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De Pretto-Lazarova A, Fuchs C, van Eeuwijk P, Burri C. Defining clinical trial quality from the perspective of resource-limited settings: A qualitative study based on interviews with investigators, sponsors, and monitors conducting clinical trials in sub-Saharan Africa. PLoS Negl Trop Dis 2022; 16:e0010121. [PMID: 35085242 PMCID: PMC8794119 DOI: 10.1371/journal.pntd.0010121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 12/23/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Increasing clinical trial cost and complexity, as well as a high waste of clinical trial investment over the past decades, have changed the way clinical trial quality is managed. Recent evidence has highlighted that the lack of a clear clinical trial quality definition may have contributed to previous inefficiencies. This study aims to support the understanding of what clinical trial quality entails from the perspective of resource-limited settings. METHODOLOGY/PRINCIPAL FINDINGS We conducted 46 semi-structured interviews involving investigators, sponsors, and monitors with experience in conducting clinical trials in 27 countries in sub-Saharan Africa. The questionnaire addressed the overall meaning of clinical trial quality and a conclusive clinical trial quality definition, as well as specific aspects of resource-limited settings across the clinical trial process. We held the interviews either in person, via Skype or by phone. They were recorded and transcribed verbatim, and we performed the analysis using The Framework Method. The analysis of clinical trial quality definitions resulted in 11 elements, which were summarised into a clinical trial quality concept consisting of two components: 1) clinical trial quality building factors (Scientific factors and Moral factors) and 2) promoting factors (Context adaptation; Infrastructure; Partnership; Operational excellence; Quality system). 12 resource-limited settings specific themes were identified. These themes were all categorised under the promoting factors "Context adaptation", "Infrastructure", and "Partnership". CONCLUSIONS/SIGNIFICANCE We found that in order to enable comprehensive clinical trial quality management, clinical trial quality should be defined by a multidimensional concept that includes not only scientific and ethical, but also quality-promoting factors. Such a concept is of general relevance and not limited to clinical trials in resource-limited settings, where it naturally carries particular weight. In addition, from the perspective of sub-Saharan Africa, we identified specific categories that appear to be critical for the conduct of clinical trials in resource-limited settings, and we propose respective changes to a particular existing clinical trial quality framework (i.e., INQUIRE).
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Affiliation(s)
- Angela De Pretto-Lazarova
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Claudia Fuchs
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Peter van Eeuwijk
- University of Basel, Basel, Switzerland
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Institute of Social Anthropology, Basel, Switzerland
| | - Christian Burri
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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Albers PN, Wright CY. Clinical Trial Data Management in Environmental Health Tailored for an African Setting. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020402. [PMID: 31936227 PMCID: PMC7013767 DOI: 10.3390/ijerph17020402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Revised: 12/08/2019] [Accepted: 12/19/2019] [Indexed: 11/16/2022]
Abstract
Clinical trial data management tools are widely available—some free to access and others relatively expensive, particularly for low- and middle-income countries. Such tools also do not always permit adaptation for local conditions nor include options to capture environmental and meteorological data. In the context of climate change and pressing environmental health threats, more studies that aim to assess the impacts of environmental change on public health are being carried out. Here, using freely available software, we tailor-made a clinical trial data management tool that managed all aspects of an intervention-based clinical trial to assess the impact of personal solar ultraviolet radiation exposure on vaccine effectiveness. Data captured and associated procedures included patient data, scheduling, reporting, analysis and data management. Moreover, patient enrolment, recruitment, follow-up and decision-making in response to patient data were managed. Given the multidisciplinary study approach, the tool also managed all environmental and meteorological data for the rural African study site. Application of the tool ensured efficient communication between rural sites, a relatively high overall participant response rate (87%) and minimal loss to follow-up. This study suggests that it is possible to tailor-make a clinical trial data management tool for environmental and public health studies.
