Trends: What We Are Watching in 2021

We know we are not alone when we say we are happy to put 2020 behind us. It was a challenging year for everyone, and we look forward to better days ahead. Despite the difficulties that the research community faced, we witnessed remarkable flexibility, resilience and creativity in dealing with significant hurdles. Last year lent new meaning to the phrase “hindsight is 2020.” In this article, we look ahead at 2021 and share the issues that we will be monitoring.

Diversity and inclusion in clinical trials

The COVID-19 pandemic highlighted serious racial and economic disparities in health care.[1] Some racial and ethnic minority groups have been disproportionately affected by COVID-19. Conditions in the places where people live, learn, work, play, and worship affect a wide range of health risks and outcomes, such as COVID-19 infection, severe illness, and death. Long-standing inequities in social determinants of health that affect these groups, such as poverty and healthcare access, are interrelated and influence a wide range of health and quality-of-life risks and outcomes.

Likewise, racial and ethnic minorities are underrepresented in clinical trials. The research community, which includes industry sponsors and government agencies, is actively pursuing strategies that address disparities in clinical research. The FDA issued guidance in November aimed at enhancing diversity and encouraging inclusivity in medical research, specifically in the development of medical products. The industry trade group PhRMA adopted Principle 6, Commitment to Enhancing Diversity in Clinical Trial Participation, aimed at enhancing racial and ethnic diversity among clinical trial participants, with an effective date of April 14, 2021.

We will be watching how industry-sponsored and investigator-initiated trials implement strategies for increased inclusion.

Re-starting Clinical Trials

The pandemic led to the halting of hundreds of clinical trials[2]. Lockdowns and other mandatory public health orders forced research staff to work from home and made in-person patient visits nearly impossible. Additionally, staff resources were redeployed to shore up shortages and support hospitals’ responses to the surge in COVID-19 cases in communities in the U.S. and around the world.

For some patients, particularly with end stage disease, the suspension of clinical trials had serious implications. Likewise, enrollment for new trials staggered as patients were wary of visiting any medical facilities. In an editorial in JAMA[3], researchers said “Mitigation efforts [against COVID-19] interfere with all aspects of a successful clinical trial: efficient accrual and randomization, intervention adherence and delivery, and outcome collection.”

Even now, research institutions are grappling with solutions to reduce the impact of fluctuating and shifting public health mandates on existing trials. Investigators continue to evaluate how to re-start trials safely.

Increase in Observational Trials

Investigators have immense opportunities to design and implement investigational trials evaluating patient outcomes and long-term effects of COVID, as well as different treatment modalities. Additionally, researchers may consider trials evaluating various aspects of the different COVID vaccines currently on the market as well as other that are in the development and approval pipeline.

Opportunities for social-behavioral-education research

Stay-at-home orders and increased isolation, negative impacts on the economy and lost jobs, not to mention a daily barrage of dramatic news and social media coverage, have led to an increase in stress and anxiety. The pandemic also led to a disruption in mental health services.

We are still learning what the long term social and behavioral impacts will be. But we expect to see an increase in studies to evaluate this.

Remote Monitoring and Decentralized Clinical Trials

Since the pandemic began, over half of all active clinical trials are using remote and virtual support, according to a study by The Tufts Center for the Study of Drug Development.[4] We expect to see the continued use of telemedicine, remote monitoring and virtual IRB meetings and reviews.

Research professionals will continue to make adjustments to how they run research programs. Many institutions may need to make policy decisions in the absence of specific regulatory guidance.

In September 2018, the Clinical Trials Transformation Initiative https://www.ctti-clinicaltrials.org/projects/decentralized-clinical-trials defined decentralized clinical trials (DCTs) as those executed through telemedicine and mobile/local healthcare providers (HCPs), using procedures that vary from the traditional clinical trial model. For example, the investigational medical product is shipped directly to the trial participant).

The research community may need to continue to develop awareness and understanding about DCTs and/or hybrid trial designs, and what is in the best interest of patient safety as well as research integrity.

Using Digital Technology and Telemedicine in Clinical Trials

The trend toward digital technology, such as health tracking devices and virtual clinic visits, had started before COVID. The pandemic accelerated the implementation of these technologies to allow study participants to sign consents, submit vital statistics and data, and communicate with clinical research coordinators and investigators — all from the convenience of their home.

We are loath to make any predictions in this most unpredictable time. The story of COVID and its impact on research is still unfolding. With that, we plan to continue monitoring these issues and offering support to clients that are navigating these uncharted circumstances.

Happy new year from the team at BRANY.

