Final NIH Policy on the Use of a Single Institutional Review Board for Multi-Site Research, 40325-40331 [2016-14513]
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DEPARTMENT OF HEALTH AND
HUMAN SERVICES
National Institutes of Health
Final NIH Policy on the Use of a Single
Institutional Review Board for MultiSite Research
National Institutes of Health.
Notice.
AGENCY:
ACTION:
The National Institutes of
Health (NIH) is issuing this policy on
the use of a single Institutional Review
Board (IRB) for multi-site research to
establish the expectation that a single
IRB (sIRB) of record will be used in the
ethical review of non-exempt human
subjects research protocols funded by
the NIH that are carried out at more than
one site in the United States. The goal
of this policy is to enhance and
streamline the IRB review process in the
context of multi-site research so that
research can proceed as effectively and
expeditiously as possible. Eliminating
duplicative IRB review is expected to
reduce unnecessary administrative
burdens and systemic inefficiencies
without diminishing human subjects
protections. The shift in workload away
from conducting redundant reviews is
also expected to allow IRBs to
concentrate more time and attention on
the review of single site protocols,
thereby enhancing research oversight.
DATES: This policy will take effect May
25, 2017.
FOR FURTHER INFORMATION CONTACT:
Office of Science Policy, National
Institutes of Health, 6705 Rockledge
Drive, Suite 750, Bethesda, MD 20892,
SUMMARY:
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301–496–9838, SingleIRBpolicy@
mail.nih.gov.
The NIH
published for public comment a
proposed draft sIRB policy in a notice
in the NIH Guide for Grants and
Contracts on December 3, 2014, (https://
grants.nih.gov/grants/guide/notice-files/
NOT-OD-15-026.html) and in the
Federal Register on January 6, 2015, (80
FR 511) (https://federalregister.gov/a/
2014-30964). The NIH received 167
comments from a range of stakeholders,
including individual researchers,
academic institutions, IRBs, patient
advocacy groups, scientific societies,
healthcare organizations, Tribal Nation
representatives, and the general public.
A compilation of the public comments
is available at https://osp.od.nih.gov/
sites/default/files/resources/
sIRB%2007-21-2015.pdf. The NIH
appreciated the public interest in the
draft policy and the time and effort
stakeholders made to provide
comments. The NIH carefully
considered those comments in the
development of the final policy.
SUPPLEMENTARY INFORMATION:
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Overview of the Public Comments
In general, most of the comments that
were submitted on the draft policy were
supportive of NIH’s goal of enhancing
and streamlining IRB review in multisite research. Commenters, especially
individual researchers, scientific and
professional societies, and patient
advocacy organizations, generally
agreed that the use of a single IRB for
multi-site studies involving the same
protocol would help streamline IRB
review and would not undermine and
might even enhance protections for
research participants. Most of the
comments also favored the approach the
NIH proposed to promote the use of
single IRBs by making reliance on an
sIRB an expectation for all non-exempt
multi-site studies carried out at U.S.
sites. At the same time, a number of
commenters, mainly academic
institutions and organizations
representing them, did not agree with
the scope of the proposed policy or that
it should become a term and condition
of funding, and suggested the NIH
incentivize, not mandate, reliance on an
sIRB.
Comments from researchers that
supported the draft policy described
unnecessary delays and additional costs
caused by duplicative IRB reviews.
They noted that IRB submission
requirements at each site differ and take
time to navigate and manage. They also
indicated that review of the same
protocol by multiple IRBs can
sometimes lead to protocol and consent
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document changes that can introduce
inconsistencies in the execution of the
protocol across sites, lead to enrollment
imbalances, and skew the analysis of the
aggregated data. More often, however,
multiple IRB reviews result in changes
to consent documents that are merely
stylistic and not substantive, or changes
that focus on institutional interests (e.g.,
liability management) rather than
human research protections.
Commenters raised the concern that the
current practice of requiring multiple
IRB reviews may actually contribute to
some researchers’ reluctance to
participate in rigorous, multi-site
research and may incentivize smaller
and simpler study designs.
Scientific and professional societies
generally favored the proposed policy.
These stakeholders stated that the
policy would decrease administrative
burdens on clinical research staff, speed
up participant recruitment, and
streamline the research process and that
these changes would result in
enhancements to the efficiency of
research and acceleration of research
progress. They also suggested that the
benefits of such a policy include
enhanced adverse event monitoring and
improvements to the quality and
consistency of IRB reviews.
Most of the comments from patient
advocacy groups and participant
representatives were supportive of the
proposed policy. These stakeholders
pointed out that greater use of single
IRBs will lead to enhanced protections
through increased accountability and
improved efficiency.
In general, comments from academic
institutions, IRBs, and organizations
that represent them cited concerns
about the proposed policy, even though
many also expressed support for its goal
and agreed it could have a positive
impact in reducing research review and
initiation time to the study. These
stakeholders suggested that the scope of
the proposed policy is too broad and
that the NIH should not make the policy
a term and condition of award. They
said that decisions about whether to use
a single IRB should be voluntary and
that the NIH should offer incentives to
promote change. For example, they
suggested that the NIH encourage
investigators and institutions to use
single IRBs in grant applications by
providing additional funding to those
grants that agree to use a single IRB.
Some suggested that before issuing a
broad policy, the NIH should pilot and
evaluate a narrower use of single IRBs
and provide appropriate resources to
support the participating awardees.
Others suggested that the NIH should
fund research on existing central IRB
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models to evaluate potential benefits
and costs before mandating single IRB
review. A few commenters raised
concerns about the timing of the policy
in relation to the revisions of the
Common Rule, stating their preference
that the NIH not adopt a single IRB
policy until Common Rule revisions
have been finalized. However, other
commenters praised the NIH for
addressing the single IRB issue in the
absence of an updated Common Rule.
Finally, a few commenters discussed
how the policy could be harmonized
with other federal policies. One
commenter recommended that the
Office for Human Research Protections
(OHRP) in the Department of Health and
Human Services (HHS) provide
guidance to support the policy’s stance
on duplicative IRB review.
Stakeholders from academic
institutions were concerned that the
membership of any given sIRB would
not be able to achieve the level of local
support for a particular research study
or its acceptability in terms of all the
participating sites’ institutional
commitments and regulations,
applicable laws, and standards of
professional conduct and practice. Some
commenters contended that only a local
IRB is able to understand the specific
protections required for a vulnerable
population that comprises their research
participant base. Some suggested that
site-specific practices for recruitment
and retention, especially for vulnerable
populations, would pose challenges for
an sIRB. A number of commenters
stated that their institutional IRBs are in
the best position to know and
understand competencies of and
potential conflicts of interest of specific
investigators. Others stressed the
importance of the relationship between
an investigator and the local IRB and
noted that IRB members can serve as
mentors to investigators whose
protocols they oversee.
Some commenters asserted that the
proposed policy does not recognize the
time and effort needed to identify and
establish a single IRB of record,
including negotiating and executing
authorization agreements and standard
operating procedures, conducting study
initiation meetings, creating account
activities, and modifying information
technology (IT) systems. They suggested
that the policy would result in the
formation of hundreds of different
‘‘single IRBs of record’’ with which
institutions and investigators will need
to interact. Some questioned whether an
sIRB would be equipped to ensure local
compliance at a relying institution and
expressed the concern that a compliance
problem for an sIRB would lead to
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compliance actions against the sites
relying on that sIRB. Several
commenters who supported the use of
sIRBs recommended that rather than
having participating sites identify a
single IRB for each protocol, the NIH
should establish a central IRB to review
all multi-site research studies, akin to
the National Cancer Institute’s Central
Institutional Review Board (CIRB). They
suggested that this approach would
create an even ‘‘playing field’’ for every
institution, big or small, regardless of
whether their own IRB has the resources
to act as a single IRB of record.
Many commenters, regardless of
whether or not they supported the
proposed policy, noted that over the
past several decades, the IRB’s role has
been expanded to include functions that
go beyond ethical review of proposed
research. For example, IRBs are often
responsible for reviewing compliance
with institutional policies, such as
conflict of interest and investigator
training. Commenters in favor of the
proposed policy thought that greater use
of sIRBs would help to return sIRB
review to its primary mission of
ensuring appropriate protections for
human subjects rather than protecting
the institution from legal liability or
damage to its reputation. They also
suggested that when institutions rely on
a single IRB of record for multi-site
research studies, IRB responsibilities are
clearer, which helps institutions to
develop policies and to provide
resources beyond IRB review (e.g.,
human research protections experts) to
facilitate compliance with the
institutional human research
protections program. Some commenters
opposed to the proposed Policy
suggested that the ancillary
responsibilities of IRBs are so
intertwined with the research oversight
responsibilities that using a sIRB would
disrupt the existing system of ‘‘checks
and balances’’ at institutions. They also
argued that the opportunity for the IRB
to recommend protocol changes for
reasons unrelated to ethical review (e.g.,
scientific improvements, changes to
study design) would be lost.
