Revised Common Rule and Proposed VHA Directive 1200.05 Update

Update on the significant changes in the Revised Common Rule and Proposed VHA Directive 1200.05, focusing on the impact on the IRB, membership, functions, and review of research. Details provided on the status of the Revised Common Rule, VHA Handbook 1200.05, and applicability of pre-2018 and 2018 requirements for studies with IRB approval or exemption determination.

• Common Rule Update
• VHA Directive
• IRB Changes
• Research Compliance
• Regulatory Updates

cweek Follow

Uploaded on Sep 08, 2024 | 0 Views

Download Presentation

Please find below an Image/Link to download the presentation.

The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author. Download presentation by click this link. If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.

Presentation Transcript

1. PART 2: The Revised Common Rule, Proposed VHA Directive 1200.05, and the IRB - Focus on Significant Changes C. Karen Jeans, PhD Soundia A. Duche, MA, MS ORPP&E (formerly PRIDE) Dial in: (213) 929-4212 Access Code: 870-113-815 Slides in Handout Tab December 18, 2018

2. Dial in: (213) 929-4212 Access Code: 870-113-815 Slides in Handout Tab Overview Provide a Status Update on the Revised Common Rule and VHA Directive 1200.05 VA Research on January 21, 2019 Review the remaining significant changes in the Revised Rule, Proposed VHA Directive 1200.05 and its effect on the IRB IRB Membership, Functions, and Review of Research (Part 1) Exempt Research (Part 1) IRB Review of Research (Part 1) Informed Consent and HIPAA (Part 1) Vulnerable Populations (Part 2) Definition (Part 2) Respond to unanswered questions from the November 29th 2 cyberseminar

3. Dial in: (213) 929-4212 Access Code: 870-113-815 Slides in Handout Tab Status of the Revised Common Rule September 2016 January 19, 2017 January 19, 2018 January 23, 2018 June 19, 2018 July 19, 2018 January 21, 2019 July 2011 1st six month delay to July 19, 2018 2nd six month delay to January 21, 2019 Final Rule revising the Common Rule Original effective/ compliance date Effective date Three burden- reducing provisions Compliance date 2018 Common Rule ANPRM NPRM Cooperative research provision (single IRB) compliance date remains January 20, 2020. 3

4. Dial in: (213) 929-4212 Access Code: 870-113-815 Slides in Handout Tab Status of VHA Handbook 1200.05 Will be issued as VHA Directive 1200.05 ORD's goal is to harmonize as much as possible VA's implementation of the revised Common Rule with other Federal Agencies and Departments, but there will be some VA specific requirements. Incorporates VHA Directive 1058.06, Research Conducted by Employees of VHA Program Offices Directive 1200.05 is in the final stages of concurrence All Program Offices have concurred VHA Office of General Counsel has concurred Office of Labor Management Relations (Union) is final step in the concurrence process prior to signature and publication 4

5. Two Common Rules, Which Applies? OR Pre-2018 Requirements 2018 Requirements (Revised Common Rule) Studies with IRB approval or exemption determination before January 21, 2019 Studies with IRB approval or exemption determination on/after January 21, 2019 Studies with IRB approval between July 19, 2018 - January 20, 2019 AND used burden reducing provision IRBs will be operating under both the 2018 and pre-2018 requirements for the foreseeable future 5

6. Must Comply with 2018 Requirements 2018 Requirements (Revised Common Rule) ORD Policy Decision: Studies with a final IRB approval date on or after January 21, 2019 must comply with the revised Common Rule, even if the convened board review generating an approval with modifications was conducted before January 21, 2019. Studies with IRB approval or exemption determination on/after January 21, 2019 Studies with IRB approval between July 19, 2018 - January 20, 2019 AND used burden reducing provision 6

7. IRB Approval on/after January 21, 2019 = 2018 Requirements Final, unconditional approval or exemption determination on or after January 21, 2019 Convened Board on/after January 21, 2019 Expedited review Reviewer signs off on/after January 21, 2019 Exempt studies IRB determined study to be exempt on/after January 21, 2019 7

