Research is vital to inform future treatment and care decisions as well as for the advancement of scientific knowledge. To date there has been a paucity of controlled clinical trials in low and middle-income countries. However some programmes such as HIV-NAT in Thailand and HIV-NET in South Africa have paved the way for successful needs based research applicable to local requirements. This has been achieved through interaction between local researchers, governments and international funding and research agencies. Such partnerships for clinical research not only provide locally applicable evidence for treatment strategies but also build research capacity in low and middle-income countries.
It is vital to ask appropriate research questions that will have an impact locally but which could also be applicable to other settings. Most treatment advances will have initially been evaluated during the licensing process in industrialised countries. Whilst not aiming at duplicating research, an evidence base for local application of ART interventions must be developed for resource limited settings.
A vast amount of medical research is underway worldwide in the field of HIV. Researchers have a duty to establish that their studies are not unnecessarily repetitive, ask appropriate questions and do not unduly raise expectations in advance of favourable findings. The establishment of local research committees and a Data and Safety Monitoring Board for individual studies can help to maintain transparency and probity of the research process.
All research conducted must adhere to the ethical guidelines which exist in individual countries and which reflect those established by International regulatory authorities.
Suitable topics for research could be:
• Research in supportive medication and processes related to medication
• Alternative therapies including traditional approaches to care and treatment
• Assessment of cost-effectiveness of novel treatment strategies using antiretrovirals, particularly those investigating simplified regimens, new induction-maintenance regimens and pulsed/cycled antiretroviral therapy.
• Treatment and monitoring strategies adapted to resource limited settings.
• Research related to treatments which have not been studied in the populations in which they will be used
• Research on utility of treatments against local viral strains and HIV-2