Acceptability of Aedes aegypti blood feeding on dengue virus-infected human volunteers for vector competence studies in Iquitos, Peru

As part of a study to investigate drivers of dengue virus (DENV) transmission dynamics, this qualitative study explored whether DENV-infected residents of Iquitos, Peru, considered it acceptable (1) to participate in direct mosquito feeding experiments (lab-reared Aedes aegypti mosquitoes fed directly on human volunteers) and (2) to provide blood meals indirectly (Ae. aegypti fed on blood drawn from participants by venipuncture). Twelve focus group discussions (FGDs; 94 participants: 82 females and 12 males) were conducted in January 2014 to explore six themes: (1) concerns and preferences regarding direct mosquito feeds and blood draws, (2) comprehension of and misconceptions about study procedures, (3) motivating factors for participation, (4) acceptability of children’s participation, (5) willingness to provide multiple samples over several days, and (6) preference for direct feedings in homes versus the study laboratory. Results of FGDs, including one with 5 of 53 past direct mosquito feed participants, indicated that mosquito feeding procedures are acceptable to Iquitos residents when they are provided with information and a few key messages are properly reinforced. FGD participants’ concerns focused primarily on safety issues rather than discomfort associated with mosquito bites. A video explaining the study dramatically increased comprehension of the study procedures. The majority of participants expressed a preference for mosquito feeding over venipuncture. Adults supported child participation if the children themselves assented. For most participants, home feedings were preferred over those in a laboratory. A major impetus for participation was the idea that results would contribute to an improved understanding of DENV transmission in Iquitos. Findings from our study will support future large-scale studies that employ direct mosquito feeding, a low-risk, non-invasive procedure that is experimentally superior to artificial mosquito feeding methods.Author summary: Approximately half of the world’s population is at risk of contracting dengue virus (DENV). Ethical and logistical concerns with feeding lab-raised mosquitoes directly on naturally infected human subjects, and the lack of a relevant animal model for DENV experimental infection, are important obstacles to better understanding DENV transmission from humans to mosquitoes. Results from artificial infectious blood meals can bias estimates of mosquito infection and transmission rates. Based on 12 focus group discussions, we determined that the practice of feeding uninfected lab-raised mosquitoes on naturally infected human subjects is highly acceptable to people living in Iquitos, Peru, especially after common concerns are addressed. The majority of participants were willing to have mosquitoes feed on them directly and to give venous blood samples to feed to mosquitoes indirectly. Most participants stated a preference for direct feeding. This formative research, including recognition of and addressing common misconceptions, will help guide future development of protocols using biologically relevant direct mosquito feeding methods.