Randomized Controlled Trials of HIV/AIDS Prevention and Treatment in Africa: Results from the Cochrane HIV/AIDS Specialized Register

Abstract

IntroductionTo effectively address HIV/AIDS in Africa, evidence on preventing new infections and providing effective treatment is needed. Ideally, decisions on which interventions are effective should be based on evidence from randomized controlled trials (RCTs). Our previous research described African RCTs of HIV/AIDS reported between 1987 and 2003. This study updates that analysis with RCTs published between 2004 and 2008.ObjectivesTo describe RCTs of HIV/AIDS conducted in Africa and reported between 2004 and 2008.MethodsWe searched the Cochrane HIV/AIDS Specialized Register in September 2009. Two researchers independently evaluated studies for inclusion and extracted data using standardized forms. Details included location of trials, interventions, methodological quality, location of principal investigators and funders.ResultsOur search identified 834 RCTs, with 68 conducted in Africa. Forty-three assessed prevention-interventions and 25 treatment-interventions. Fifteen of the 43 prevention RCTs focused on preventing mother-to-child HIV transmission. Thirteen of the 25 treatment trials focused on opportunistic infections. Trials were conducted in 16 countries with most in South Africa (20), Zambia (12) and Zimbabwe (9). The median sample size was 628 (range 33-9645). Methods used for the generation of the allocation sequence and allocation concealment were adequate in 38 and 32 trials, respectively, and 58 reports included a CONSORT recommended flow diagram. Twenty-nine principal investigators resided in the United States of America (USA) and 18 were from African countries. Trials were co-funded by different agencies with most of the funding obtained from USA governmental and non-governmental agencies. Nineteen pharmaceutical companies provided partial funding to 15 RCTs and African agencies co-funded 17 RCTs. Ethical approval was reported in 65 trials and informed consent in 61 trials.ConclusionPrevention trials dominate the trial landscape in Africa. Of note, few principal investigators and funders are from Africa. These findings mirror our previous work and continue to indicate a need for strengthening trial research capacity in Africa.

A bibliometric analysis of COVID-19 research in Africa

“…Few studies were funded by African organizations, and specifically, African governments. This is similar to other previous studies which also observed few funders from the continent 23,24 . Overall, the lack of funding from African governments may reflect lack of economic ability, political will or capacity to fund research.…”

Equity in global health research in the new millennium: trends in first-authorship for randomized controlled trials among low- and middle-income country researchers 1990-2013

“…(11) Smith et al examined research partnerships between LMIC and other country researchers and made some recommendations, most importantly emphasizing the importance of empirical research into capacity building in LMICs. (10,12) In this context, the aim of this study was to examine trends in first-authorship by researchers from LMIC institutions over time (LMIC first-authors hereafter). If capacity building initiatives in recent years have been successful, then the number and proportion of articles with first-authors from LMIC institutions would be expected to have increased.…”

Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) clinical trial activity on the African Continent: An analysis of HIV/AIDS trials registered on the Pan African Clinical Trials Registry

“…This is linked to the large number of multi-center trials with sites in the Africa region that are collaborating to answer questions for this region. This is encouraging as previous studies of published trials noted that not many trials were being conducted in Africa (Siegfried et al, 2005;Zani et al, 2011). The increase in the number of African principal investigators is equally encouraging as it is an indicator of regional capacity to conduct research.…”