American Journal of Tropical Medicine and Hygiene
February 2016; 94 (2)
http://www.ajtmh.org/content/current

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Perspective Piece
Clinical Research and the Training of Host Country Investigators: Essential Health Priorities for Disease-Endemic Regions
Ousmane A. Koita, Robert L. Murphy, Saharé Fongoro, Boubakar Diallo, Seydou O. Doumbia, Moussa Traoré, and Donald J. Krogstad
Am J Trop Med Hyg 2016 94:253-257; Published online November 23, 2015, doi:10.4269/ajtmh.15-0366
Abstract
The health-care needs and resources of disease-endemic regions such as west Africa have been a major focus during the recent Ebola outbreak. On the basis of that experience, we call attention to two priorities that have unfortunately been ignored thus far: 1) the development of clinical research facilities and 2) the training of host country investigators to ensure that the facilities and expertise necessary to evaluate candidate interventions are available on-site in endemic regions when and where they are needed. In their absence, as illustrated by the recent uncertainty about the use of antivirals and other interventions for Ebola virus disease, the only treatment available may be supportive care, case fatality rates may be unacceptably high and there may be long delays between the time potential interventions become available and it becomes clear whether those interventions are safe or effective. On the basis of our experience in Mali, we urge that the development of clinical research facilities and the training of host country investigators be prioritized in disease-endemic regions such as west Africa.