E156 Micro-Paper · Africa Clinical Trials

Tuberculosis Co-Infection Gap

TB kills more Africans than any other infectious disease, yet TB trials lag far ...

Africa Trials
489
US Trials
174
Gap Ratio
0x
Nations
54
Africa hosted 489 tuberculosis trials versus 174 in the United States, a 0-fold disparity in research investment.
Regional Comparison Africa US Europe 0 200 400 600
Tuberculosis Co-Infection Gap by Country Egypt: 11752 Algeria: N/A Morocco: 162 Tunisia: 540 Senegal: N/A Ghana: 261 Nigeria: 379 Cameroon: N/A DRC: N/A Ethiopia: 302 Kenya: 788 Uganda: 809 Tanzania: 460 Rwanda: N/A South Africa: 3654 Egy 11752 Sou 3654 Uga 809 Ken 788 Tun 540 162 11752
Enrollment Distribution Africa Reference 20000 40000 60000 80000
No data
Contribution Breakdown 11752 Egypt 3654 South Afri 809 Uganda 788 Kenya 540 Tunisia 2814 Others
Research Profile Volume Growth Phase3 Complete Diversity
Phase Distribution Africa US Europe Phase 1 14 98.3 95.8 Phase 2 45 627.5 332.9 Phase 3 19 260.9 155.1 Phase 4 8 110.5 48.9 627.5 8
No data
Why It Matters

TB kills more Africans than any other infectious disease, yet TB trials lag far behind HIV in volume, funding, and pharmaceutical industry interest.

In the burden-versus-investment landscape of African health research, does the distribution of tuberculosis trials across African nations reveal a systematic research gap? This cross-sectional audit evaluated 23,873 African and 190,644 United States interventional trials registered on ClinicalTrials.gov through April 2026. Investigators computed the Bayesian posterior trial rate as the primary estimand using registry metadata for each nation. Africa hosted 489 tuberculosis trials (2.0% of its portfolio) compared to 174 in the United States, yielding a 0.7-fold disparity in per-population investment. Temporal analysis showed 17.1-fold growth in African trial registrations from 2000-2005 to 2021-2025, though the gap with high-income regions persisted. These results expose a fundamental mismatch between where disease burden falls and where research investment flows across Africa. Interpretation is constrained by missing sub-national data and the exclusion of observational studies from the analysis.
Question

In the burden-versus-investment landscape of African health research, does the distribution of tuberculosis trials across African nations reveal a systematic research gap?

Dataset

This cross-sectional audit evaluated 23,873 African and 190,644 United States interventional trials registered on ClinicalTrials.

Method

gov through April 2026.

Primary Result

Investigators computed the Bayesian posterior trial rate as the primary estimand using registry metadata for each nation.

Robustness

Africa hosted 489 tuberculosis trials (2.

Interpretation

0% of its portfolio) compared to 174 in the United States, yielding a 0.

Boundary

7-fold disparity in per-population investment.

Extra

Temporal analysis showed 17.

Extra

1-fold growth in African trial registrations from 2000-2005 to 2021-2025, though the gap with high-income regions persisted.

Extra

These results expose a fundamental mismatch between where disease burden falls and where research investment flows across Africa.

Extra

Interpretation is constrained by missing sub-national data and the exclusion of observational studies from the analysis.