# Public engagement for the conduct of a controlled human infection study testing vaccines against Necator americanus (hookworm) in areas of active hookworm transmission in Brazil

## TL;DR

This study explores how a community in Brazil perceives a controlled human infection study for a hookworm vaccine and how an educational intervention can improve understanding and cooperation.

## Contribution

The study introduces a novel educational intervention to enhance community engagement and understanding of controlled human infection studies in a rural Brazilian setting.

## Key findings

- Participants recognized the importance of the study for the community but expressed fears about infection risks.
- The educational intervention helped participants memorize and disseminate information about the study.
- Dialogue and discussion improved understanding and created new knowledge among participants.

## Abstract

Controlled Human Infection Models (CHIS) involve administering human pathogens to healthy participants in controlled medical settings, which can elicit complex bioethical issues. Understanding how the community perceives such studies can significantly increase the participant’s sense of cooperation and increases the researcher’s and the participant’s transparency. The current study describes the development of an educational intervention to achieve these ends as it aims to (1) analyze perceptions of the Controlled Human Infection Studies (CHIS), and (2) evaluate the participants’ comprehension of the CHIS. Methods: This is a qualitative action research that includes the development of an educational intervention with residents of a rural area in Minas Gerais, Brazil, where there is continuous natural transmission of the human pathogen Necator americanus (“hookworm”). In this area, it is intended to carry out a proposed phase 3 vaccine clinical trial in the future to test the efficacy of hookworm vaccines using controlled human infection. Two data collection strategies were used: an educational intervention and a focus group. Results: The participants’ perceptions showed distinct perspectives on CHIS. On one side, they recognized that the investigation is essential for the community, but on the other side, they thought that there would be resistance to its conduct by fear of infection. The idea that the study would generate a benefit for the greater good, contributing to the prevention of hookworm infection, was clearly stated. The participants perceived that the study offered concrete risks that could be reduced by constant monitoring by the researchers. They also mentioned the importance of access to information and the positive influence those who express interest in participating in the study can exert in the community. In relation to comprehension the participants memorized the information, mobilized it to explain everyday situations and created strategies to disseminate the study and engage the community in its development. By repeating and making sense of the information, the participant not only assimilates the knowledge transmitted, but also creates new knowledge. Conclusion: We concluded that an educational process of discussion and dialogue around participants’ perceptions about the CHIS, promotes understanding and allows ways to disseminate information about the research to be collectively created.