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Affiliation(s)
- Patricia Nicole Albers
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria 0028, South Africa;
- Correspondence:
| | - Caradee Yael Wright
- Department of Geography, Geoinformatics and Meteorology, University of Pretoria, Pretoria 0028, South Africa;
- Environment and Health Research Unit, South African Medical Research Council, Pretoria 0084, South Africa
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Aliyu A, El-Kamary S, Brown J, Agins B, Ndembi N, Aliyu G, Jumare J, Adelekan B, Dakum P, Abimiku A, Charurat M. Performance and trend for quality of service in a large HIV/AIDS treatment program in Nigeria. AIDS Res Ther 2019; 16:29. [PMID: 31575377 PMCID: PMC6774212 DOI: 10.1186/s12981-019-0242-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/29/2019] [Indexed: 11/10/2022] Open
Abstract
Background As antiretroviral therapy (ART) programs expand access, there is an increase in burden to a healthcare system. These results are reduced provider-patient contact time and poor programmatic and patient outcomes. Quality management offers providers a standardized approach for addressing the appropriateness of care to be applied in resource-limited settings. This study aimed to determine the trend of performance on HIV/AIDS quality management indicators of health facilities providing ART over a period of 5 years. Methods The annual performance scores of quality of care (QoC) indicators of 31 health facilities providing ART was extracted from a database covering a period of 5 years (from October 2008 to September 2012). The data are percentages that indicate scores of each health facility assessed based on compliance to National ART guidelines categorized into several indicator domains. A Chi square statistic for the trend, as well as test for departure from the trend line was determined. The p value associated with each indicator provides the significant level for testing an alternative hypothesis that the rate of change over the period considered for that indicator does not equal to zero. The slope of the regression line also gives the magnitude of the rate of change for each indicator by healthcare level across the review period. Results Generally, performance trends showed improvement across most indicator domains. The highest improvement occurred for “3 month loss to follow-up” and “1 year no-visit”, with scores declining from 37 to 3%, and 42% to 12% respectively. However, there was a sharp decline in performance between 2010 and 2012 in weight monitoring of patients (p < 0.01), adherence assessment to ARVs (p < 0.01) and hematocrit measurements (p = 0.01). The aggregate rate of change β, as obtained from the slope of the trend line is highly significant (p < 0.01) for all the quality of care indicators considered, whether improving or declining. Conclusion Periodic assessment to determine HIV/AIDS quality of care can guide rapid scale-up of services to achieve universal coverage in resource-limited settings. Determining trends to understand patterns is very useful for improving programmatic and patient outcomes.
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Walker KF, Turzanski J, Whitham D, Montgomery A, Duley L. Monitoring performance of sites within multicentre randomised trials: a systematic review of performance metrics. Trials 2018; 19:562. [PMID: 30326948 PMCID: PMC6192157 DOI: 10.1186/s13063-018-2941-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 09/26/2018] [Indexed: 11/11/2022] Open
Abstract
Background Large multicentre trials are complex and expensive projects. A key factor for their successful planning and delivery is how well sites meet their targets in recruiting and retaining participants, and in collecting high-quality, complete data in a timely manner. Collecting and monitoring easily accessible data relevant to performance of sites has the potential to improve trial management efficiency. The aim of this systematic review was to identify metrics that have either been proposed or used for monitoring site performance in multicentre trials. Methods We searched the Cochrane Library, five biomedical bibliographic databases (CINAHL, EMBASE, Medline, PsychINFO and SCOPUS) and Google Scholar for studies describing ways of monitoring or measuring individual site performance in multicentre randomised trials. Records identified were screened for eligibility. For included studies, data on study content were extracted independently by two reviewers, and disagreements resolved by discussion. Results After removing duplicate citations, we identified 3188 records. Of these, 21 were eligible for inclusion and yielded 117 performance metrics. The median number of metrics reported per paper was 8, range 1–16. Metrics broadly fell into six categories: site potential; recruitment; retention; data collection; trial conduct and trial safety. Conclusions This review identifies a list of metrics to monitor site performance within multicentre randomised trials. Those that would be easy to collect, and for which monitoring might trigger actions to mitigate problems at site level, merit further evaluation.
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Affiliation(s)
- Kate F Walker
- Nottingham Clinical Trials Unit, QMC, Nottingham, NG7 2UH, UK.
