title: Ethics in Community-Based Research with Vulnerable Children: Perspectives from Rwanda.
abstract: A "risk of harm" protocol to identify youth in need of immediate emergency assistance in a study on mental health and HIV in Rwanda among 680 youth ages 10-17 is described. Cases are presented that describe the experience in using this protocol to ensure safety of participants, with ethical and logistical challenges considered. Among the population of the study, 3.2% were deemed "risk of harm." The most prevalent presenting problem was non-fatal suicidal behavior (91% of risk of harm cases), with 36% having a history of a reported previous attempt. Challenges included: acute food insecurity/significant poverty; lack of support/adequate supervision from family members; family violence; alcohol abuse; and HIV-related stigma. Development of a "risk of harm" protocol and collaboration between study staff, community leadership, health authorities, and health workers are critical to ensuring participants' safety in research among vulnerable populations.
authors.affiliation: Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, Massachusetts, United States of America.
authors.forename: Theresa
authors.initials: T
authors.lastname: Betancourt
authors.affiliation: Harvard Medical School, Department of Global Health and Social Medicine, Boston, Massachusetts, United States of America.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Smith Fawzi
authors.affiliation: Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, Massachusetts, United States of America.
authors.forename: Anne
authors.initials: A
authors.lastname: Stevenson
authors.affiliation: Partners In Health-Rwanda/ Inshuti Mu Buzima (PIH-IMB), Kigali, Rwanda.
authors.forename: Fredrick
authors.initials: F
authors.lastname: Kanyanganzi
authors.affiliation: Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, Massachusetts, United States of America.
authors.forename: Catherine
authors.initials: C
authors.lastname: Kirk
authors.affiliation: Harvard T.H. Chan School of Public Health, Department of Global Health and Population, Boston, Massachusetts, United States of America.
authors.forename: Lauren
authors.initials: L
authors.lastname: Ng
authors.affiliation: Partners In Health-Rwanda/ Inshuti Mu Buzima (PIH-IMB), Kigali, Rwanda.
authors.forename: Christina
authors.initials: C
authors.lastname: Mushashi
authors.affiliation: Ministry of Health, Government of Rwanda, Kigali, Rwanda.
authors.forename: Justin I
authors.initials: JI
authors.lastname: Bizimana
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts, United States of America.
authors.forename: William
authors.initials: W
authors.lastname: Beardslee
authors.affiliation: Harvard Medical School, Department of Global Health and Social Medicine, Boston, Massachusetts, United States of America.|Partners In Health, Boston, Massachusetts, United States of America.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Raviola
authors.affiliation: Harvard Medical School, Department of Global Health and Social Medicine, Boston, Massachusetts, United States of America.|Partners In Health, Boston, Massachusetts, United States of America.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Smith
authors.affiliation: Ministry of Health, Government of Rwanda, Kigali, Rwanda.|University of Global Health Equity, Kigali, Rwanda.|Rwanda Biomedical Center, Kigali, Rwanda.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Kayiteshonga
authors.affiliation: Harvard Medical School, Department of Global Health and Social Medicine, Boston, Massachusetts, United States of America.|Ministry of Health, Government of Rwanda, Kigali, Rwanda.|Dartmouth College, Hanover, New Hampshire, United States of America.|University of Global Health Equity, Kigali, Rwanda.
authors.forename: Agnes
authors.initials: A
authors.lastname: Binagwaho
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D000293:Adolescent; D002648:Child; D055812:Community-Based Participatory Research / Q000941:ethics* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data; D012432:Rwanda; D012959:Socioeconomic Factors; D013405:Suicide / Q000706:statistics & numerical data; D035862:Vulnerable Populations