Risk and mitigation actions for clinical trials during COVID-19 pandemic (RiMiCOPa)

Critical path activities in clinical trial setup and conduct: How to avoid bottlenecks and accelerate clinical trials

Most clinical trials are delayed due to scientific and/or operational challenges. Any effort to minimize delays can generate value for patients and sponsors. This article reviews critical path process steps commonly identified by practitioners, such as during protocol development, site contracting, or patient recruitment. Commonly considered measures, such as adding more trial sites or countries, were contrasted with less frequented measures, such as evidence-based feasibility or real-world evidence analysis, to help validate assumptions before clinical trial initiation. In a broad analysis, we integrated a literature review with a practitioner survey into a framework to help decision makers on the most critical process steps when setting up or conducting clinical trials in order to bring critical treatments to patients faster.

Efficient Risk Mitigation Planning for a Clinical Trial

Each clinical trial faces numerous risks. Neglecting or reacting spontaneously at each materialized risk may delay trial completion, affect trial objectives and even derail the clinical trial. At the same time, pre-allocating excessive contingency resources to eliminate all potential risks, even with a low probability of occurrence and impact, may not be necessary. Therefore, optimal risk planning means finding the "right" balance between contingency resources, risk mitigation strategy, and risk tolerance. Most risk planning publications focus only on risk identification and risk assessment. Risk mitigation strategy planning is often overlooked. A contingency budget is routinely assigned as a percentage of a clinical trial budget, e.g., 10-20%, and is not aligned with the clinical trial risk level. Therefore, to derive an effective clinical trial risk mitigation strategy, a new methodology based on mathematical modeling was developed and validated for a Ph2 clinical trial.

Responding to COVID-19 threats to trial conduct: lessons learned from a feasibility trial of a psychological intervention for South African adolescents

The COVID-19 pandemic has posed challenges to the conduct of clinical trials. Strategies for overcoming common challenges to non-COVID-19 trial continuation have been reported, but this literature is limited to pharmacological intervention trials from high-income settings. The purpose of this paper is to expand the literature to include a low- and middle-income country perspective. We describe the challenges posed by COVID-19 for a randomised feasibility trial of a psychological intervention for adolescents in Cape Town, South Africa, and lessons learned when implementing strategies to facilitate trial continuation in this context. We used a Plan-Do-Study-Act cycle method to explore whether our adaptations were having the desired effect on trial accrual and retention. We found that stakeholder engagement, trial coordination and team communication need to be intensified while testing these procedural changes. We learned that strategies found to be effective in high-income countries required significant adaptation to our resource-constrained setting. The detailed documentation of extraneous influences, procedural changes and trial process information was essential to guiding decisions about which adaptations to retain. This information will be used to examine the potential impact of these changes on study outcomes. We hope that these reflections will be helpful to other trialists from low- and middle-income countries grappling with how to minimise the impact of public health emergencies on their research. TRIAL REGISTRATION: The trial is registered with the Pan African Clinical Trials Registry (PACTR20200352214510). Registered 28 February 2020.   https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9795 .