Africa: Greater local ownership of HIV research needed
Unless African governments increase their funding for and engagement in HIV research, the continent cannot hope to attain equal status in determining its research agenda and priorities, speakers said at the 16th International Conference on AIDS and Sexually Transmitted Infections (STIs) in Africa.
"In most low-income or poor countries, health research is donor-driven, with insignificant local budgets compared to the 2 percent annual budget recommended by WHO [World Health Organization]," said Dr Beyene Petros, chair of the Ethiopian Bioethics Initiative.
Donor-driven funding often means that research starts and ends on the say-so of funders, rather than being based on a country's needs. Beyene noted a Dutch grant of approximately US$13 million to the Ethiopian government to investigate capacity development in HIV/AIDS research for eight years.
When the grant ended in 2002, the Ethiopian government applied for a renewal. It was denied, leaving scientists, who had been hoping to launch a local vaccine initiative, at a loss. The Dutch government instead decided to fund family planning and HIV prevention activities in the country.
The field of HIV research - largely donor-driven - is vibrant in eastern and southern Africa. But "West Africa, in particular, is characterized by an absence in of clinical trials of potential HIV vaccines, and or microbicides, and a lack of data on drug-resistant tuberculosis," said Dr Souleymane Mboup, of Senegal’s Cheikh Anta Diop University.
Prof Nelson Sewankambo, principal of the College of Health Sciences at Uganda's Makerere University, said heavy donor involvement in local research can actually harm existing national institutions, which may lose strategic direction and become retarded by the loss of key staff to research projects and distortion of institutional structures and governance.
"Inequities in collaboration can lead to lack of transparency in the decision-making process, as well as disputes over publication rights, ownership of data, specimens and equipment," Sewankambo said.
Speakers also noted that inadequate community engagement was common when partnerships were skewed in favour of the donor priorities. "There ought to be distributive justice and fair partnerships between sponsors, investigators, subjects, communities and countries," said Cameroonian writer Prof Godfrey Tangwa, of the University of Yaounde.
Sewankambo noted that in the past, weak local institutions had allowed ethical violations in research projects, such as the use of placebos in studies on mother-to-child HIV transmission.
"Even when these issues were pointed out, the debate began in the North. Where were we Africans when these wrongs were going on? It is not enough for us to blame countries in the North for the state of health research - we need to look at what we in the South are not doing right in government funding of research and in negotiation of research partnerships," he said.
Sewankambo noted that there was a need to build new, more equitable partnership models and expand local capacity to sustain research activities once donor-funded projects ended.
The involvement of policy-makers is key to ensuring that research is turned into evidence-based policy, said Anne Cockroft, of Canada's Global Health Research Initiative (GHRI). She pointed out that there was often a gap in "knowledge translation" between researchers and policy-makers, leading to poor decisions being taken.
"[HIV] prevention research results have to be translated into policies and action, and research users and decision-makers need skills to evaluate findings and prioritise for action," she said, adding that outside interests and funding often led to externally driven policy decisions, while poor understanding of research led to policies based partly on evidence, or based on poor evidence.
GHRI has been working with parliamentarians in Botswana to expand their ability to make decisions based on evidence after many said they experienced difficulties in interpreting scientific evidence.
There has been some progress in the past few decades. Wen Kilama, managing trustee of the African Malaria Network Trust, said partnerships have largely moved on from "colonial style" research, in which Africans had little or no say in research conducted in their countries, and African scientists are now more involved in priority-setting and actual research.
"The Ugandan government has created an enabling environment for research and recently came up with a law which led to the creation of the Uganda National Health Research Organization, which, if managed properly, has the potential to greatly improve the way research is conducted in the country," Sewankambo said.
Kenya and Tanzania have similar bodies, and African scientists have created several networks to strengthen research capacity, but regulation has lagged behind the development of research capability.
The East Africa Consortium for Clinical Research has been established, but it has yet to develop a regional policy to guide the regulation of health research and clinical trials, and remains largely donor-dependent in the development of health research policy.
Ethiopia's Beyene pointed out that "Unless we strengthen our own research capacity, dependence on donors will be perpetuated."