8. Compliance Date with the 2018 Requirements Q1: Does the date of 1/21/2019 for compliance with the 2018 Requirements apply to final approval by the IRB or by the R&D Committee? Q2: Isn t the IRB approval date for a study the date that the convened IRB Votes to approve the study and not the date of the designated review? That is the way most IRBs function and the study (if approved) is approved for a time period from the date of the convened meeting. This simplifies the tracking of expiration dates as well. Form my reading of the Handbook, the IRB determines in their SOPs how they want to address this. Is this a misinterpretation? 8

9. Revised Common Rule/2018 Requirements and Proposed Changes in VHA Directive 1200.05: Significant Changes 9

10. Vulnerable Populations 10

11. Pregnant Women CURRENT VHA Handbook 1200.05 The VA medical facility Director certifies that the medical facility has sufficient expertise in women s health to conduct the proposed research. PROPOSED VHA Directive 1200.05 VA medical facility Director certification required for (1) Interventional studies or invasive monitoring of pregnant women as subjects (2) Neonatal research VHA Handbook 1200.05, Paragraph 17(b)(4)

12. In Vitro Fertilization Research CURRENT VHA Handbook 1200.05 Research that involves provision of in vitro fertilization services cannot be conducted by VA investigators while on official duty, or at VA facilities, or at VA- approved off-site facilities. PROPOSED VAH Directive 1200.05 Research that involves provision of in vitro fertilization services can be conducted by VA investigators while on official VA duty, at VA facilities, or at VA-approved off-site facilities. VHA Handbook 1200.05, Paragraph 17(a)

13. Fetal and Human Stem Cells CURRENT VHA Handbook 1200.05 Research in which the focus is either a fetus, or human fetal tissue, in- utero or ex-utero (or uses human fetal tissue), cannot be conducted by VA investigators while on official duty, at VA facilities, or at VA- approved off-site facilities. Use of stem cells shall be governed by the policy set by NIH for recipients of NIH research funding. VHA Handbook 1200.05, Paragraph 17(b) PROPOSED VHA Directive 1200.05 Research in which the focus is either a fetus, either in-utero or ex-utero can be conducted by VA investigators while on official VA duty, at VA facilities, or at VA-approved off-site facilities. Use of human fetal tissue and human stem cells shall be governed by the policy set by NIH for recipients of NIH research funding.

14. Research Involving Children CURRENT VHA Handbook 1200.05 PROPOSED VHA Directive 1200.05 No significant changes in VA policy regarding research involving children Clarification added that research involving children does not include neonates Research involving neonates must follow requirements for research involving pregnant women, fetuses, and neonates. VA research involving children must be no greater than minimal risk and must be relevant to the VA. IRB must have appropriate expertise to evaluate VA research involving children All requirements of 45 CFR 46.401-46.404 and 46.408 must be met prior to approving research involving children Approval from the VA medical facility Director must be obtained VHA Handbook 1200.05 Paragraph 19

15. Individuals with Impaired Decision Making Capacity CURRENT VHA Handbook 1200.05 VHA Handbook 1200.05, Paragraph 20 describes VA specific requirements when individuals with impaired decision-making capacity are subjects in VA research. PROPOSED VHA Directive 1200.05 ORD eliminated the VA specific requirements.

16. Research Involving Prisoners CURRENT VHA Handbook 1200.05 PROPOSED VHA Directive 1200.05 Waiver requests must be submitted electronically to the CRADO by the VA medical facility Director with the following documents: A letter from the VA medical facility Director supporting the conduct of the VA study involving prisoners; Rationale for conducting the research involving prisoners to include additional ethical protections taken by the proposed research for prisoners to make truly voluntary and uncoerced decisions whether or not to participate as subjects in research; Documentation of the Investigator s qualification to conduct the research involving prisoners, such as a biosketch and a list of all research team members; Location of institutions where the research is proposed to be conducted; A copy of the IRB approval letter specifically documenting its review determinations according to 45 CFR 46.305(a); A copy of the IRB minutes approving the research with documentation that at least one member of the IRB included a prisoner or a prisoner representative for the review of the research; A copy of the IRB-approved research study; A copy of the IRB-approved informed consent document; and A copy of the written HIPAA authorization. Research involving prisoners cannot be conducted by VA investigators while on official VA duty, at VA facilities, or at VA-approved off-site facilities unless a waiver has been granted by the CRADO. NOTE: Refer to the ORD Web site at http://www.research.va.gov/resources/ policies/default.cfm for details on the procedures for waiver applications. VHA Handbook 1200.05 Paragraph 18

