Establishing a Multi-Country Sickle Cell Disease Registry in Africa: Ethical Considerations.

Munung NS1,2, Nembaware V2,3, de Vries J1, Bukini D4, Tluway F4, Treadwell M5,6, Sangeda RZ4,7, Mazandu G2,3, Jonas M2,3, Paintsil V8, Nnodu OE9, Balandya E4, Makani J4, Wonkam A2,3.

Author information

1: Department of Medicine, University of Cape Town, Cape Town, South Africa.
2: SickleInAfrica Data Coordinating Centre (SADaCC), University of Cape Town, Cape Town, South Africa.
3: Division of Human Genetics, University of Cape Town, Cape Town, South Africa.
4: Sickle Cell Programme, Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.
5: Department of Hematology/Oncology, UCSF Benioff Children's Hospital Oakland, California, United States.
6: Department of Pediatrics, UCSF School of Medicine, California, United States.
7: Department of Pharmaceutical Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
8: Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
9: Center for Sickle Cell Disease Research and Training, University of Abuja, Abuja, Nigeria.

Abstract

Sickle cell disease (SCD) is one of the most prevalent genetic conditions in sub-Saharan Africa. It is a chronic, lifelong disease often characterized by severe pain. However, SCD has received little investment terms of health research, though there is currently a growing pool of SCD data from health and research facilities in different countries. To facilitate research on SCD in Africa, the SickleInAfrica consortium has established a SickleInAfrica registry. The registry will store a systematic collection of longitudinal data from persons with SCD across sub-Saharan Africa, and currently, participants are being enrolled in Ghana, Nigeria, and Tanzania. In establishing this registry, the SickleInAfrica consortium decided to actively identify and anticipate possible ethical issues that may arise in the development and management of the registry. This was motivated, in part, by the near absence of well documented ethical issues for registry research in Africa, more-so for registries enrolling participants across multiple countries and for a genetic condition. The consortium aims to establish standards for the equitable use of data stored in the registry. This paper presents a comprehensive report on the ethical considerations that came up in setting up a genetic disease registry across multiple African countries and how they were addressed by the SickleInAfrica consortium. Major issues included: active involvement of patients in the initiation and management of the registry; questions of assent and re-consent; the importance of ensuring that fears of exploitation are not replicated in African-African research collaborations; and the importance of public engagement in the management of registries. Drawing on this experience, SickleInAfrica plans to set up an ethics helpdesk for genetic disease registries and research in Africa.