title: Randomized controlled trials of HIV/AIDS prevention and treatment in Africa: results from the Cochrane HIV/AIDS Specialized Register.
abstract: BACKGROUND
  To 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.
  
  
  OBJECTIVE
  To describe RCTs of HIV/AIDS conducted in Africa and reported between 2004 and 2008.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Our 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.
  
  
  CONCLUSIONS
  Prevention 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.
authors.affiliation: South African Cochrane Centre, Medical Research Council of South Africa, Cape Town, South Africa. bzani@mrc.ac.za
authors.forename: Babalwa
authors.initials: B
authors.lastname: Zani
authors.forename: Elizabeth D
authors.initials: ED
authors.lastname: Pienaar
authors.forename: Joy
authors.initials: J
authors.lastname: Oliver
authors.forename: Nandi
authors.initials: N
authors.lastname: Siegfried
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy*; D000349:Africa; D057239:Early Termination of Clinical Trials; D006801:Humans; D007258:Informed Consent; D009938:Organizations / Q000191:economics / Q000706:statistics & numerical data; D016032:Randomized Controlled Trials as Topic / Q000191:economics / Q000941:ethics / Q000706:statistics & numerical data*; D012042:Registries / Q000706:statistics & numerical data*; D018401:Sample Size; D013223:Statistics as Topic; D016896:Treatment Outcome