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Posted by plosmedicine on 31 Mar 2009 at 00:16 GMT

Author: Jose Luis Portero
Position: MD, PhD
Institution: Proyecto Centro de Referencia para el Control de Endemias. Fundación para la Cooperación y la Salud Internacional Carlos III. Malabo. Equatorial Guinea
Additional Authors: Maria Rubio
Submitted Date: November 08, 2007
Published Date: November 9, 2007
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

As in the past, a large number of clinical trials will be needed to establish better and more effective tuberculosis (TB) treatment strategies. Schluger et al[1] point out that, although building research capacity and infrastructure requires a large amount of initial funding, it is extremely cost-effective in the long run. However, the context must be taken into account, especially, in sub-Saharan Africa, where the current public health services are unable to answer to the TB and HIV epidemics. In this framework, lack of enough health care personnel, rundown facilities, shortage of potable water and electricity, poor maintained and equipped laboratories, stockouts of TB reagents and drugs and deficient political will are the rule.

There is a scarcity of funds to TB control and many times these resources support inefficient activities. Building clinical trials capacity for TB can be a focus for a big portion of the funding, therefore this capacity building will be only acceptable for Africa if it supports and strengthens the local competence to fight TB as well as HIV epidemics. It can be very harmful for the National Control Programmes of both diseases that the most experienced doctors, nurses and field workers are attracted by the high standards of scientific work and the well-payed jobs in detriment of the real provision of better health care. That is the case with international health organizations which practice the local brain-drainage to fill their human resources gap when they open offices in African countries.

The model developed by the British Medical Research Council and the TB Trials Consortium of the United States Centers for Disease Control and Prevention as “research islands”, although successful in the past, has to be overcome in order to launch a new alliance between science and public health in the developing countries. Local competence and better standards of health care have to be assured before clinical trials are implemented. In that matter, African governments have a huge responsibility already not properly addressed.

Last but not least, clinical trials do not have to be the only excuse to introduce good clinical practices, institutional review boards and ethics committees in order to assure the security and rights of the African patients to obtain an appropriate health care.

In science we trust.


1. Schluger N, Karunakara U, Lienhardt C, Nyirenda T, Chaisson R (2007) Building clinical trials capacity for tuberculosis drugs in high-burden countries. PLoS Med 4(11): e302. doi:10.1371/journal.pmed.0040302

Competing interests declared: We don´t have any competing interests to declare