Many commenters, regardless of
whether they supported or opposed the
proposed policy, made a number of
specific practical suggestions about
implementation. These are summarized
below.
Applicability. Most commenters
supported a broad application of the
policy to all studies involving the same
protocol carried out at multiple sites in
the U.S. These stakeholders stated that
use of a single IRB of record for all types
of studies and populations and study
arrangements would encourage
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standardization of clinical research
protocols and more effective
implementation of protocols and
protocol amendments. In contrast, a
number of commenters suggested that
the NIH should narrow the application
of the policy or phase it in over time.
Ideas about how the applicability of the
policy should be narrowed were wideranging. Some stakeholders suggested
that the level of risk should be a
consideration in whether the policy
should apply, with some pointing to
minimal risk research and others to
research involving more than minimal
risk as being more appropriate for single
IRB review. Others suggested that the
policy should apply only to multi-site
studies that involve a large number of
sites (e.g., greater than 10); only to
research involving clinical trials; only to
studies carried out within established
cooperative groups; or only to lengthy
studies requiring an extended period of
IRB oversight, e.g., three years or more.
Some commenters suggested that the
applicability of the policy remain broad,
but that it be phased in over time.
Exceptions. The draft policy proposed
exceptions only if the designated single
IRB of record is unable to meet the
needs of specific populations or where
local IRB review is required by federal,
tribal, or state laws or regulations. Most
commenters agreed that there was a
need to allow for exceptions to the ues
of a single IRB. There were a number of
comments calling for additional
exceptions to those proposed in the
policy. Commenters who generally
supported the proposed policy stated
that exceptions should be very limited.
Some were concerned that a
determination that the sIRB would be
unable to meet the needs of specific
populations was an overly subjective
criterion or that institutions would
routinely request exceptions asserting
that the needs of specific populations
could only be met by local IRBs. Tribal
Nation commenters pointed to the
importance of firsthand knowledge of
local tribal customs, cultural values, and
tribal sensitivities and supported
exceptions to address those needs and
also as a way of respecting tribal
sovereignty. Other commenters said that
the policy should allow for situational
exceptions, depending on the types and
complexity of studies and study teams,
types and numbers of involved
institutions, resources available for the
sIRB (including IT resources), available
resources for investigators, accreditation
status of the human research protection
program, or when study sites have
concerns regarding the constitution of
the designated reviewing IRB, that IRBs’
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experience reviewing a particular type
of research was inadequate, or if relying
on the single IRB would affect the
institutional IRB’s accreditation status.
Assuring Consideration of Local
Context. Commenters were divided
about the extent to which individual
sites’ local contexts would present a
challenge for an sIRB. Some
commenters suggested that in today’s
highly interconnected world, local
contexts would not be unique or
different enough to affect the review of
research protocols. Others suggested
that local context does vary, not only
from state to state and community to
community, but even among institutions
serving the same community.
Commenters identified a number of
capabilities that the sIRB would need to
have in order to be effective, and one
comment identified four such
capabilities:
• Knowledge of state law and local
standards relevant to human subject
research, e.g., age of majority and assent
laws, mandatory reporting, data
security, and awareness of differences in
laws that would affect research
conducted at sites in multiple states.
• Systems and procedures for
collecting information from
participating sites in order to ascertain
whether the research could feasibly be
carried out at the site. The sIRB would
need to consider the number of
competing studies underway, limits to
participant pools, and whether the site
had the capabilities and resources to
execute research studies. Resources for
consideration would include space,
equipment, drug/device storage,
handling, and dispensing, data storage
capacities, and personnel, needed to
support the research. Institutional
capabilities would include policies on
issues such as confidentiality,
contraception, compensation for injury,
or contacts who can answer research
subjects’ questions.
• Mechanisms in place to assess the
experience and qualifications of site
investigators and study staff, including
whether they are in good standing with
state board and other licensing
authorities and have a good record of
compliance with all laws and
regulations. Other factors to be
considered in this assessment would
include financial conflicts of interest,
research workload, and training in
research ethics and the responsible
conduct of research.
• Mechanisms for obtaining
supplemental information when
research would involve sensitive topics
or when research would require the
participation of discrete and insular
communities. In some cases, the sIRB
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might need community-related
information and demographic data
including, but not limited to, race/
ethnicity, religious affiliation, and
language.
Selection of the IRB of Record. A
number of commenters called on the
NIH to establish criteria or a minimum
set of requirements to assist in the
selection of the sIRB, as well as a need
for criteria for an sIRB to use in its
evaluation of participating sites. One
commenter suggested that the NIH
policy should require the applicant,
offeror, or intramural investigator to
justify their proposed sIRB. Since the
NIH funding Institute or Center (IC)
must approve the sIRB, one commenter
suggested that the NIH describe the
criteria to be used in making a
determination that the proposed sIRB is
acceptable.
Some commenters offered specific
suggestions for sIRB evaluation criteria.
Suggestions for evaluation criteria
included the following:
• Evidence of a commitment to the
highest ethical standards and ability to
meet rigorous standards for quality and
protection of research participants, e.g.,
through accreditation or assessment of
policies, procedures, and practices;
• Ability to meet regulatory
requirements;
• Well-established track record of
compliance and performing high quality
reviews, e.g., no regulatory errors or
failures to address Common Rule
regulatory requirements or Food and
Drug Administration regulations;
• Appropriate expertise and
experience to review the proposed
research and the capacity to review the
study protocol and participating sites;
• Recognition of the importance of
building trust across all sites;
• Capacity to develop and maintain
the respect and trust of the research
participants and the communities in
which the research is performed;
• Willingness and ability to serve as
a Privacy Board to fulfill the
requirements of the Health Insurance
Portability and Accountability Act
(HIPAA) Privacy Rule for use or
disclosure of protected health
information for research;
• Adherence to communication
standards and a commitment to
transparency through sharing
information about the review process,
e.g., meeting minutes, approval status;
• Adequate institutional
infrastructure and support, and
evidence of quality and robustness of
the institution’s human research
protection program;
• Sufficient staff to handle
communications between all sites for
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initial review, continuing review,
adverse events, amendments, etc.;
• Available interoperable information
technology resources to facilitate
communication and exchange of
information between the participating
institutions;
• Sufficient resources to negotiate
and track authorization agreements;
• Ability to account for the IRB costs
for review and management and how
those costs will be met;
• Adequate processes in place and
administrative support to handle
additional review responsibilities;
• Statement of support from the
nominated IRB and, if applicable, its
governing institution, and the
participating investigators.
Defining IRB and Institutional
Responsibilities. Many commenters
pointed out the importance of defining
the sIRB’s role and scope of
responsibility in relation to the
responsibilities of the participating
research sites. These commenters noted
that responsibilities of IRBs defined by
the 45 CFR 46 often constitute only one
part of institutions’ overall human
research protections program.
Commenters called on the NIH to
establish a common approach to the
division of responsibilities by providing
model authorization agreements or even
a uniform agreement that should be
used in all cases. In addition to helping
ensure a well-functioning review
process, clear roles and responsibilities
would, some suggested, also help
mitigate concerns about added liability
that an sIRB might assume.
A range of views were expressed
relating to responsibilities that would be
assumed by the sIRB and those that
would remain with participating sites.
Some commenters suggested that in
addition to fulfilling the requirements
set out in 45 CFR 46, i.e., conducting
initial and continuing reviews of
protocols, amendments, unanticipated
problems, protocol deviations, and
required regulatory IRB reporting, sIRBs
should adopt some of the
responsibilities that are frequently
delegated to local IRBs, in particular,
acting as a privacy board for all sites.
