Equity in global health research in the new millennium: trends in first-authorship for randomized controlled trials among low- and middle-income country researchers 1990-2013

Background: Developing the research capacity of low- and middle-income countries (LMICs) has been shown to be one of the key ways that international health programmes and health research can create sustained benefit in these countries. The aim of this study was to examine trends in first-authorship for researchers from LMIC institutions (LMIC first-authors) over the period 1990-2013. Methods: This study systematically reviewed research articles about randomized controlled trials (RCTs) in HIV/AIDS, malaria and tuberculosis (TB) conducted in LMICs from 1990 to 2013, and identified the institutional affiliations of the authors. Key variables extracted from the articles included author affiliation, funding source, disease, intervention type, region and year of publication. Poisson regression was used to explore the impact of these key variables on LMIC first-authorship over time. Results: A total of 1593 articles were identified, of which 49.8% had LMIC first-authors. From 1990 to 2000 a total of 222 trials were published, and from 2001 to 2013 a total of 1371 trials were published, with a steady year-on-year increase over the period particularly evident in trials conducted in Africa. Whereas the absolute total number of LMIC first-authors has increased, as a proportion of all authors it declined. The relative rate increase in first-authorships post 2000 was 11.8-fold for non-LMIC first-authors and 2.8-fold for LMIC authors. LMIC first-authorship increased over time for research funded from LMIC; but LMIC first-authorship declined over time for research funded from high income countries (HIC). Conclusions: The absolute increase in the number of trials in HIV/AIDS, malaria and tuberculosis in Africa has led to a modest increase in LMIC first-authors, and a much larger increase in non-LMIC authors. The findings suggest that more inclusive policies by international funders are important in shifting research control to LMICs and improving research equity in the future.