humanitarian access to unapproved interventions in public health emergencies of international concern.
(Public Library of Science., 2015) Singh, Jerome Amir.
Abstract available in pdf.
Innovations in research ethics governance in humanitarian settings.
(BioMed Central., 2015) Schopper, Doris.; Dawson, Angus.; Upshur, Ross Edward Grant.; Ahmad, Aasim.; Jesani, Amar.; Ravinetto, Raffaella.; Segelid, Michael J.; Sheel, Sunita.; Singh, Jerome Amir.
Abstract available in pdf.
The involuntary disclosure of confidential genetic information to related affected third parties.
(2016) Moodley, Saiendrie.; Singh, Jerome Amir.
Abstract not available.
The legal and ethical implications of implementing partial-birth abortion in South Africa.
(2017) Jogee, Faadiela.; Singh, Jerome Amir.
Abstract not available.
Organ donation, discrimination after death, anti-vaccination sentiments, and tuberculosis management.
(Springer Verlag., 2012) Coggon, John.; Madden, Bill.; Cockburn, Tina.; Stewart, Cameron.; Singh, Jerome Amir.; Bhan, Anant.; Upshur, Ross Edward Grant.; Richards, Bernadette.
No abstract available.