Geographical Representativeness of Published and Ongoing Randomized Controlled Trials. The Example of: Tobacco Consumption and HIV Infection

Abstract

BackgroundThe challenge for evidence-based healthcare is to reduce mortality and the burden of diseases. This study aimed to compare where research is conducted to where research is needed for 2 public health priorities: tobacco consumption and HIV infection.MethodsWe identified randomized controlled trials (RCTs) included in Cochrane systematic reviews published between 1997 and 2007 and registered ongoing RCTs identified in January 2009 through the World Health Organization's International Clinical Trials Registry Platform (WHO-ICTRP) evaluating interventions aimed at reducing or stopping tobacco use and treating or preventing HIV infection. We used the WHO and World Bank reports to classify the countries by income level, as well as map the global burden of disease and mortality attributable to tobacco use and HIV infection to the countries where the trials performed.ResultsWe evaluated 740 RCTs included in systematic reviews and 346 ongoing RCTs. For tobacco use, 4% of RCTs included in systematic reviews and 2% of ongoing trials were performed in low- and middle-income countries, even though these countries represented 70% of the mortality related to tobacco use. For HIV infection, 31% of RCTs included in systematic reviews and 33% of ongoing trials were performed in low- and middle-income countries, even though these countries represented 99% of the mortality related to HIV infection.ConclusionsOur results highlight an important underrepresentation of low- and middle-income countries in currently available evidence (RCTs included in systematic reviews) and awaiting evidence (registered ongoing RCTs) for reducing or stopping tobacco use and treating or preventing HIV infection.

Barriers for conducting clinical trials in developing countries- a systematic review

“…At the same time that the priorities of developed countries drives the research agenda of pharmaceutical companies, there is a disturbing underrepresentation of research addressing priority issues for developing countries [ 15 , 16 ]. Diseases of relevance to high-income countries are investigated in clinical trials seven to eight times more often than diseases whose burden lies mainly in low-income and middle-income countries [ 17 ].…”

Automatic classification of registered clinical trials towards the Global Burden of Diseases taxonomy of diseases and injuries

“…The World Health Organization (WHO) has indicated the pressing need for a comprehensive monitoring of health research and development (R&D) to coordinate limited resources towards reducing the gaps between health research and health needs [ 1 – 3 ]. Mapping the global landscape of health R&D will allow for identifying diseases for which there is too much or too little research at a local level as compared to their burden at the same level [ 4 ]. The WHO is developing the Global Observatory on Health R&D and aims at analyzing multiple data sources to quantify the global state of health R&D, including clinical trial registries, publications, product pipelines, patents and grants [ 3 , 5 ].…”

FRESH AIR: an implementation research project funded through Horizon 2020 exploring the prevention, diagnosis and treatment of chronic respiratory diseases in low-resource settings

“…For example, a recent study on tobacco use found that only 4% of randomised controlled trials included in systematic reviews and 2% of on-going trials were performed in LMICs, even though these countries represented 70% of the mortality related to tobacco use. 24 …”

“…The International Primary Care Respiratory Group (IPCRG) maintains a public website ( http://www.theipcrg.org/freshair ) to enable emerging findings to be shared widely and freely, and private pages for the logging of contextual data, as recommended in the latest guidance on implementation science reporting. 24 …”