Underrepresentation of Africa in HIV cure research: A systematic review of the literature from 2010 to 2022.

Problem considered: Over the past decade, there has been a significant increase in research aimed at finding a cure or achieving long-term remission for HIV. However, the extent to which this research includes Africa-the continent with the highest HIV burden-remains unclear. To address this, we conducted a systematic review of the literature to assess Africa's contributions to HIV cure research. Methods: We reviewed original HIV cure-related research published from January 1, 2010, to December 31, 2022, in Embase.com and Web of Science. Our search terms, 'HIV cure(s)' and 'research,' along with their synonyms like HIV latency, persistence, and reactivation, covered all languages and geographic locations. The study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: Of 1077 studies reviewed, 614 (57 %) were performed in North America, followed by Europe (24.3 %), Asia (17.2 %), and Australia 5.2 %). Africa contributed only 31 studies (2.9 %). Of the 31 African studies, Southern Africa accounted for 67.7 %, followed by Eastern Africa (19.4 %) and Western Africa (12.9 %). No cure-related studies were performed in Northern and Central African institutions. African contributions across the different types of studies were 18 (3.7 %) for ex vivo, 8 (10.7 %) for social science and epidemiological, 3 (3.3 %) for clinical trials, 4 (0.8 %) for basic science, and zero for animal studies. The NIH funded the majority of all cure-related studies. Conclusions: This systematic review shows that African patients and scientists are contributing little to HIV cure research, and urgent measures are needed to remedy the disparity.