title: Adapting ethical guidelines for adolescent health research to street-connected children and youth in low- and middle-income countries: a case study from western Kenya.
abstract: BACKGROUND
  Street-connected children and youth (SCCY) in low- and middle-income countries (LMIC) have multiple vulnerabilities in relation to participation in research. These require additional considerations that are responsive to their needs and the social, cultural, and economic context, while upholding core ethical principles of respect for persons, beneficence, and justice. The objective of this paper is to describe processes and outcomes of adapting ethical guidelines for SCCY's specific vulnerabilities in LMIC.
  
  
  METHODS
  As part of three interrelated research projects in western Kenya, we created procedures to address SCCY's vulnerabilities related to research participation within the local context. These consisted of identifying ethical considerations and solutions in relation to community engagement, equitable recruitment, informed consent, vulnerability to coercion, and responsibility to report.
  
  
  RESULTS
  Substantial community engagement provided input on SCCY's participation in research, recruitment, and consent processes. We designed an assent process to support SCCY to make an informed decision regarding their participation in the research that respected their autonomy and their right to dissent, while safeguarding them in situations where their capacity to make an informed decision was diminished. To address issues related to coercion and access to care, we worked to reduce the unequal power dynamic through street outreach, and provided access to care regardless of research participation.
  
  
  CONCLUSIONS
  Although a vulnerable population, the specific vulnerabilities of SCCY can to some extent be managed using innovative procedures. Engaging SCCY in ethical research is a matter of justice and will assist in reducing inequities and advancing their health and human dignity.
authors.affiliation: College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya. lonnie.embleton@gmail.com.|Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. lonnie.embleton@gmail.com.
authors.forename: L
authors.initials: L
authors.lastname: Embleton
authors.affiliation: Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA. maott@iu.edu.
authors.forename: M A
authors.initials: MA
authors.lastname: Ott
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya. wachirajuddy@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Wachira
authors.affiliation: College of Health Sciences, Department of Behavioral Sciences, Moi University, Eldoret, Kenya. vnaanyu@gmail.com.
authors.forename: V
authors.initials: V
authors.lastname: Naanyu
authors.affiliation: Moi Teaching and Referral Hospital, Eldoret, Kenya. akamanda1@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Kamanda
authors.affiliation: Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya. dmackos30@yahoo.com.
authors.forename: D
authors.initials: D
authors.lastname: Makori
authors.affiliation: College of Health Sciences, Department of Behavioral Sciences, Moi University, Eldoret, Kenya. dayuku_2000@yahoo.com.
authors.forename: D
authors.initials: D
authors.lastname: Ayuku
authors.affiliation: College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya. pbraitstein@gmail.com.|Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. pbraitstein@gmail.com.|Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya. pbraitstein@gmail.com.|Fairbanks School of Public Health, Department of Epidemiology, Indiana University, Indianapolis, IN, USA. pbraitstein@gmail.com.|Regenstrief Institute, Inc., Indianapolis, IN, USA. pbraitstein@gmail.com.|Division of Epidemiology, 155 College Street, Toronto, M5T 3M7, ON, Canada. pbraitstein@gmail.com.
authors.forename: P
authors.initials: P
authors.lastname: Braitstein
mesh_terms: D000293:Adolescent; D000067697:Adolescent Health; D026686:Beneficence; D002648:Child; D000067576:Child Health; D002985:Clinical Protocols / Q000592:standards; D032984:Ethics, Research; D017408:Guidelines as Topic / Q000592:standards*; D018453:Homeless Youth; D006801:Humans; D007258:Informed Consent / Q000941:ethics; D007630:Kenya; D008297:Male; D026684:Personal Autonomy; D011203:Poverty; D012935:Social Justice; D035862:Vulnerable Populations