One commenter noted that systems
would be required to ensure that
duplicative reviews are not conducted
by the sIRB and local IRBs, and several
commenters expressed concerns about
the difficulty of coordinating required
sIRB reviews with additional reviews
that are not required by regulation, such
as reviews for conflict of interest,
investigator qualifications, and
scientific merit. Some of these
commenters questioned how sIRB
reviews required by the HHS regulations
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should be coordinated with other
required reviews that may have been
delegated to the local IRB. These
commenters noted that many
institutions have established systems
and standard operating procedures for
coordinating local IRB review with
other required reviews, such as
institutional biosafety reviews, radiation
safety reviews, pharmacy reviews,
reviews required by state or local laws,
post-approval monitoring and for-cause
auditing purposes, and research billing.
One commenter suggested that sIRBs
should not be responsible for adverse
event reporting. Another commenter
suggested that sIRBs should be
responsible for maintaining databases of
relevant state laws. In addition, a small
number of commenters indicated that
the regulations of other Common Rule
agencies, FDA in particular, may create
contradictory requirements, and called
for clarification and a more unified
approach.
Several commenters stated that
coordinating these additional reviews
with sIRB reviews would limit the gains
in efficiency realized from reliance on
an sIRB. One commenter recommended
that the NIH develop a template IRB
authorization agreement and guidelines
to define the institutional obligations
that are distinct from the IRB review
responsibilities. Another commenter
recommended that the NIH publish
guidance delineating the specific
regulatory requirements for which the
sIRB would be responsible, shared
responsibilities, and responsibilities
that an sIRB could negotiate with IRBs
at participating sites.
Resources and Funding. Several
commenters described the proposed
policy as an unfunded mandate, or
stated that it would result in a shifting
of expenses from one institution to
another. Many commenters expressed
the concern that if costs associated with
using a single IRB are taken from a
participating institution’s indirect costs,
there would be insufficient funds for the
local Human Research Protection
Program (HRPP) that still has
institutional oversight responsibilities,
even if the IRB of record is external.
Most commenters with experience using
a single IRB of record for multi-site
research studies recommended that
indirect costs remain unchanged for
relying institutions in order to ensure
that the human research protections
infrastructure are available for
institutional responsibilities, e.g., postapproval compliance monitoring,
conflict of interest reviews. Many
commenters noted funding sIRBs
through indirect costs would divert
funds required to conduct research and
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serve as a disincentive to conducting
multisite research. The majority of
commenters stated a preference for
including the additional costs
associated with a single IRB review in
the study budget as direct cost, although
one commenter stated a preference that
sIRB review be included as an indirect
cost in order to maximize the amount of
funding available for research.
Several commenters stated that the
costs and resources needed to establish
sIRBs were not addressed by the
proposed policy. Infrastructure needs
noted by these commenters included
additional staff and/or staff time to
perform sIRB-related activities, costs to
create or adapt electronic managements
systems that are interoperable with
outside institutions, and the time and
cost of developing communication tools
to link investigators to IRBs outside
their institution. Other commenters
familiar with the operations and use of
sIRBs noted that while initial financial
support from the NIH may be required
to establish or expand the capacity of
some IRBs to serve as the IRB of record,
most sIRBs should be able to become
self-supporting eventually.
Commenters had questions about
whether plans for single IRB review
would be required in grant applications
and how plans would be reviewed.
Need for Implementation Guidance. A
number of commenters pointed out how
important it would be for the NIH to
provide practical guidance to facilitate
the implementation of the policy, with
some commenters stating that, in the
absence of such guidance, burden and
costs would only shift between
institutions rather than adding
efficiency to the IRB process. A few
commenters noted that this guidance
could be developed using the
experiences of IRBs that have already
implemented centralized IRB review
processes.
In addition to general requests for
implementation guidance, a number of
commenters made specific guidance
suggestions. These suggestions included
the need for guidance covering:
• The specific criteria to use for
evaluation of IRBs of record when
selecting a single IRB for a multisite
study;
• The process for determining roles
and responsibilities of the sIRB versus
IRBs of participating research sites and
a standard authorization agreement
template that specifies these roles and
responsibilities. One commenter
recommended that this guidance clearly
define who is responsible for ensuring
investigator compliance, while another
recommended that this guidance cover
review of modifications to approved
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research, addition of research sites, and
other post- approval monitoring issues
including the relationship between the
IRB and a data monitoring committee
(such as a data and safety monitoring
board). A number of commenters asked
the NIH to provide guidance about
liability as part of this guidance;
• Processes for local IRBs working
with an sIRB, including what types of
reviews will be performed by the local
IRB (radiation safety review, pharmacy
review, conflicts of interest) and best
practices for maintaining oversight of
research reviewed and approved by a
non-institutional IRB. Additionally, one
commenter requested that NIH
encourage and provide guidance for
institutional review of the impact the
sIRB will have on the institution’s HRPP
business goals, policies, accreditation
status, tracking and management
processes;
• Consent forms, including the
process of consent approval by the sIRB
and participating sites, and whether and
how local institutions could alter an
sIRB informed consent document to fit
local needs;
• Plans to ensure quality and
processes for institutions relying on an
sIRB to question or appeal sIRB
decisions, and to address and resolve
issues arising from duplicate reviews.
In addition, commenters requested:
• Guidance and tools to enable sIRBs
to consider local context issues. Specific
guidance was requested on the process
by which sIRBs would collect local
information (e.g., through a standard
form or through an ad hoc member or
consultant with local context
knowledge), and what types of
information should be provided to sIRBs
(e.g., how to apply state and local laws).
One commenter also recommended that
the NIH develop a set of guidelines for
how the sIRB would apply local
standards, knowledge of institutional
policies, institutional capacity issues,
investigator and study staff
qualifications, and local community and
subject considerations to their reviews;
• An explanation of costs associated
with development and maintenance of
sIRBs and guidance on how the use of
an sIRB should be proposed at the grant
level, including a fee structure to help
investigators incorporate sIRB review
into their budgets;
• A more detailed description of the
standards for permitting exceptions for
sIRB review;
• A description of what resources, if
any, NIH would make available to assist
in training IRBs and researchers
regarding single IRB review.
Some of the commenters who
requested guidance recommended that
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any NIH guidance on sIRBs be released
along with or prior to the issuance of the
final policy.
Implementation of the Policy. In
developing the final policy set out
below, the NIH carefully considered the
many thoughtful comments we received
on the Draft NIH Policy on the Use of
a Single Institutional Review Board
(IRB) for Multi-Site Research (NOT–OD–
15–026). While we found no compelling
reason to narrow the essential scope of
the final policy—it will cover all
domestic sites of NIH-funded nonexempt multi-site studies as was
proposed—we have clarified the policy
intent and modified several provisions.
The final policy is intended to apply
only to studies where the same research
protocol is being conducted at more
than one site; it does not apply to
studies that involve more than one site
but the sites have different roles in
carrying out the research. Applicants/
offerors will be expected to submit a
plan identifying the sIRB that will serve
as the IRB of record for all study sites.
It will be the responsibility of the
applicant/offeror to assure that the sIRB
is qualified to serve; the applicant’s plan
will not be evaluated in peer review.
The additional costs associated with
sIRB review may be charged to grants or
contracts as direct costs, provided that
such costs are well-justified and
consistently treated as either direct or
indirect costs according to applicable
cost principles in the NIH Grants Policy
Statement and the FAR 31.202 (Direct
Costs) and FAR 31.203 (Indirect Costs).
Exceptions to the policy will be granted,
as was proposed, if the use of an sIRB
is prohibited by federal, state, or tribal
laws or regulations. We will also grant
exceptions where the federal, state, or
tribal prohibition on the use of an sIRB
is established by policy, and we will
consider granting an exception if a
request is made and a compelling
justification provided for why an
exception is needed. Such justifications
could be for reasons other than that the
sIRB is unable to meet the needs of a
specific population, as was proposed in
the draft policy. The final policy also
clarifies that multi-site studies within
ongoing, non-competing awards will not
be expected to comply with the policy
until a competing renewal application is
submitted.
The NIH recognizes that the policy
will begin a paradigm shift in IRB
review. As such, the final policy will
not take effect until May 25, 2017. In the
interim, the NIH will issue guidance
and provide resources to assist awardees
in adapting to the shift.
Guidance materials will be issued
before the policy’s effective date and
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posted along with the policy on the
following site: https://osp.od.nih.gov/
office-clinical-research-and-bioethicspolicy/clinical-research-policy/modelsirb-review. Among other topics, the
guidance will address:
• How costs associated with sIRBs
may be charged as direct versus indirect
costs;
• Considerations in the selection of
the sIRB;
• The content of the sIRB plan that
must be submitted with applications
and proposals;
• Process for applicants/offerors to
submit a request for an exception and
process for NIH review of the request for
exception;
• Roles and responsibilities of the
sIRB and participating sites;
• Model authorization agreement that
lays out the roles and responsibilities of
each signatory;
• Models for gathering and evaluating
information from all the reliant sites
about community attitudes and the
acceptability of proposed research;
• A model communication plan that
identifies when and which documents
are to be completed and shared with
those involved so each may fulfill their
responsibilities.
