AU Health Strategy Alignment and Inequality in African Clinical Trials: A Cross-Sectional Analysis of ClinicalTrials.gov Data

Justine Kirabo; Anna Nankabira; Shamim Nabidda; Aminah Mohamud Fidow; Christine Muhumuza; Ronnie Ssenfuma; Rhoda Chikula; Ruchius Philbert; Joshua Tulengerayo; Paul Brian Mukisa; Derrick Tumwesigye

Vol. 4 No. 1 (2026), Methods Note

Vol. 4 No. 1 (2026)

AU Health Strategy Alignment and Inequality in African Clinical Trials: A Cross-Sectional Analysis of ClinicalTrials.gov Data

Methods Note

Published 2026-06-06

Justine Kirabo⁺⁻
Anna Nankabira⁺⁻
Shamim Nabidda
Aminah Mohamud Fidow⁺⁻
Christine Muhumuza⁺⁻
Ronnie Ssenfuma⁺⁻
Rhoda Chikula⁺⁻
Ruchius Philbert⁺⁻
Joshua Tulengerayo
Mukisa Paul Brian
Derrick Tumwesigye

Justine Kirabo

Makerere University

Anna Nankabira

Makerere University, School of Public Health

Shamim Nabidda

Aminah Mohamud Fidow

Makerere University, School of Public Health

Christine Muhumuza

Makerere University, School of Public Health

Ronnie Ssenfuma

Makerere University, School of Public Health

Rhoda Chikula

Makerere University, School of Public Health

Ruchius Philbert

Department of Paediatrics and Child Health, Muhimbili National Hospital, Dar es Salaam, Tanzania

https://orcid.org/0000-0002-3453-6853

Joshua Tulengerayo

Mukisa Paul Brian

Derrick Tumwesigye

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Keywords

Health
Clinical trials
research equity
health research
Africa
Uganda

How to Cite

Kirabo, J., Nankabira, A., Nabidda, S., Mohamud Fidow, A., Muhumuza, C., Ssenfuma, R., … Tumwesigye, D. (2026). AU Health Strategy Alignment and Inequality in African Clinical Trials: A Cross-Sectional Analysis of ClinicalTrials.gov Data. Synthēsis, 4(1). Retrieved from https://synthesis-medicine.org/index.php/journal/article/view/77

Abstract

Background: Alignment of clinical trials with African Union (AU) health priorities is critical for evidence-based policy, yet disparities in research investment may limit this alignment.

Methods: This cross-sectional meta-research study analyzed 23,873 and 190,644 interventional trials from Africa and the United states respectively done during April 2026. AU Agenda 2063 priorities were mapped using registry metadata, and alignment assessed using the Jaccard similarity index. Inequality was measured using Shannon entropy and the Gini coefficient.

Results: Africa contributed 3,515 aligned trials versus 159,433 in the United States (45-fold gap). Trial distribution was highly unequal (entropy 2.46; Gini 0.711), with concentration in a few countries. In Uganda, trial activity remains limited despite high disease burden.

Conclusion: Structural financing and governance constraints drive unequal trial distribution and weak alignment with AU priorities, underscoring the need for equitable investment and strengthened research capacity.

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References

1. ClinicalTrials.gov API v2 Documentation. U.S. National Library of Medicine. https://clinicaltrials.gov/data-api/about-api

2. Jin, C., 2024. Examining the Evolution of Clinical Trials in Africa and Asia: A 14-Year Review. The Challenge of Regulating Pharmaceutical Clinical Trials in the 21st Century with a Focus on Guatemala, 12, p.74.

3. Union, A., 2016. Africa health strategy 2016–2030. Addis Ababa: African Union.

4. Nabyonga-Orem, J., Asamani, J.A. and Makanga, M., 2021. The state of health research governance in Africa: what do we know and how can we improve?. Health Research Policy and Systems, 19(1), p.11.

This work is licensed under a Creative Commons Attribution 4.0 International License.

Copyright (c) 2026 Justine Kirabo, Anna Nankabira, Shamim Nabidda, Aminah Mohamud Fidow, Christine Muhumuza, Ronnie Ssenfuma, Rhoda Chikula, Ruchius Philbert, Joshua Tulengerayo, Mukisa Paul Brian, Derrick Tumwesigye

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AU Health Strategy Alignment and Inequality in African Clinical Trials: A Cross-Sectional Analysis of ClinicalTrials.gov Data

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