Perceptions of persons deprived of liberty regarding tuberculosis vaccine research

Several tuberculosis (TB) vaccine candidates are currently advancing to late-stage clinical trials. Prisons in low-and middle-income countries harbor some of the highest rates of TB in the world, making persons deprived of liberty (PDL) an important population to prioritize for the introduction of effective vaccines. However, the inclusion in clinical trials raises significant ethical concerns due to a history of exploitation and mistreatment within medical research. To date, PDL own perspectives on participating in vaccine research have been largely overlooked. This multicenter qualitative study employed focus group (FG) discussions in seven state prisons across four of the five regions of Brazil, involving 91 incarcerated individuals (64 men and 27 female) between February and August 2024. The discussions explored participants' perceptions regarding health in prisons, TB, vaccines in general, new TB vaccines, and their potential participation in research. Participants reported encountering difficulties in accessing healthcare services within the prison system and shared personal or indirect experiences with TB, as well as concerns about their family members being at risk for TB exposure. While they generally held positive perceptions about vaccines and trials, they emphasized the need for clear and transparent information, respect for individual autonomy, and assurances of accountability from researchers as conditions of their willingness to participate in future trials. PDL perceptions regarding participation in clinical trials for new TB vaccines are significantly influenced by their prior experiences with the prison health system and their level of trust in research institutions. To ethically and effectively include PDL in future research, it is crucial to prioritize respect for autonomy and transparent communication about the risks and potential benefits involved.