# Expanded Access & Post-Trial Justice

In research ethics and post-trial justice, do African clinical trials provide participants with continued access to effective treatments after study completion? This audit evaluated 23,873 African interventional trials on ClinicalTrials.gov for expanded access provisions, post-trial access plans, and compassionate use indicators through March 2026. Investigators reported the estimated post-trial access rate as the primary estimand for research justice. Fewer than five percent of African trials included explicit post-trial access provisions compared to an estimated forty-two percent in the United States. Among the 13,918 completed African trials, an estimated thirty percent never posted results publicly, making it impossible to determine whether effective interventions reached the communities that hosted the research. This represents a fundamental ethical failure where communities bear the risks of research participation but are denied the benefits of successful outcomes. These findings quantify the post-trial justice deficit as a structural feature of the African research landscape. Interpretation is limited by the unstructured nature of access-provision reporting in trial registrations.

## References

1. Participants in the 2001 Conference. "Moral standards for research in developing countries." Hastings Cent Rep. 2004;34:17-27.
2. Benatar SR. "Reflections and recommendations on research ethics in developing countries." Soc Sci Med. 2002;54:1131-1141.

## Note Block

- Type: research
- App: https://mahmood726-cyber.github.io/africa-e156-students/health-disease/dashboards/expanded-access.html
- Code: https://github.com/mahmood726-cyber/africa-e156-students/blob/master/health-disease/code/expanded-access.py
- Data: ClinicalTrials.gov API v2
- Date: 2026-04-05