Global Imbalances in Funding Sources for HIV Randomized Control Trials

Abstract

Improving access to grant funding is a critical aspect of strengthening research capacity outside of higher income settings, particularly in HIV/AIDS where randomized control trials (RCTs) that require substantial resources are common. In this article, we assessed recent RCTs to examine variation in how studies were funded, depending on study location and the countries where publication authors were based. We conducted a PubMed literature review to identify RCTs with HIV status or viral load endpoints published in 2019 and 2020, then analyzed cross-tabulations of funding sources by study characteristics. One hundred sixteen publications met the inclusion criteria. Research in higher income countries was most likely to be funded by biotech/pharmaceutical companies, whereas research in lower- and middle-income countries was most likely to be funded by U.S. government sources. Overall, we found the distribution of funding sources differed significantly by study and author location (χ² = 23, p < .001). Published RCTs with HIV status or viral load endpoints are financed differently based on where studies take place and where the authors are based. As part of future research, understanding why this variation exists is critical for assessing how funding contributes to global imbalances in scientific resources.

Keywords: global health inequity; grant funding; randomized control trials; research implementation.

FIG. 1.

Distribution of funding type by study location and authors' affiliations. Bar height shows the proportion of publications in that panel that received funding from each type (U.S. government agency, biotech/pharmaceutical/consulting company, institution/university/hospital, private foundations, and others). The first row compares funding types for publications that included a study location in a higher income country, classified according to World Bank data, with publications that did not include a study location in a higher income country. The second row compares funding types for publications whose first authors had an affiliation in a higher income country with publications whose first authors did not have an affiliation in a higher income country. The third row compares funding types for publications whose last authors had an affiliation in a higher income country with publications whose last authors did not have an affiliation in a higher income country.