Background
Research is paramount for informing policy and intervention in any sphere of life and the importance of inventorying such cannot be overemphasised. HIV infection represents a global health concern [
1]. The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that 36.7 million people were living with HIV globally in 2015 and 1.1 million people died in the same year from AIDS resulting from HIV infection [
2]. Countries in Asia and sub-Saharan Africa are the worst affected [
1]. However, research on major health issues, including HIV/AIDS, in Africa and Asia continues to trail behind that of developed countries [
3], mainly due to brain drain [
4], lack of mentorship [
5], inadequate research funding [
6], and marginal collaboration [
7]. To promote and strengthen research capacity in targeted research areas, including HIV/AIDS, the WHO emphasises the development and periodic review of national research agendas [
8]. This is crucial, particularly for the worst affected countries, such as Lesotho.
Lesotho, located 29.6100° S, 28.2336° E, is a small landlocked country enclaved within South Africa, with a territory of about 30,000 square kilometres and a population of about 2 million [
9]. The United Nations [
10] notes that Lesotho is a poor country, with 40% of its population living below the official poverty line of US$1.25 per day. The country, with a 23.3% adult HIV prevalence rate, is ranked second highest in HIV prevalence worldwide [
11]. HIV/AIDS have adversely affected the country’s economy and, in 2012, the Government of Lesotho spent 12% of its national budget on HIV/AIDS mitigation and treatment programmes [
12].
In Lesotho, the Ministry of Health (MoH) sets the 5-year research agenda on health matters in consultation with the implementing partners, academics and civil society based on priorities of research. The current agenda (2013–2018) has 190 priority research areas classified under three major research focus areas, namely (1) health programmes and services, (2) specific health conditions and (3) support services [
13]. The research focus areas are clustered into four levels of priority, defined as high, medium, low and not urgent. HIV/AIDS, classified under the specific health conditions research focus area, is one of the key high-level priority areas for the MoH. Due to the problem of HIV/AIDS in Lesotho, the 2013–2018 national research agenda allocated a conspicuous place to HIV/AIDS research [
13]. Thus, by proportion, research areas on HIV/AIDS dominate the agenda, constituting 16% of the 190 priority research areas. However, the volume and scope of the general research output on HIV/AIDS, and the coverage of the set research goals in the country remain, at best, undescribed. This lack of evidence on the progress of research on HIV/AIDS affects the national research focus and evidence-based policymaking. As 2018 approaches, the year when the present health research agenda term for the country ends, a bibliometric review of the literature on HIV/AIDS in Lesotho seems imperative.
The purpose of this study was to assess the volume and scope of the general research output on HIV/AIDS in Lesotho and to evaluate the coverage of the national research agenda on HIV/AIDS. The overarching aim was to highlight research areas on HIV/AIDS that are on this agenda which need to be strengthened.
Discussion
The fact that out of the 1280 total publications retrieved, research on basic measures, particularly on new vaccines and drugs, had the lowest number of publications emphasises the need to strengthen basic research in Lesotho. However, Scott et al. [
53] note that lack of funding for basic research is a major obstacle in developing countries, although Lesotho has a fairly high research volume with a very uneven spread. Over-strained public budgets in developing countries rarely support basic research. Scott et al. [
53] further argue that, globally, basic research is predominantly supported by public funds while the private sector mainly funds applied research and technology development, clearly for its own benefit. Similarly, the research gaps on preventive measures, including on the methodologies of interrupting HIV transmission, identified in this study highlight the need to increase focus on this research area. Moreover, the need to increase efforts on research in national planning and its sub-elements cannot be overemphasised.
The fact that only 40.3% of the retrieved studies matched the national research agenda implies that a considerable volume of research outputs on HIV/AIDS in Lesotho does not address the national research agenda in this research area. This emphasises the need to strengthen the national research focus in this study area. One way of achieving this goal may be by conducting workshops with researchers to sensitise them about the priority research areas. Research areas with hardly any publications identified in this study need urgent attention, with the possible need of special funding and incentives to bridge the gaps. Literature on long-term strategies to stimulate research in targeted areas is abundant. The strategies include increasing targeted research funding to researchers [
6], tackling mentorship challenges through retaining experienced researchers [
5], and encouraging research collaborations [
7].
This study was focused on and limited to the bibliometric analysis of the research output on HIV/AIDS. The study did not assess the programmatic impact of the research studies included in this review, which could be a potentially interesting future study. It is important to note that this study investigated the research output on HIV/AIDS in Lesotho based on absolute numbers of publications retrieved using pre-defined search criteria. Therefore, the quality of studies classified herein as addressing particular research priority areas cannot be entirely guaranteed, neither can the overall comprehensiveness of the literature used. However, this limitation is intrinsic to all bibliometric studies [
54,
55]. Furthermore, the conceptual framework adopted for analysing and classifying the scope of research on HIV/AIDS in this study is not exhaustive, while the scope of research led by civil society and people living with HIV in Lesotho is limited mostly to secondary participation; as such, these research areas were not dealt with in this paper. Consequently, studies promoting the application of broader frameworks for classifying the scope of research on HIV/AIDS are recommended.
Comparative analysis of research outputs within and between different countries needs caution. McKee et al. [
3] note that such analysis is also affected by a lack of comparable international indicators for research outputs. The authors further argue that the gross national product per capita and total health expenditure should be factored in the comparative analysis of research output across countries. Therefore, this study should be interpreted in the context of Lesotho and may only be extrapolated to other countries with comparable international indicators of research outputs.
As the year 2018 approaches and the set period for the national research agenda comes to an end, this study is useful, particularly for the MoH, in reviewing the research progress made on HIV/AIDS, setting priority research areas for the subsequent national research agendas and for national and sub-national allocation of research funds. This study may also stimulate and channel academic research towards the national research agenda of Lesotho. In addition, implementing partners working on HIV/AIDS projects in the country may find this study useful in identifying research areas that need to be prioritised for funding. Furthermore, this study augments the efforts by the WHO on its drive to encourage the development and periodic review of national research agenda on HIV/AIDS in regions worst affected by the disease, particularly in sub-Saharan African countries [
8].
Conclusion
The study revealed that there is a considerable research output on HIV/AIDS in Lesotho. However, there is insufficient coverage of the national research agenda on HIV/AIDS. The major research gaps are in basic and preventive measures as well as national planning. Some research areas in the national research agenda on HIV/AIDS are hardly covered by a single study, including high priority research areas. The current study therefore highlights the need to increase targeted funding for HIV/AIDS research, especially towards the research areas with the most compelling gaps and national needs. The present study also delineates focus areas for research within its theme.
Acknowledgements
We would like to thank individuals who assisted with compiling of data for this study.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (
http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (
http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.