BHIVA competing interest disclosure form (BHIVA guidelines)

This form is for submissions to BHIVA of competing interest disclosures. If you have any queries, please contact the Secretariat at [email protected].

Requirements for declaration

BHIVA requires that all members of BHIVA guideline writing groups as well as any expert external peer reviewers and literature searchers must declare all interests and membership of other committees. Declaration is required to be made prior to the commencement of service on the relevant guideline writing group retrospectively for the 12 months preceding the beginning of membership of the guideline writing group. All members of guideline writing groups must undertake a declaration of interests prior to serving on a writing group and this declaration is confirmed and repeated on the publication of the completed guideline. This form will be retained by the Guidelines Coordinator and the Secretariat, and the details will be made available for publication.

Please report all relationships with pharmaceutical, diagnostic or similar companies involved in HIV-related products, or other products relevant to the guideline you are working on, during the period required by BHIVA. For the purposes of this disclosure, the term ‘member’ includes the writing group member and any spouse/partner/family member.

If any positive responses are given in the sections below, please provide further information. Chairs of guidelines writing groups must be free of specific conflicts of interest relating to the topic of the guideline.

If undisclosed competing interest is later proven, the writing group will follow Committee on Publication Ethics (COPE) guidelines.

Please complete all sections of this form. If there is nothing to disclose in any section, please indicate ‘£0’ or ‘none’.

 

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Period covered
Declaration of financial interests

Consultancy work
This refers to any paid retainer or agreement between the member and a company usually with a contract for a specific period and includes payment for attending Advisory Board meetings.

Consultancy work

Speaker fees
This mainly concerns fees (e.g. for lectures, commissioned articles or other suchlike paid activity) received from a commercial sponsor and where the member has benefited personally.

Speaker fees

Company shares
This includes any shares held by the member in the biomedical industry (e.g. pharmaceutical, diagnostic or similar companies).

Company shares

Grant support
This refers to fees and grants paid to the member which have been used for research, education, equipment, salaries (including fellowships) in your department and for personal travel/hospitality for conferences and meetings.

Grant support

Other paid income
This refers to patents or royalties, serving as an expert witness, or performing other activities for an entity with a financial interest in this area undertaken by the member.

Other paid income

Other relevant disclosure
This refers to any other relationship which is financial or with an organisation that, if not disclosed by the member, could compromise the member or BHIVA as a charitable organisation.

Other relevant disclosure
Declaration of non-financial interests

You are required to declare any trusteeships in non-BHIVA organisations and non-BHIVA committee memberships or directorships, which have conflicting or competing interests. Please ensure that you give full information regarding dates and length of term. Please mark ‘none’ if there is nothing to disclose.

Trusteeships
Give full name of organisation(s), plus term served to date and retirement date.

Committee memberships
This mainly concerns fees (e.g. for lectures, commissioned articles or other suchlike paid activity) received from a commercial sponsor and where the member has benefited personally.

Directorships
Give full name of organisation(s), plus term served to date and retirement date.