Finally, while the NIH anticipates that
that there will be challenges associated
with implementation, we expect these
to be short-lived. Once the transition to
the new way of operating is made, the
benefits of widespread use of sIRBs will
outweigh any costs and, ultimately,
reduce burdens to the research process.
At the same time, the NIH will also
closely monitor the implementation of
the policy, consider its impact on
research such as improvements in time
to initiation of research and reduction of
unnecessary burden, and be vigilant
about any diminution in the protection
of human subjects.
Final NIH Policy on the Use of a Single
Institutional Review Board for MultiSite Research
asabaliauskas on DSK3SPTVN1PROD with NOTICES
Purpose
The National Institutes of Health
(NIH) Policy on the Use of a Single
Institutional Review Board of Record for
Multi-Site Research establishes the
expectation that all sites participating in
multi-site studies involving non-exempt
human subjects research funded by the
National Institutes of Health (NIH) will
use a single Institutional Review Board
(sIRB) to conduct the ethical review
required by the Department of Health
and Human Services regulations for the
Protection of Human Subjects at 45 CFR
part 46. This policy, which is consistent
with 45 CFR part 46.114, is intended to
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enhance and streamline the process of
IRB review and reduce inefficiencies so
that research can proceed as
expeditiously as possible without
compromising ethical principles and
protections for human research
participants.
Scope and Applicability
This policy applies to the domestic
sites of NIH-funded multi-site studies
where each site will conduct the same
protocol involving non-exempt human
subjects research, whether supported
through grants, cooperative agreements,
contracts, or the NIH Intramural
Research Program. It does not apply to
career development, research training or
fellowship awards.
This policy applies to domestic
awardees and participating domestic
sites. Foreign sites participating in NIHfunded, multi-site studies will not be
expected to follow this policy.
Consistent with the Roles and
Responsibilities section, applicants/
offerors will be expected to include a
plan for the use of an sIRB in the
applications/proposals they submit to
the NIH. The NIH’s acceptance of the
submitted plan will be incorporated as
a term and condition in the Notice of
Award or in the Contract Award. This
policy also applies to the NIH
Intramural Research Program.
Definitions
The Authorization Agreement, which
is also called a reliance agreement, is
the agreement that documents
respective authorities, roles,
responsibilities, and communication
between an institution/organization
providing the ethical review and a
participating site relying on the sIRB.
A multi-site study uses the same
protocol to conduct non-exempt human
subjects research at more than one site.
Participating site in a multi-site study
is a domestic entity that will rely on the
sIRB to carry out the site’s initial and
continuing IRB review of human
subjects research for the multi-site
study.
sIRB is the single IRB of record that
has been selected to carry out the IRB
review requirements at 45 CFR part 46
for participating sites of the multi-site
study.
Roles and Responsibilities
This policy establishes the following
roles and responsibilities:
Applicant/Offeror. In the application/
proposal for research funding, the
applicant/offeror is expected to submit
a plan describing the use of an sIRB that
will be selected to serve as the IRB of
record for all study sites. The plan
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should include a statement confirming
that participating sites will adhere to the
sIRB Policy and describe how
communications between sites and sIRB
will be handled. If, in delayed-onset
research, an sIRB has not yet been
identified, applications/proposals
should include a statement that
awardees will follow this Policy and
communicate plans to use a registered
IRB of record to the funding NIH
Institute/Center prior to initiating a
multi-site study. The applicant/offeror
may request direct cost funding for the
additional costs associated with the
establishment and review of the multisite study by the sIRB, with appropriate
justification; all such costs must be
reasonable and consistent with cost
principles, as described in the NIH
Grants Policy Statement and the Federal
Acquisition Regulation (FAR) 31.302
(Direct Costs) and FAR 31.203 (Indirect
Costs).
Awardees. Awardees are responsible
for ensuring that authorization
agreements are in place; copies of
authorization agreements and other
necessary documentation should be
maintained in order to document
compliance with this policy, as needed.
As appropriate, awardees are
responsible for ensuring that a
mechanism for communication between
the sIRB and participating sites is
established. Awardees may delegate the
tasks associated with these
responsibilities.
Funding Institute or Center (IC).
Funding ICs are responsible for
management and oversight of the award,
including communicating with the
awardee regarding the implementation
of its proposed plan to comply with the
sIRB Policy. In the event that questions
arise about the awardee’s plan,
including the IRB that has been selected
to serve as the sIRB, the funding IC will
work with the awardee to resolve them.
sIRB. The sIRB is responsible for
conducting the ethical review of NIHfunded multi-site studies for
participating sites. The sIRB will be
expected to carry out the regulatory
requirements as specified under the
HHS regulations at 45 CFR part 46. In
reviewing multi-site research protocols,
the sIRB may serve as a Privacy Board,
as applicable, to fulfill the requirements
of the HIPAA Privacy Rule for use or
disclosure of protected health
information for research purposes. The
sIRB will collaborate with the awardee
to establish a mechanism for
communication between the sIRB and
the participating sites.
Participating Site. All sites
participating in a multi-site study are
expected to rely on an sIRB to carry out
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the functions that are required for
institutional compliance with IRB
review set forth in the HHS regulations
at 45 CFR 46. Participating sites are
responsible for meeting other regulatory
obligations, such as obtaining informed
consent, overseeing the implementation
of the approved protocol, and reporting
unanticipated problems and study
progress to the sIRB. Participating sites
must communicate relevant information
necessary for the sIRB to consider local
context issues and state/local regulatory
requirements during its deliberations.
Participating sites are expected to rely
on the sIRB to satisfy the regulatory
requirements relevant to the ethical
review. Although IRB ethical review at
a participating site would be counter to
the intent and goal of this policy, the
policy does not prohibit any
participating site from duplicating the
sIRB. However, if this approach is taken,
NIH funds may not be used to pay for
the cost of the duplicate review.
Exceptions
Exceptions to this policy will be made
where review by the proposed sIRB
would be prohibited by a federal, tribal,
or state law, regulation, or policy.
Requests for exceptions that are not
based on a legal, regulatory, or policy
requirement will be considered if there
is a compelling justification for the
exception. The NIH will determine
whether to grant an exception following
an assessment of the need.
Effective Date
asabaliauskas on DSK3SPTVN1PROD with NOTICES
This policy applies to all competing
grant applications (new, renewal,
revision, or resubmission) with receipt
dates on or after May 25, 2017. Ongoing,
non-competing awards will not be
expected to comply with this policy
until the grantee submits a competing
renewal application. For contracts, the
policy applies to all solicitations issued
on or after May 25, 2017. For the
intramural program, the policy applies
to intramural multi-site studies
submitted for initial review after May
25, 2017.
Dated: June 14, 2016.
Lawrence Tabak,
Deputy Director, National Institutes of Health.
[FR Doc. 2016–14513 Filed 6–20–16; 8:45 am]
BILLING CODE 4140–01–P
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DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Substance Abuse and Mental Health
Services Administration
Agency Information Collection
Activities: Submission for OMB
Review; Comment Request
Periodically, the Substance Abuse and
Mental Health Services Administration
(SAMHSA) will publish a summary of
information collection requests under
OMB review, in compliance with the
Paperwork Reduction Act (44 U.S.C.
Chapter 35). To request a copy of these
documents, call the SAMHSA Reports
Clearance Officer on (240) 276–1243.
Project: Now Is The Time (NITT)–
Project AWARE (Advancing Wellness
and Resilience in Education)
Evaluation—New
SAMHSA is conducting a national
evaluation of the Now is the Time
(NITT) initiative, which includes
separate programs—NITT Project
AWARE (Advancing Wellness and
Resilience in Education)—State
Educational Agency (SEA), Healthy
Transitions (HT), and two Minority
Fellowship Programs (Youth and
Addiction Counselors). These programs
are united by their focus on capacity
building, system change, and workforce
development.
NITT-Project AWARE, which is the
focus of this data collection, represents
a response to the third and fourth
components of President Obama’s NITT
Initiative: making schools safer and
focusing on access to mental health
services. The goal of NITT-Project
AWARE is to develop a comprehensive,
coordinated, and integrated program for
advancing wellness and resilience in
educational settings for school-aged
youth.