| | - Julie Turzanski
- Nottingham Clinical Trials Unit, QMC, Nottingham, NG7 2UH, UK
| | - Diane Whitham
- Nottingham Clinical Trials Unit, QMC, Nottingham, NG7 2UH, UK
| | - Alan Montgomery
- Nottingham Clinical Trials Unit, QMC, Nottingham, NG7 2UH, UK
| | - Lelia Duley
- Nottingham Clinical Trials Unit, QMC, Nottingham, NG7 2UH, UK
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Vischer N, Pfeiffer C, Joller A, Klingmann I, Ka A, Kpormegbe SK, Burri C. The Good Clinical Practice guideline and its interpretation - perceptions of clinical trial teams in sub-Saharan Africa. Trop Med Int Health 2016; 21:1040-1048. [PMID: 27260671 DOI: 10.1111/tmi.12734] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To explore the advantages and challenges of working with the Good Clinical Practice (GCP)-International Conference of Harmonization (ICH) E6 guideline and its interpretation from the perspective of clinical trial teams based in sub-Saharan Africa. METHODS We conducted 60 key informant interviews with clinical trial staff at different levels in clinical research centres in Kenya, Ghana, Burkina Faso and Senegal and thematically analysed the responses. RESULTS Clinical trial teams perceived working with ICH-GCP as highly advantageous and regarded ICH-GCP as applicable to their setting and efficiently applied. Only for informed consent did some clinical trial staff (one-third) perceive the guideline as insufficiently applicable. Specific challenges included meeting the requirements for written and individual consent, conditions for impartial witnesses for illiterates or legally acceptable representatives for children, guaranteeing voluntary participation and ensuring full understanding of the consent given. It was deemed important to have ICH-GCP compliance monitored by relevant ethics committees and regulatory authorities, without having guidelines applied overcautiously. CONCLUSION Clinical trial teams in sub-Saharan Africa perceived GCP as a helpful guideline, despite having been developed by northern organisations and despite the high administrative burden of implementing it. To mitigate consent challenges, we suggest adapting GCP and making use of the flexibility it offers.
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Affiliation(s)
- N Vischer
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - C Pfeiffer
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - A Joller
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - I Klingmann
- European Forum for Good Clinical Practice, Brussels, Belgium
| | - A Ka
- Département de Sociologie, Université Cheikh Anta Diop de Dakar, Dakar, Senegal
| | - S K Kpormegbe
- Department of Sociology, University of Ghana, Legon, Ghana
| | - C Burri
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Adewole I, Martin DN, Williams MJ, Adebamowo C, Bhatia K, Berling C, Casper C, Elshamy K, Elzawawy A, Lawlor RT, Legood R, Mbulaiteye SM, Odedina FT, Olopade OI, Olopade CO, Parkin DM, Rebbeck TR, Ross H, Santini LA, Torode J, Trimble EL, Wild CP, Young AM, Kerr DJ. Building capacity for sustainable research programmes for cancer in Africa. Nat Rev Clin Oncol 2014; 11:251-9. [PMID: 24614139 PMCID: PMC4403794 DOI: 10.1038/nrclinonc.2014.37] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Cancer research in Africa will have a pivotal role in cancer control planning in this continent. However, environments (such as those in academic or clinical settings) with limited research infrastructure (laboratories, biorespositories, databases) coupled with inadequate funding and other resources have hampered African scientists from carrying out rigorous research. In September 2012, over 100 scientists with expertise in cancer research in Africa met in London to discuss the challenges in performing high-quality research, and to formulate the next steps for building sustainable, comprehensive and multi-disciplinary programmes relevant to Africa. This was the first meeting among five major organizations: the African Organisation for Research and Training in Africa (AORTIC), the Africa Oxford Cancer Foundation (AfrOx), and the National Cancer Institutes (NCI) of Brazil, France and the USA. This article summarizes the discussions and recommendations of this meeting, including the next steps required to create sustainable and impactful research programmes that will enable evidenced-based cancer control approaches and planning at the local, regional and national levels.
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Affiliation(s)
- Isaac Adewole
- Gynecologic Oncology Unit, Department of Obsterics and Gynecology, College of Medicine, University of Ibadan, PMB 5017, GPO, Ibadan, Nigeria
| | | | | | | | | | | | | | | | | | | | - Rosa Legood
- London School of Hygiene and Tropical Medicine, UK
| | | | | | | | | | | | | | | | | | - Julie Torode
- Union for International Cancer Control, Switzerland
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Cornu C, Binquet C, Thalamas C, Vigouroux C, Gaillard S, Ginhoux T, Vaz B, Jossan C, Félin A, Sailly A, Gueyffier F, Journot V, Kassaï B. [Public clinical trials: which kind of monitoring should be used?]. Therapie 2013; 68:135-41. [PMID: 23886457 DOI: 10.2515/therapie/2013032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 04/04/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Sponsors must take responsibility for the quality of trials at the best possible cost. Our objective was to describe the most frequent quality failures, how they impact trial results, and identify the most efficient monitoring strategies using published articles and reports. RESULTS Errors affecting clinical trials include conception, procedures, data management, and data analysis. The consequences are usually an overestimation of the treatment effect. No study shows that monitoring reduces the risk of errors, and there is no comparison of monitoring methods. Many research organisations advocate for monitoring based on risk analysis and recommend an extensive use of centralised monitoring. CONCLUSIONS Trial quality depends on trial conception and design. Study conduct should guarantee a maximum level of quality level. This should be done using risk management and extensive centralised monitoring.
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