Communities of practice
Deciding on the priorities for tuberculosis research
10 Dec 2010
Citation: Rylance J, Pai M, Lienhardt C, Garner P (2010). Priorities for tuberculosis research: a systematic review. Lancet Infect Dis; 10(12):886-892.
2010 Elsevier Limited
Every year there are nine million new cases of tuberculosis and nearly two million people die from the disease. Research is crucial in addressing this major global health concern but on which priority areas should this research focus?
The authors of a new systematic review searched the PubMed database for publications that attempted specifically to outline TB research priorities during the period 1998 to 2010. They retrieved 33 documents that met their inclusion criteria and found these could be classified into two types: consensus statements from a convened group or expert panel (12), and review or commentary articles on TB research that mentioned priorities or agendas for future work (21). The reviewers identified the areas of interest and the specific questions that most frequently appeared in the documents.
Several different methods were employed by the writers of the included publications to reach their conclusions on priority areas. Most articles (27 of 33) were traditional narrative reviews of primary research and did not provide information on how the studies referred to were found, or on the criteria set for inclusion in the review. Some relied on input from an expert panel. (The review discusses all the methods employed.)
The top priority areas identified in the included publications were: drug development (28 articles), diagnosis and diagnostic tests (27), epidemiology (20), health services research (16), basic research (13), and vaccine development and use (13). The most frequently identified specific question was the treatment and prevention of multidrug-resistant tuberculosis in people co-infected with HIV.
The dominance of drug development and diagnosis is unsurprising and reflects the widespread concern regarding the limitations of current treatment regimens and diagnostic tests, particularly when they are used in populations with a high prevalence of HIV infection. The reviewers also note that epidemiological research does indeed have much to contribute, and they are encouraged by the recognition of the importance of health services research in improving TB control at programme level. However, they express their concern that basic scientific research and vaccine development were not mentioned in most of the publications.
The authors say they would like to see more use made of the process of systematic review in identifying research priorities, and they are right to do so. Subjectivity and bias must be avoided when such decisions are made. Reviews of the available data must not only be conducted rigorously, their methods should be adequately reported in the interests of transparency.
The review also offers suggestions as to how the use of expert panels might be made more effective. The reviewers note that the pool of academics and specialists involved in the 33 articles was relatively small, with many authors contributing to more than one document. In contrast patient interests were rarely represented.
This article will be helpful in the ongoing process of developing the TB research agenda. As the authors themselves conclude:
“The research areas frequently identified and summarised here should help to provide a platform for explicit development of a transparent and widely approved system for the establishment of priorities for tuberculosis research.”
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