SAMHSA awarded NITT-Project
AWARE grants to 20 SEAs. Each SEA
proposed partnerships between at least
three high-need Local Educational
Agencies (LEAs) to develop a
coordinated and integrated plan of
services and strategies to address the
Project NITT-Project AWARE–SEA goals
and objectives. Project AWARE grantees
will plan and implement activities
designed to increase the capacity of
SEAs in three areas: (1) Increase mental
health awareness among school-aged
(K–12) youth; (2) train those who work
with school-aged children to identify
and respond to mental health issues in
children and young adults; and (3)
connect children, youth, and families
with mental health services. The
intention is to encourage cross-system
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40331
collaboration and use evidence-based
strategies to address mental health
needs.
The Project AWARE evaluation will
examine the process and outcomes of
activities by SEA grantees and their LEA
and school partners. It will evaluate the
capacity of SEAs to effectively involve
family and youth, provide a culturally
and linguistically competent and
family-centered mental health service
array, and implement a process for
identifying need and delivering services
that is informed by data and
coordinated across child-serving
agencies. Evaluation questions have
been developed to understand grantee
context, planning, implementation,
outputs, and outcomes across each of
the NITT priority areas. Data collection
efforts that will support the evaluation
are described below.
AWARE Planning and
Implementation Activities Inventory
(AWARE Activities Inventory), to
capture information about all activities
supported by Project AWARE resources
during the grant period. The inventory
will be reviewed and updated on an
annual basis at the SEA level with the
grant project director, at the LEA level
with the grant program coordinators,
and at the school level with
coordinators in each participating
school. The questionnaires will guide
review and input of additional
information as needed for all activities
captured in the AWARE Activities
Inventory and conducted under Project
AWARE. Each questionnaire will be
conducted annually to review and
update the AWARE Activities Inventory
with 20 SEA-level respondents, 62 LEAlevel respondents, and 432 school-level
respondents.
SEA Collaborative Partner Survey
(SEA–CPS), to collect information about
collaborative processes and partnerships
at the state level to examine the
networks involved in successful
information sharing and collaborations
across child-serving agencies and the
families and youth they serve. SAMHSA
estimates that there will be 24
collaborative partner respondents at
each SEA grantee who will complete the
annual SEA–CPS.
Local Educational Agency
Collaborative Partner Survey (LEA–
CPS), to collect information about
collaborative processes and partnerships
at the local level to examine the
networks involved in successful
information sharing and collaborations
across child-serving agencies and the
families and youth they serve. The
survey will be administered twice
during the grant period, with 15
respondents in each of the 62 LEAs.
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Agencies
[Federal Register Volume 81, Number 119 (Tuesday, June 21, 2016)]
[Notices]
[Pages 40325-40331]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-14513]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
National Institutes of Health
Final NIH Policy on the Use of a Single Institutional Review
Board for Multi-Site Research
AGENCY: National Institutes of Health.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: The National Institutes of Health (NIH) is issuing this policy
on the use of a single Institutional Review Board (IRB) for multi-site
research to establish the expectation that a single IRB (sIRB) of
record will be used in the ethical review of non-exempt human subjects
research protocols funded by the NIH that are carried out at more than
one site in the United States. The goal of this policy is to enhance
and streamline the IRB review process in the context of multi-site
research so that research can proceed as effectively and expeditiously
as possible. Eliminating duplicative IRB review is expected to reduce
unnecessary administrative burdens and systemic inefficiencies without
diminishing human subjects protections. The shift in workload away from
conducting redundant reviews is also expected to allow IRBs to
concentrate more time and attention on the review of single site
protocols, thereby enhancing research oversight.
DATES: This policy will take effect May 25, 2017.
FOR FURTHER INFORMATION CONTACT: Office of Science Policy, National
Institutes of Health, 6705 Rockledge Drive, Suite 750, Bethesda, MD
20892,
[[Page 40326]]
301-496-9838, SingleIRBpolicy@mail.nih.gov.
SUPPLEMENTARY INFORMATION: The NIH published for public comment a
proposed draft sIRB policy in a notice in the NIH Guide for Grants and
Contracts on December 3, 2014, (https://grants.nih.gov/grants/guide/notice-files/NOT-OD-15-026.html) and in the Federal Register on January
6, 2015, (80 FR 511) (https://federalregister.gov/a/2014-30964). The
NIH received 167 comments from a range of stakeholders, including
individual researchers, academic institutions, IRBs, patient advocacy
groups, scientific societies, healthcare organizations, Tribal Nation
representatives, and the general public. A compilation of the public
comments is available at https://osp.od.nih.gov/sites/default/files/resources/sIRB%2007-21-2015.pdf. The NIH appreciated the public
interest in the draft policy and the time and effort stakeholders made
to provide comments. The NIH carefully considered those comments in the
development of the final policy.
Overview of the Public Comments
In general, most of the comments that were submitted on the draft
policy were supportive of NIH's goal of enhancing and streamlining IRB
review in multi-site research. Commenters, especially individual
researchers, scientific and professional societies, and patient
advocacy organizations, generally agreed that the use of a single IRB
for multi-site studies involving the same protocol would help
streamline IRB review and would not undermine and might even enhance
protections for research participants. Most of the comments also
favored the approach the NIH proposed to promote the use of single IRBs
by making reliance on an sIRB an expectation for all non-exempt multi-
site studies carried out at U.S. sites. At the same time, a number of
commenters, mainly academic institutions and organizations representing
them, did not agree with the scope of the proposed policy or that it
should become a term and condition of funding, and suggested the NIH
incentivize, not mandate, reliance on an sIRB.
Comments from researchers that supported the draft policy described
unnecessary delays and additional costs caused by duplicative IRB
reviews. They noted that IRB submission requirements at each site
differ and take time to navigate and manage. They also indicated that
review of the same protocol by multiple IRBs can sometimes lead to
protocol and consent document changes that can introduce
inconsistencies in the execution of the protocol across sites, lead to
enrollment imbalances, and skew the analysis of the aggregated data.
More often, however, multiple IRB reviews result in changes to consent
documents that are merely stylistic and not substantive, or changes
that focus on institutional interests (e.g., liability management)
rather than human research protections. Commenters raised the concern
that the current practice of requiring multiple IRB reviews may
actually contribute to some researchers' reluctance to participate in
rigorous, multi-site research and may incentivize smaller and simpler
study designs.
Scientific and professional societies generally favored the
proposed policy. These stakeholders stated that the policy would
decrease administrative burdens on clinical research staff, speed up
participant recruitment, and streamline the research process and that
these changes would result in enhancements to the efficiency of
research and acceleration of research progress. They also suggested
that the benefits of such a policy include enhanced adverse event
monitoring and improvements to the quality and consistency of IRB
reviews.
Most of the comments from patient advocacy groups and participant
representatives were supportive of the proposed policy. These
stakeholders pointed out that greater use of single IRBs will lead to
enhanced protections through increased accountability and improved
efficiency.
In general, comments from academic institutions, IRBs, and
organizations that represent them cited concerns about the proposed
policy, even though many also expressed support for its goal and agreed
it could have a positive impact in reducing research review and
initiation time to the study. These stakeholders suggested that the
scope of the proposed policy is too broad and that the NIH should not
make the policy a term and condition of award. They said that decisions
about whether to use a single IRB should be voluntary and that the NIH
should offer incentives to promote change. For example, they suggested
that the NIH encourage investigators and institutions to use single
IRBs in grant applications by providing additional funding to those
grants that agree to use a single IRB. Some suggested that before
issuing a broad policy, the NIH should pilot and evaluate a narrower
use of single IRBs and provide appropriate resources to support the
participating awardees. Others suggested that the NIH should fund
research on existing central IRB models to evaluate potential benefits
and costs before mandating single IRB review. A few commenters raised
concerns about the timing of the policy in relation to the revisions of
the Common Rule, stating their preference that the NIH not adopt a
single IRB policy until Common Rule revisions have been finalized.
However, other commenters praised the NIH for addressing the single IRB
issue in the absence of an updated Common Rule. Finally, a few
commenters discussed how the policy could be harmonized with other
federal policies. One commenter recommended that the Office for Human
Research Protections (OHRP) in the Department of Health and Human
Services (HHS) provide guidance to support the policy's stance on
duplicative IRB review.
