Аннотация:We applaud the excellent letter by Sugarman and Grace [1] in this issue of the journal. They are correct; having ethical standards to which we all agree is essential. We would like to highlight one criterion for determining control-group services delineated in their letter and in the HIV Prevention Trials Network's Ethics Guidance Document: that the control programme be ‘practically achievable as a standard in the local setting’ [2]. By achievable, we assume that this also means sustainable. In many of the trials we reviewed [3], the services in the control arm, although perhaps theoretically achievable as a local standard, were not sustained after the trials were completed, nor was there any explicit plan or commitment to do so. It seems then, that this critical ethical criterion was not met in these cases. Because such comparisons do not reflect the effect of the intervention compared with the true standard in the local setting before, during, or after the study, such trials are also compromised from a methodological standpoint. In the future, the HIV prevention research community should consider either comparisons to the existing local standard, or the provision of a feasible, well documented plan for the sustainability of proposed new services as a measure of both the ethical and methodological appropriateness of interventions in control groups.
