Africa’s HIV research output not matching infection burden

Despite Africa’s contribution to the global Human Immunodeficiency Virus (HIV) research output, which has increased over the past 35 years since the epidemic first became a cause for concern, only a modest improvement in scholarly work compared to the continent’s burden of infection has been seen, a study has found.

In 2020, the last year of the study period, Africa’s research output surged to 7,310 indexed articles compared to the 188 indexed articles in the first year, 1986. The continent’s proportion of the world’s total HIV publications rose from 5.1% in 1986 to a record high of 31.3% in 2020, with Africa’s lowest proportions in 1986 (5.1%), 1988 (5.2%), 1987 (5.3%) and 1989 (5.3%). It is important to note that HIV was recognised in Africa only in the early 1980s, according to a history of the epidemic.

The study, ‘HIV research output in African Countries between 1986-2020’, published in PLOS Global Public Health recently, found that the continent is underrepresented in global HIV research output, and this must be addressed in other fields, such as COVID-19 research.

Africa’s contribution to global health research output in 2014 was estimated at 1.3%, accounting for about 31% of global HIV research publications in 2020, which is markedly higher than the continent’s total contribution to global health research. But, for a continent that has the highest burden of HIV infections, this is relatively low, they say.

Output over 35 years investigated

The authors noted that, for the study, they searched the PubMed database in June 2021 to obtain the HIV research output by volume of each African country over a 35-year period (1 January 1986-31 December 2020). The search was conducted by specifying the search parameters: search terms, place, and year of publication. The country names were written in their different possible spelling formats – for example, ‘Cape Verde’ = ‘Cape Verde OR Cabo Verde’. They also considered that some country names double as names of parts of other countries – for example, Benin and Niger are names of African countries and also of places in Nigeria. To address potential errors that could arise from this nomenclature, appropriate search command coding restrictions were written: ‘Benin’ = ‘Benin NOT Nigeria’ and ‘Niger’ = ‘Niger NOT Nigeria’.

The volume of HIV research articles indexed in the PubMed database over the study period was used as a proxy for total HIV research output in Africa. The total number of publications was the total of all published articles returned from the search indexed on PubMed. A comparative weighting for population, gross domestic product (GDP), and the number of persons living with HIV (PLHIV) was determined by calculating the ratio of articles from each country.

These variables were selected for inclusion in the analysis based on the availability of reliable data throughout the study period. The population and GDP estimates were obtained from the World Development Indicators database of the World Bank, while the PLHIV burden estimates among adults and children (all ages) were obtained from the UNAIDS Global database on HIV epidemiology and response.

A total of 83,527 articles on HIV indexed in PubMed between 1986 and 2020 were included for analysis. Countries in East Africa accounted for 39% of the total indexed publications, followed closely by countries in Southern Africa with 36% of the total indexed publications.

Most research from Sub-Saharan Africa

Countries in these two regions and countries in West Africa (16%) collectively account for 90% of all indexed publications on HIV. Conversely, the Republic of South Africa in the Southern African sub-region had the highest research productivity by volume, namely 32%.

Within each sub-region, Uganda (22%), Cameroon (37%), Western Sahara (31%), the Republic of South Africa (89%), and Nigeria (33%) represent countries with the highest number of indexed articles in Eastern, Middle, Northern, Southern and Western Africa, respectively.

A co-author of the study, Mukhtar A Ijaiya of the Johns Hopkins Programme for International Education in Gynaecology and Obstetrics, told University World News that multiple factors have contributed to the relatively limited research output in Africa. “One of the primary factors is the comparatively limited funding available for research,” he said, adding that other factors such as infrastructure challenges, brain drain (migration of skilled researchers), and limited collaboration added to the problem.

In addition, he said, there are limited knowledge-sharing opportunities, policy and regulatory environment, the state of the educational system, the number and distribution of health research institutions, and the translation and implementation of research findings all play significant roles in shaping research productivity in the region.

Governments are not all in

Unfortunately, governments across the continent are not contributing to solving the problem. Ijaiya said that, although African governments understand the significance of research in combating the HIV/AIDS epidemic and have made efforts to support and participate in HIV research actively, they have provided limited funding.

“Competing priorities, and challenges in the education sector, often result in insufficient financial resources allocated to research. Interestingly, our findings highlight a notable spike in research output coinciding with the commencement of funding from the Global Fund and PEPFAR [the United States’ President’s Emergency Plan for AIDS relief] for HIV/AIDS interventions in Africa. This underscores the positive impact that increased funding can have on research endeavours related to HIV/AIDS on the continent,” he added.

Ijaiya blamed the fact that HIV infection is not meeting research output on the continent on “regulatory environment, as well as the number and distribution of health research institutions and the state of the educational system.

“Africa has historically had a relatively low contribution to global health research output, despite facing a high burden of HIV infections.”

In his view, this study should be of interest to policymakers in the health sector across Africa because it provides crucial insights and reveals the current state of HIV research, regional disparities and factors influencing research productivity.

Sound info for policymakers

“Policymakers can use this information to direct resources to under-represented regions, address language-related barriers, prioritise funding based on disease burden and economic indicators, and learn from successful initiatives like The Global Fund and the US President’s Emergency Plan for AIDS Relief,” Ijaiya said.

In addition, he said, policymakers can take a broader perspective, considering disparities beyond HIV research to foster a more equitable research landscape and promote collaborations. By leveraging these findings, they can make informed decisions to strengthen research capacity, advance evidence-based practices, and improve health outcomes related to HIV in Africa.