Stakeholders from academic institutions were concerned that the
membership of any given sIRB would not be able to achieve the level of
local support for a particular research study or its acceptability in
terms of all the participating sites' institutional commitments and
regulations, applicable laws, and standards of professional conduct and
practice. Some commenters contended that only a local IRB is able to
understand the specific protections required for a vulnerable
population that comprises their research participant base. Some
suggested that site-specific practices for recruitment and retention,
especially for vulnerable populations, would pose challenges for an
sIRB. A number of commenters stated that their institutional IRBs are
in the best position to know and understand competencies of and
potential conflicts of interest of specific investigators. Others
stressed the importance of the relationship between an investigator and
the local IRB and noted that IRB members can serve as mentors to
investigators whose protocols they oversee.
Some commenters asserted that the proposed policy does not
recognize the time and effort needed to identify and establish a single
IRB of record, including negotiating and executing authorization
agreements and standard operating procedures, conducting study
initiation meetings, creating account activities, and modifying
information technology (IT) systems. They suggested that the policy
would result in the formation of hundreds of different ``single IRBs of
record'' with which institutions and investigators will need to
interact. Some questioned whether an sIRB would be equipped to ensure
local compliance at a relying institution and expressed the concern
that a compliance problem for an sIRB would lead to
[[Page 40327]]
compliance actions against the sites relying on that sIRB. Several
commenters who supported the use of sIRBs recommended that rather than
having participating sites identify a single IRB for each protocol, the
NIH should establish a central IRB to review all multi-site research
studies, akin to the National Cancer Institute's Central Institutional
Review Board (CIRB). They suggested that this approach would create an
even ``playing field'' for every institution, big or small, regardless
of whether their own IRB has the resources to act as a single IRB of
record.
Many commenters, regardless of whether or not they supported the
proposed policy, noted that over the past several decades, the IRB's
role has been expanded to include functions that go beyond ethical
review of proposed research. For example, IRBs are often responsible
for reviewing compliance with institutional policies, such as conflict
of interest and investigator training. Commenters in favor of the
proposed policy thought that greater use of sIRBs would help to return
sIRB review to its primary mission of ensuring appropriate protections
for human subjects rather than protecting the institution from legal
liability or damage to its reputation. They also suggested that when
institutions rely on a single IRB of record for multi-site research
studies, IRB responsibilities are clearer, which helps institutions to
develop policies and to provide resources beyond IRB review (e.g.,
human research protections experts) to facilitate compliance with the
institutional human research protections program. Some commenters
opposed to the proposed Policy suggested that the ancillary
responsibilities of IRBs are so intertwined with the research oversight
responsibilities that using a sIRB would disrupt the existing system of
``checks and balances'' at institutions. They also argued that the
opportunity for the IRB to recommend protocol changes for reasons
unrelated to ethical review (e.g., scientific improvements, changes to
study design) would be lost.
Many commenters, regardless of whether they supported or opposed
the proposed policy, made a number of specific practical suggestions
about implementation. These are summarized below.
Applicability. Most commenters supported a broad application of the
policy to all studies involving the same protocol carried out at
multiple sites in the U.S. These stakeholders stated that use of a
single IRB of record for all types of studies and populations and study
arrangements would encourage standardization of clinical research
protocols and more effective implementation of protocols and protocol
amendments. In contrast, a number of commenters suggested that the NIH
should narrow the application of the policy or phase it in over time.
Ideas about how the applicability of the policy should be narrowed were
wide-ranging. Some stakeholders suggested that the level of risk should
be a consideration in whether the policy should apply, with some
pointing to minimal risk research and others to research involving more
than minimal risk as being more appropriate for single IRB review.
Others suggested that the policy should apply only to multi-site
studies that involve a large number of sites (e.g., greater than 10);
only to research involving clinical trials; only to studies carried out
within established cooperative groups; or only to lengthy studies
requiring an extended period of IRB oversight, e.g., three years or
more. Some commenters suggested that the applicability of the policy
remain broad, but that it be phased in over time.
Exceptions. The draft policy proposed exceptions only if the
designated single IRB of record is unable to meet the needs of specific
populations or where local IRB review is required by federal, tribal,
or state laws or regulations. Most commenters agreed that there was a
need to allow for exceptions to the ues of a single IRB. There were a
number of comments calling for additional exceptions to those proposed
in the policy. Commenters who generally supported the proposed policy
stated that exceptions should be very limited. Some were concerned that
a determination that the sIRB would be unable to meet the needs of
specific populations was an overly subjective criterion or that
institutions would routinely request exceptions asserting that the
needs of specific populations could only be met by local IRBs. Tribal
Nation commenters pointed to the importance of firsthand knowledge of
local tribal customs, cultural values, and tribal sensitivities and
supported exceptions to address those needs and also as a way of
respecting tribal sovereignty. Other commenters said that the policy
should allow for situational exceptions, depending on the types and
complexity of studies and study teams, types and numbers of involved
institutions, resources available for the sIRB (including IT
resources), available resources for investigators, accreditation status
of the human research protection program, or when study sites have
concerns regarding the constitution of the designated reviewing IRB,
that IRBs' experience reviewing a particular type of research was
inadequate, or if relying on the single IRB would affect the
institutional IRB's accreditation status.
Assuring Consideration of Local Context. Commenters were divided
about the extent to which individual sites' local contexts would
present a challenge for an sIRB. Some commenters suggested that in
today's highly interconnected world, local contexts would not be unique
or different enough to affect the review of research protocols. Others
suggested that local context does vary, not only from state to state
and community to community, but even among institutions serving the
same community.
Commenters identified a number of capabilities that the sIRB would
need to have in order to be effective, and one comment identified four
such capabilities:
Knowledge of state law and local standards relevant to
human subject research, e.g., age of majority and assent laws,
mandatory reporting, data security, and awareness of differences in
laws that would affect research conducted at sites in multiple states.
Systems and procedures for collecting information from
participating sites in order to ascertain whether the research could
feasibly be carried out at the site. The sIRB would need to consider
the number of competing studies underway, limits to participant pools,
and whether the site had the capabilities and resources to execute
research studies. Resources for consideration would include space,
equipment, drug/device storage, handling, and dispensing, data storage
capacities, and personnel, needed to support the research.
Institutional capabilities would include policies on issues such as
confidentiality, contraception, compensation for injury, or contacts
who can answer research subjects' questions.
Mechanisms in place to assess the experience and
qualifications of site investigators and study staff, including whether
they are in good standing with state board and other licensing
authorities and have a good record of compliance with all laws and
regulations. Other factors to be considered in this assessment would
include financial conflicts of interest, research workload, and
training in research ethics and the responsible conduct of research.
Mechanisms for obtaining supplemental information when
research would involve sensitive topics or when research would require
the participation of discrete and insular communities. In some cases,
the sIRB
[[Page 40328]]
might need community-related information and demographic data
including, but not limited to, race/ethnicity, religious affiliation,
and language.
Selection of the IRB of Record. A number of commenters called on
the NIH to establish criteria or a minimum set of requirements to
assist in the selection of the sIRB, as well as a need for criteria for
an sIRB to use in its evaluation of participating sites. One commenter
suggested that the NIH policy should require the applicant, offeror, or
intramural investigator to justify their proposed sIRB. Since the NIH
funding Institute or Center (IC) must approve the sIRB, one commenter
suggested that the NIH describe the criteria to be used in making a
determination that the proposed sIRB is acceptable.
Some commenters offered specific suggestions for sIRB evaluation
criteria. Suggestions for evaluation criteria included the following:
Evidence of a commitment to the highest ethical standards
and ability to meet rigorous standards for quality and protection of
research participants, e.g., through accreditation or assessment of
policies, procedures, and practices;
Ability to meet regulatory requirements;
Well-established track record of compliance and performing
high quality reviews, e.g., no regulatory errors or failures to address
Common Rule regulatory requirements or Food and Drug Administration
regulations;
Appropriate expertise and experience to review the
proposed research and the capacity to review the study protocol and
participating sites;
Recognition of the importance of building trust across all
sites;
Capacity to develop and maintain the respect and trust of
the research participants and the communities in which the research is
performed;
Willingness and ability to serve as a Privacy Board to
fulfill the requirements of the Health Insurance Portability and
Accountability Act (HIPAA) Privacy Rule for use or disclosure of
protected health information for research;
Adherence to communication standards and a commitment to
transparency through sharing information about the review process,
e.g., meeting minutes, approval status;
Adequate institutional infrastructure and support, and
evidence of quality and robustness of the institution's human research
protection program;
Sufficient staff to handle communications between all
sites for initial review, continuing review, adverse events,
amendments, etc.;
Available interoperable information technology resources
to facilitate communication and exchange of information between the
participating institutions;
Sufficient resources to negotiate and track authorization
agreements;
Ability to account for the IRB costs for review and
management and how those costs will be met;
Adequate processes in place and administrative support to
handle additional review responsibilities;
Statement of support from the nominated IRB and, if
applicable, its governing institution, and the participating
investigators.