 

[1] https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/racial-ethnic-disparities/index.html

[2] https://www.npr.org/sections/health-shots/2020/04/11/832210606/coronovirus-pandemic-brings-hundreds-of-u-s-clinical-trials-to-a-halt

[3] https://jamanetwork.com/journals/jama/fullarticle/2763819

[4] https://secure.touchnet.net/C21525_ustores/web/product_detail.jsp?PRODUCTID=1432

News Release – BRANY Names Michael Belotto as Chairperson for Social-Behavioral IRB

NEWS RELEASE

BRANY (brany.com) has announced that Michael Belotto, PhD, MPH, CCRC, CCRA, will serve as chairperson for their social-behavioral IRB. The SBER IRB is comprised of a multidisciplinary group of experts in social and behavioral research, as well as human subject protection.

“Dr. Belotto has been a great contributor to BRANY IRB’s success over the past 20 years,” says Raffaella Hart, MS, CIP, Vice President, IRB and IBC Services for BRANY. “In serving as an IRB member and Quality Assurance auditor, he has been dedicated to ensuring that investigators conduct research in compliance with federal regulations and ethical guidelines. Researchers and research participants will be well-served with Michael serving as the Chairman of BRANY SBER IRB.”

BRANY started the SBER IRB in 2016 in response to an unmet need identified by social, behavioral, and education researchers. Common feedback from this group of researchers centered on the fact that most IRB processes and procedures were rooted in biomedical research which often did not align with the needs of social and behavioral researchers. The issues in social-behavioral research are distinct from biomedical research in a variety of critical ways, and need the review of experts in the relevant fields. Research protocols can include graduate student dissertations, research outside the U.S., as well as focus groups.

Dr. Belotto serves as a research compliance expert responsible for auditing sites to ensure investigators’ compliance with FDA regulations and ethical guidelines. He will continue to serve as a member of BRANY IRB in addition to chairing the SBER IRB.

Dr. Belotto worked as a paramedic in the New York City Emergency Medical Service 9-1-1 system for 10 years, with 7 years of experience in Hospital Administration.

Dr. Belotto is a graduate of New York Medical College where he completed a Master’s in Public Health with a concentration in epidemiology. He completed his doctorate in Public Health at Walden University.

The SBER IRB is part of BRANY’s Connected IRB model, which helps maintain an ongoing connection among investigators, institutions and the IRB, by promoting communication with key stakeholders. This includes email alerts for investigators and research coordinators as well as specific alerts for critical concerns such as unanticipated problems involving risks to subjects or others.

Protocol Builder Launches Protocol Template for Social-Behavioral – Educational Research

BRANY announced today the release of a new research protocol template specifically designed to address the unique needs of social-behavioral-education researchers, as part of Protocol Builder®, a secure, cloud-based protocol writing application.

“Social and behavioral research is distinct from biomedical research,” says Jeffrey Cohen, PhD, a principal with HRP Consulting Group, also a division of BRANY. “The process of writing a protocol can be more subtle than an interventional drug study, for example.”

“Although historically many social behavior researchers have not developed full protocols for their research prior to submitting to an IRB, many institutions are now requesting social behavioral protocol development templates as research in this area continues to grow,” says Kimberly Irvine, Executive Vice President and Chief Operating Office for BRANY. BRANY now also has a social behavioral IRB as part of its comprehensive IRB service offering. This new template is a response to our customers’ requests for a tool that provides them with a more comprehensive approach to protocol development for social and behavioral research.

The specially-designed template provides a guided, step-by-step protocol-writing process for investigators who specialize in psychology, nursing, education and other disciplines that are focused on behavioral and social functioning. It is one of several standard and customizable templates offered through Protocol Builder®, including the new NIH IND/IDE template.

Protocol Builder® is currently in use at leading academic medical centers and universities as a tool to foster compliance with institutional protocol writing standards among their investigators, including residents and fellows.

Protocol Builder® is a division of BRANY, the leading provider of research support services to hospitals, academic medical centers and investigators. In addition to Protocol Builder®, BRANY offers a wide array of services designed to improve research efficiency and quality. These include IRB, human subject protection consulting and continuing education.

BRANY IRB Services

BRANY IRB, AAHRPP-accredited since 2006, has been providing high quality, customer service oriented IRB services to client for more than 18 years. BRANY IRB specializes in , single IRB (sIRB) for multi-site research, and SBER IRB review by a committee with expertise specific to social, behavioral and education research.   BRANY’s “Connected IRB” model has provided institutions with a customized solution that results in high quality human subject protection oversight, as well as efficiency for industry sponsored and investigator initiated research.

HRP Consulting

Through its consulting division, the HRP Consulting Group, BRANY provides institutions human subject protection and research compliance consulting services.

CITI Program

The Collaborative Institutional Training Initiative (CITI Program) at the University of Miami, also part of BRANY, is the leading provider of online research ethics education courses and materials. CITI’s web-based training materials serve millions of learners at academic institutions, government agencies, and commercial organizations in the U.S. and around the world. CITI Program now offers the CTSA created GCP – Social and Behavioral Research Best Practices for Clinical Research course.*  This course introduces GCP principles and discusses how they apply to clinical trials using behavioral interventions and social science research.