D²EFT Graphical Informed Consent

D²EFT-GIC is a substudy of D²EFT study (NCT03017872), a randomised clinical trial of second-line antiretroviral therapies. The goal of D²EFT-GIC is to evaluate a novel tool, the "Graphical Informed Consent" (GIC), within D²EFT.

The GIC is designed to supplement the informed consent process with a set of culturally- and gender-adapted illustrations, with an explanatory script for researchers, that complements the mandatory written participant information sheet and consent form.

The investigators propose to assess the acceptability and feasibility of this tool from the participants and researchers perspectives. The GIC will be first pre-tested in one or more site(s) - where the informed consent process is challenging because of literacy, language or culture barriers - in 10 prospective participants for D²EFT. If this stage shows there is no negative impact of the GIC on the consent process, the second stage will study the feasibility of implementing the GIC in the usual practice.

Informed consent requires provision of complex medical information in an easily understandable format. During the consent process, researchers may encounter potential research participants who are not thoroughly used to care services and thus may struggle to understand what clinical research is, the purpose of the specific research in relation to their health, research methods, its risks and benefits, and their options and rights. Clinical trials in people living with HIV can present additional challenges due to stigma surrounding the infection, as the need for a third-party witness to ensure adequate comprehension of the presented information may be concerning to the participant. These barriers to an optimal informed consent are particularly significant in low and lower-middle income countries (LMICs).

To try to overcome these barriers and to make written information sheet and consent forms (PICFs) more accessible and understandable for key-populations, and more user-friendly for on-site researchers, tools including interactive videos have been developed for various diseases and different settings. Many of these tools are study-specific or developed in high-income countries with limited reproducibility; few have been studied in the consent process for HIV treatment trials or across multiple LMIC settings. Data evaluating these tools and their impact on participants' understanding or researchers' satisfaction are limited.

With the D²EFT community advisory board (CAB) and protocol steering committee (PSC), the investigators developed the "Graphical Informed Consent" (GIC). This tool is designed to supplement the informed consent process with a set of culturally- and gender-adapted illustrations with an explanatory script for researchers, that complement the mandatory written PICF.

The investigators propose to evaluate this novel tool within D²EFT study, a randomised clinical trial of HIV second-line therapy in LMICs, by undertaking a pilot study. The study aims to assess acceptability and feasibility of the GIC by measuring implementation outcomes: participants' acceptability and acceptance, and researchers' utilisation and satisfaction.

Eligibility Criteria:
Inclusion Criteria:

* Fulfil the eligibility criteria for D²EFT and willing to undertake D²EFT informed consent process;
* Being able to give a verbal consent for the D²EFT-GIC.

Exclusion Criteria:

* Unwilling to comply with the substudy requirements.