Defining IRB and Institutional Responsibilities. Many commenters
pointed out the importance of defining the sIRB's role and scope of
responsibility in relation to the responsibilities of the participating
research sites. These commenters noted that responsibilities of IRBs
defined by the 45 CFR 46 often constitute only one part of
institutions' overall human research protections program. Commenters
called on the NIH to establish a common approach to the division of
responsibilities by providing model authorization agreements or even a
uniform agreement that should be used in all cases. In addition to
helping ensure a well-functioning review process, clear roles and
responsibilities would, some suggested, also help mitigate concerns
about added liability that an sIRB might assume.
A range of views were expressed relating to responsibilities that
would be assumed by the sIRB and those that would remain with
participating sites. Some commenters suggested that in addition to
fulfilling the requirements set out in 45 CFR 46, i.e., conducting
initial and continuing reviews of protocols, amendments, unanticipated
problems, protocol deviations, and required regulatory IRB reporting,
sIRBs should adopt some of the responsibilities that are frequently
delegated to local IRBs, in particular, acting as a privacy board for
all sites. One commenter noted that systems would be required to ensure
that duplicative reviews are not conducted by the sIRB and local IRBs,
and several commenters expressed concerns about the difficulty of
coordinating required sIRB reviews with additional reviews that are not
required by regulation, such as reviews for conflict of interest,
investigator qualifications, and scientific merit. Some of these
commenters questioned how sIRB reviews required by the HHS regulations
should be coordinated with other required reviews that may have been
delegated to the local IRB. These commenters noted that many
institutions have established systems and standard operating procedures
for coordinating local IRB review with other required reviews, such as
institutional biosafety reviews, radiation safety reviews, pharmacy
reviews, reviews required by state or local laws, post-approval
monitoring and for-cause auditing purposes, and research billing. One
commenter suggested that sIRBs should not be responsible for adverse
event reporting. Another commenter suggested that sIRBs should be
responsible for maintaining databases of relevant state laws. In
addition, a small number of commenters indicated that the regulations
of other Common Rule agencies, FDA in particular, may create
contradictory requirements, and called for clarification and a more
unified approach.
Several commenters stated that coordinating these additional
reviews with sIRB reviews would limit the gains in efficiency realized
from reliance on an sIRB. One commenter recommended that the NIH
develop a template IRB authorization agreement and guidelines to define
the institutional obligations that are distinct from the IRB review
responsibilities. Another commenter recommended that the NIH publish
guidance delineating the specific regulatory requirements for which the
sIRB would be responsible, shared responsibilities, and
responsibilities that an sIRB could negotiate with IRBs at
participating sites.
Resources and Funding. Several commenters described the proposed
policy as an unfunded mandate, or stated that it would result in a
shifting of expenses from one institution to another. Many commenters
expressed the concern that if costs associated with using a single IRB
are taken from a participating institution's indirect costs, there
would be insufficient funds for the local Human Research Protection
Program (HRPP) that still has institutional oversight responsibilities,
even if the IRB of record is external. Most commenters with experience
using a single IRB of record for multi-site research studies
recommended that indirect costs remain unchanged for relying
institutions in order to ensure that the human research protections
infrastructure are available for institutional responsibilities, e.g.,
post-approval compliance monitoring, conflict of interest reviews. Many
commenters noted funding sIRBs through indirect costs would divert
funds required to conduct research and
[[Page 40329]]
serve as a disincentive to conducting multisite research. The majority
of commenters stated a preference for including the additional costs
associated with a single IRB review in the study budget as direct cost,
although one commenter stated a preference that sIRB review be included
as an indirect cost in order to maximize the amount of funding
available for research.
Several commenters stated that the costs and resources needed to
establish sIRBs were not addressed by the proposed policy.
Infrastructure needs noted by these commenters included additional
staff and/or staff time to perform sIRB-related activities, costs to
create or adapt electronic managements systems that are interoperable
with outside institutions, and the time and cost of developing
communication tools to link investigators to IRBs outside their
institution. Other commenters familiar with the operations and use of
sIRBs noted that while initial financial support from the NIH may be
required to establish or expand the capacity of some IRBs to serve as
the IRB of record, most sIRBs should be able to become self-supporting
eventually.
Commenters had questions about whether plans for single IRB review
would be required in grant applications and how plans would be
reviewed.
Need for Implementation Guidance. A number of commenters pointed
out how important it would be for the NIH to provide practical guidance
to facilitate the implementation of the policy, with some commenters
stating that, in the absence of such guidance, burden and costs would
only shift between institutions rather than adding efficiency to the
IRB process. A few commenters noted that this guidance could be
developed using the experiences of IRBs that have already implemented
centralized IRB review processes.
In addition to general requests for implementation guidance, a
number of commenters made specific guidance suggestions. These
suggestions included the need for guidance covering:
The specific criteria to use for evaluation of IRBs of
record when selecting a single IRB for a multisite study;
The process for determining roles and responsibilities of
the sIRB versus IRBs of participating research sites and a standard
authorization agreement template that specifies these roles and
responsibilities. One commenter recommended that this guidance clearly
define who is responsible for ensuring investigator compliance, while
another recommended that this guidance cover review of modifications to
approved research, addition of research sites, and other post- approval
monitoring issues including the relationship between the IRB and a data
monitoring committee (such as a data and safety monitoring board). A
number of commenters asked the NIH to provide guidance about liability
as part of this guidance;
Processes for local IRBs working with an sIRB, including
what types of reviews will be performed by the local IRB (radiation
safety review, pharmacy review, conflicts of interest) and best
practices for maintaining oversight of research reviewed and approved
by a non-institutional IRB. Additionally, one commenter requested that
NIH encourage and provide guidance for institutional review of the
impact the sIRB will have on the institution's HRPP business goals,
policies, accreditation status, tracking and management processes;
Consent forms, including the process of consent approval
by the sIRB and participating sites, and whether and how local
institutions could alter an sIRB informed consent document to fit local
needs;
Plans to ensure quality and processes for institutions
relying on an sIRB to question or appeal sIRB decisions, and to address
and resolve issues arising from duplicate reviews.
In addition, commenters requested:
Guidance and tools to enable sIRBs to consider local
context issues. Specific guidance was requested on the process by which
sIRBs would collect local information (e.g., through a standard form or
through an ad hoc member or consultant with local context knowledge),
and what types of information should be provided to sIRBs (e.g., how to
apply state and local laws). One commenter also recommended that the
NIH develop a set of guidelines for how the sIRB would apply local
standards, knowledge of institutional policies, institutional capacity
issues, investigator and study staff qualifications, and local
community and subject considerations to their reviews;
An explanation of costs associated with development and
maintenance of sIRBs and guidance on how the use of an sIRB should be
proposed at the grant level, including a fee structure to help
investigators incorporate sIRB review into their budgets;
A more detailed description of the standards for
permitting exceptions for sIRB review;
A description of what resources, if any, NIH would make
available to assist in training IRBs and researchers regarding single
IRB review.
Some of the commenters who requested guidance recommended that any
NIH guidance on sIRBs be released along with or prior to the issuance
of the final policy.
