Priorities for antiretroviral therapy research in sub-Saharan Africa: a 2002 consensus conference in Zambia.
BACKGROUND
A consensus conference was held to discuss priorities for antiretroviral therapy (ART) research in Zambia, one of the world's most heavily HIV-afflicted nations. Zambia, like other resource-limited settings, has increasing access to highly active antiretroviral therapy (HAART) because of declining drug costs, use of government-purchased generic medications, and increased global donations. For sustained delivery of care with HAART in a resource-constrained medical and public health context, operational research is required and clinical trials are desirable. The priority areas for research are most relevant today given the increasing availability of HAART.


METHODS
A conference was held in Lusaka, Zambia, in January 2002 to discuss priority areas for ART research in Zambia, with participants drawn from a broad cross section of Zambian society. State-of-the-art reviews and 6 intensive small group discussions helped to formulate a suggested research agenda.


RESULTS
Conference participants believed that the most urgent research priorities were to assess how therapeutic resources could be applied for the greatest overall benefit and to minimize the impact of nonadherence and viral resistance. Identified research priorities were as follows:Conference participants recommended that HIV-related clinical care and research be integrated within home-based care services and operated within the existing health delivery structures to ensure sustainability, reduce costs, and strengthen the structures.


CONCLUSIONS
Our consensus was that antiretroviral clinical trials and operational research are essential for Zambia to address the new challenges arising from increasing ART availability. There is global consensus that antiretroviral clinical trials in resource-constrained countries are possible, and the capacity for such trials should be developed further in Africa.
Zulu
Isaac
I
University Teaching Hospital, Lusaka, Zambia. zuluisaac@yahoo.com
Schuman
Paula
P
Musonda
Rosemary
R
Chomba
Elwyn
E
Mwinga
Kasonde
K
Sinkala
Moses
M
Chisembele
Maureen
M
Mwaba
Peter
P
Kasonde
Dorothy
D
Vermund
Sten H
SH
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy; D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D002648:Child; D003695:Delivery of Health Care; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000635:transmission / Q000821:virology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010349:Patient Compliance; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy; D012107:Research Design; D015024:Zambia
D019380:Anti-HIV Agents