Khoza, S. | Search bioRxiv

bioRxiv2026

Participant engagement and feedback in microbiome projects: a case of AWI-Gen 2

Returning individualized microbiome results in ways that are ethical, comprehensible, and useful remains under-explored in African settings. We nested a multi-site, mixed-methods study within the AWI-Gen Wave 2 gut microbiome sub-study of 1,801 women aged 42 - 86 years to engage the participants and provide feedback. All (1,001) participants from Agincourt and Soweto (South Africa) and Nairobi (Kenya) were invited to feedback meetings: 496 from Agincourt, 87 from Soweto, and 195 from Nairobi responded. Engagement strategies were tailored by site (small-group and home-based sessions, visual metaphors, Foldscopes, and local-language delivery). Using semi-structured discussions and structured observations analysed thematically in MAXQDA under COREQ, five cross-cutting themes emerged: (1) understanding of microbiome reports, (2) emotional responses to feedback, (3) perceived health relevance, (4) trust in research institutions, and (5) suggestions for improving engagement. Culturally grounded explanations and local-language facilitation enhanced comprehension and perceived relevance; English-heavy sessions were associated with more confusion. Most participants expressed satisfaction and described planned or enacted dietary and lifestyle changes, while frustration centred on long delays between sampling and feedback. Trust increased with transparency and individualized return of results but was often conditional on minimizing burdensome procedures such as repeat blood sampling (phlebotomy) and ensuring timely feedback. Engagement was feasible and low-cost (approximately USD 29-59 per participant) with site-specific resource needs. Limitations included constrained generalizability beyond the three study sites. Returning individualized microbiome findings in community settings in Africa is acceptable, feasible, and can motivate health-promoting behaviours when delivered promptly and in culturally and linguistically appropriate ways. IMPORTANCEMicrobiome studies rarely return individualized results in low-resource settings due to concerns about appropriate feedback and associated costs. This gap risks eroding trust and diminishing research impact. In three African communities, tailored feedback on gut microbiome profiles was provided to 778 women. By documenting a costed, multi-site engagement model and the themes influencing acceptance and actionability, this work offers a practical framework for ethically returning complex -omics results at scale in underrepresented populations - advancing scientific equity and strengthening community trust in microbiome research.

scientific communication and education↗

bioRxiv2024

Proteomic analysis identifies dysregulated proteins in albuminuria: a South African pilot study

Albuminuria may precede decreases in glomerular filtration rate (GFR) and both tests are insensitive predictors of early stages of kidney disease. Our aim was to characterise the urinary proteome in black African individuals with albuminuria and well-preserved GFR from South Africa. A case-controlled study that compared urinary proteomes of 52 normoalbuminuric (urine albumin: creatinine ratio (uACR) <3 mg/mmol) and 56 albuminuric (uACR [≥] 3 mg/mmol) adults of Black African ethnicity. Urine proteins were precipitated, reduced, alkylated, digested, and analysed using an Evosep One LC coupled to a Sciex 5600 Triple-TOF in data-independent acquisition mode. Data were searched on SpectronautTM 15. Differentially abundant proteins (DAPs) were filtered [≥] 2.25-fold change and false discovery rate [≤] 1%. Receiver operating characteristic curves were used to assess the discriminating ability of proteins of interest. Pathway analysis was performed using Enrichr software. The albuminuric group had a higher uACR (7.9 vs 0.55 mg/mmol, p <0.001). The median eGFR (mL/min/1.73m2) showed no difference between the groups (111 vs 114, p=0.707). We identified 80 DAPs in the albuminuria group compared to normoalbuminuria, of which 59 proteins increased while 21 proteins decreased in abundance. We found 12 urinary proteins with AUC > 0.8, and p-value <0.001 in the multivariate analysis. Furthermore, an 80-protein model was developed that showed a high AUC >0.907 and a predictive accuracy of 91.3% between the two groups. Pathway analysis associated with DAPs were involved in insulin growth factor (IGF) functions, innate immunity, platelet degranulation, and extracellular matrix organization. In albuminuric individuals with well-preserved eGFR, pathways involved in preventing the release and uptake of IGF by insulin growth factor binding protein were significantly enriched. These proteins are indicative of a homeostatic imbalance in a variety of cellular processes underlying renal dysfunction and are implicated in chronic kidney disease.

biochemistry↗