Implementation of the Policy. In developing the final policy set
out below, the NIH carefully considered the many thoughtful comments we
received on the Draft NIH Policy on the Use of a Single Institutional
Review Board (IRB) for Multi-Site Research (NOT-OD-15-026). While we
found no compelling reason to narrow the essential scope of the final
policy--it will cover all domestic sites of NIH-funded non-exempt
multi-site studies as was proposed--we have clarified the policy intent
and modified several provisions. The final policy is intended to apply
only to studies where the same research protocol is being conducted at
more than one site; it does not apply to studies that involve more than
one site but the sites have different roles in carrying out the
research. Applicants/offerors will be expected to submit a plan
identifying the sIRB that will serve as the IRB of record for all study
sites. It will be the responsibility of the applicant/offeror to assure
that the sIRB is qualified to serve; the applicant's plan will not be
evaluated in peer review. The additional costs associated with sIRB
review may be charged to grants or contracts as direct costs, provided
that such costs are well-justified and consistently treated as either
direct or indirect costs according to applicable cost principles in the
NIH Grants Policy Statement and the FAR 31.202 (Direct Costs) and FAR
31.203 (Indirect Costs). Exceptions to the policy will be granted, as
was proposed, if the use of an sIRB is prohibited by federal, state, or
tribal laws or regulations. We will also grant exceptions where the
federal, state, or tribal prohibition on the use of an sIRB is
established by policy, and we will consider granting an exception if a
request is made and a compelling justification provided for why an
exception is needed. Such justifications could be for reasons other
than that the sIRB is unable to meet the needs of a specific
population, as was proposed in the draft policy. The final policy also
clarifies that multi-site studies within ongoing, non-competing awards
will not be expected to comply with the policy until a competing
renewal application is submitted.
The NIH recognizes that the policy will begin a paradigm shift in
IRB review. As such, the final policy will not take effect until May
25, 2017. In the interim, the NIH will issue guidance and provide
resources to assist awardees in adapting to the shift.
Guidance materials will be issued before the policy's effective
date and
[[Page 40330]]
posted along with the policy on the following site: https://osp.od.nih.gov/office-clinical-research-and-bioethics-policy/clinical-research-policy/models-irb-review. Among other topics, the guidance
will address:
How costs associated with sIRBs may be charged as direct
versus indirect costs;
Considerations in the selection of the sIRB;
The content of the sIRB plan that must be submitted with
applications and proposals;
Process for applicants/offerors to submit a request for an
exception and process for NIH review of the request for exception;
Roles and responsibilities of the sIRB and participating
sites;
Model authorization agreement that lays out the roles and
responsibilities of each signatory;
Models for gathering and evaluating information from all
the reliant sites about community attitudes and the acceptability of
proposed research;
A model communication plan that identifies when and which
documents are to be completed and shared with those involved so each
may fulfill their responsibilities.
Finally, while the NIH anticipates that that there will be
challenges associated with implementation, we expect these to be short-
lived. Once the transition to the new way of operating is made, the
benefits of widespread use of sIRBs will outweigh any costs and,
ultimately, reduce burdens to the research process. At the same time,
the NIH will also closely monitor the implementation of the policy,
consider its impact on research such as improvements in time to
initiation of research and reduction of unnecessary burden, and be
vigilant about any diminution in the protection of human subjects.
Final NIH Policy on the Use of a Single Institutional Review Board for
Multi-Site Research
Purpose
The National Institutes of Health (NIH) Policy on the Use of a
Single Institutional Review Board of Record for Multi-Site Research
establishes the expectation that all sites participating in multi-site
studies involving non-exempt human subjects research funded by the
National Institutes of Health (NIH) will use a single Institutional
Review Board (sIRB) to conduct the ethical review required by the
Department of Health and Human Services regulations for the Protection
of Human Subjects at 45 CFR part 46. This policy, which is consistent
with 45 CFR part 46.114, is intended to enhance and streamline the
process of IRB review and reduce inefficiencies so that research can
proceed as expeditiously as possible without compromising ethical
principles and protections for human research participants.
Scope and Applicability
This policy applies to the domestic sites of NIH-funded multi-site
studies where each site will conduct the same protocol involving non-
exempt human subjects research, whether supported through grants,
cooperative agreements, contracts, or the NIH Intramural Research
Program. It does not apply to career development, research training or
fellowship awards.
This policy applies to domestic awardees and participating domestic
sites. Foreign sites participating in NIH-funded, multi-site studies
will not be expected to follow this policy.
Consistent with the Roles and Responsibilities section, applicants/
offerors will be expected to include a plan for the use of an sIRB in
the applications/proposals they submit to the NIH. The NIH's acceptance
of the submitted plan will be incorporated as a term and condition in
the Notice of Award or in the Contract Award. This policy also applies
to the NIH Intramural Research Program.
Definitions
The Authorization Agreement, which is also called a reliance
agreement, is the agreement that documents respective authorities,
roles, responsibilities, and communication between an institution/
organization providing the ethical review and a participating site
relying on the sIRB.
A multi-site study uses the same protocol to conduct non-exempt
human subjects research at more than one site.
Participating site in a multi-site study is a domestic entity that
will rely on the sIRB to carry out the site's initial and continuing
IRB review of human subjects research for the multi-site study.
sIRB is the single IRB of record that has been selected to carry
out the IRB review requirements at 45 CFR part 46 for participating
sites of the multi-site study.
Roles and Responsibilities
This policy establishes the following roles and responsibilities:
Applicant/Offeror. In the application/proposal for research
funding, the applicant/offeror is expected to submit a plan describing
the use of an sIRB that will be selected to serve as the IRB of record
for all study sites. The plan should include a statement confirming
that participating sites will adhere to the sIRB Policy and describe
how communications between sites and sIRB will be handled. If, in
delayed-onset research, an sIRB has not yet been identified,
applications/proposals should include a statement that awardees will
follow this Policy and communicate plans to use a registered IRB of
record to the funding NIH Institute/Center prior to initiating a multi-
site study. The applicant/offeror may request direct cost funding for
the additional costs associated with the establishment and review of
the multi-site study by the sIRB, with appropriate justification; all
such costs must be reasonable and consistent with cost principles, as
described in the NIH Grants Policy Statement and the Federal
Acquisition Regulation (FAR) 31.302 (Direct Costs) and FAR 31.203
(Indirect Costs).
Awardees. Awardees are responsible for ensuring that authorization
agreements are in place; copies of authorization agreements and other
necessary documentation should be maintained in order to document
compliance with this policy, as needed. As appropriate, awardees are
responsible for ensuring that a mechanism for communication between the
sIRB and participating sites is established. Awardees may delegate the
tasks associated with these responsibilities.
Funding Institute or Center (IC). Funding ICs are responsible for
management and oversight of the award, including communicating with the
awardee regarding the implementation of its proposed plan to comply
with the sIRB Policy. In the event that questions arise about the
awardee's plan, including the IRB that has been selected to serve as
the sIRB, the funding IC will work with the awardee to resolve them.
sIRB. The sIRB is responsible for conducting the ethical review of
NIH-funded multi-site studies for participating sites. The sIRB will be
expected to carry out the regulatory requirements as specified under
the HHS regulations at 45 CFR part 46. In reviewing multi-site research
protocols, the sIRB may serve as a Privacy Board, as applicable, to
fulfill the requirements of the HIPAA Privacy Rule for use or
disclosure of protected health information for research purposes. The
sIRB will collaborate with the awardee to establish a mechanism for
communication between the sIRB and the participating sites.
Participating Site. All sites participating in a multi-site study
are expected to rely on an sIRB to carry out
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the functions that are required for institutional compliance with IRB
review set forth in the HHS regulations at 45 CFR 46. Participating
sites are responsible for meeting other regulatory obligations, such as
obtaining informed consent, overseeing the implementation of the
approved protocol, and reporting unanticipated problems and study
progress to the sIRB. Participating sites must communicate relevant
information necessary for the sIRB to consider local context issues and
state/local regulatory requirements during its deliberations.
Participating sites are expected to rely on the sIRB to satisfy the
regulatory requirements relevant to the ethical review. Although IRB
ethical review at a participating site would be counter to the intent
and goal of this policy, the policy does not prohibit any participating
site from duplicating the sIRB. However, if this approach is taken, NIH
funds may not be used to pay for the cost of the duplicate review.
Exceptions
Exceptions to this policy will be made where review by the proposed
sIRB would be prohibited by a federal, tribal, or state law,
regulation, or policy. Requests for exceptions that are not based on a
legal, regulatory, or policy requirement will be considered if there is
a compelling justification for the exception. The NIH will determine
whether to grant an exception following an assessment of the need.
Effective Date
This policy applies to all competing grant applications (new,
renewal, revision, or resubmission) with receipt dates on or after May
25, 2017. Ongoing, non-competing awards will not be expected to comply
with this policy until the grantee submits a competing renewal
application. For contracts, the policy applies to all solicitations
issued on or after May 25, 2017. For the intramural program, the policy
applies to intramural multi-site studies submitted for initial review
after May 25, 2017.
Dated: June 14, 2016.
Lawrence Tabak,
Deputy Director, National Institutes of Health.
[FR Doc. 2016-14513 Filed 6-20-16; 8:45 am]
BILLING CODE 4140-01-P