17. Definitions 17

18. Definitions PROPOSED VHA Directive 1200.05 Eliminated In vitro Fertilization; Multi-site research; Serious Adverse Events New Clinical Trial; Federal-wide Assurance; Identifiable Private Info.; Identifiable Biospecimens; Sub-investigator; Signatory Official; Program Office Employee; Program Office Revised per 2018 Requirements Human Subject (38 CFR 16.102(e)); Intervention (38 CFR 16.102(e)(2)); LAR (38 CFR 16.102(i)); Research (38 CFR 16.102(l)) Minor Clarifications COC; De-identified info; Fetus; IO; Investigator; VA Investigator; Pregnancy; Private Info.; VA Research Unchanged Remaining definitions 18

19. Outstanding Questions from Part 1 (11/29/2018 Cyberseminar) 19

20. IRBs of Record CURRENT VHA Handbook 1200.05 The facility s IRB(s) of Record may include the facility s own IRB(s), the VHA Central Office IRB (VA Central IRB), an IRB of another VA facility, the IRB s of its affiliated medical or dental school, or an IRB of another federal agency PROPOSED VHA Directive 1200.05 The facility s IRB(s) of Record may include the facility s own IRB(s), VHA Central Office IRB (VA Central IRB), an IRB of another VA facility, the IRB(s) of an affiliated medical or dental school, or the IRB of another federal agency. A facility may also use for multi-site protocols an IRB from a non-affiliated medical or dental school if that IRB has been specifically designated by ORD as an IRB that may serve as a multi-site IRB for VA facilities. VHA Handbook 1200.05, Paragraph 5(d)(1)

21. IRB of Record Q3: Will their be a list of academic IRBs that are already approved by ORD on January 21, 2019? How can we get academic IRBs that are not on this list to be added to the ORD list? Q4: Will all current IRBs of Record be required to request inclusion on the list? Q5: You mentioned that 4 new IRBs are being considered as an external IRB for VA Are any commercial IRBs? 21

22. Privacy Officer/ISO Review CURRENT VHA Handbook 1200.05 PROPOSED VHA Directive 1200.05 Privacy and confidentiality provisions must take into consideration the requirements of Standards for Privacy of Individually-Identifiable Health Information (HIPAA Privacy Rule), 45 CFR Parts 160 and 164, and other laws regarding protection and use of Veterans and others information, including the Privacy Act of 1974, 5 U.S.C. 552a; VA Claims Confidentiality Statute, 38 U.S.C. 5701; Confidentiality of Drug Abuse, Alcoholism and Alcohol Abuse, Infection with Human Immunodeficiency Virus (HIV), and Sickle Cell Anemia Medical Records, 38 U.S.C. 7332; and Confidentiality of Healthcare Quality Assurance Review Records, 38 U.S.C. 5705 (see VHA Handbook 1605.1) VA-specific approval requirements has been eliminated. POs/IOs continue to serve as advisors to the IRB as either non-voting members or as consultants. POs must determine that appropriate authority exists to allow disclosure of individual names and other information to firms an Investigator contracts with to conduct research activities involving human subjects and their identifiable information. VHA Handbook 1200.05, Paragraph 10c(1) 22

23. ISO/PO Review Q6: Please clarify ISO and PO review role. Is their review still required for new VA protocols submitted to the IRB? Q7: Do the PO and ISO still have to fill out the Department of Veterans Affairs Checklist for reviewing Privacy, Confidentiality, and Information Security in Research? Q8: Is PO and ISO input required for exemptions requiring limited IRB review to ensure there are adequate provisions to protect the privacy of subjects and to maintain the confidentiality of their data? 23

24. IRB Approval and Limited IRB Review Addition of new approval criteria specific to limited IRB review for certain types of activities eligible for exemption (38 CFR 111(a)(8)) Limited IRB Review requirements: IRB does not have to ensure that all of the 111 approval criteria are met 4 instances when limited IRB review is required: Exempt Category 2(iii) and Exempt Category 3(i)(c): Ensuring that adequate provisions exist to protect the privacy of subjects and to maintain the confidentiality of their data. Exempt Category 7: Determine broad consent was obtained in accordance with the requirements; broad consent is appropriately documented or documentation is waived; and if a change is made for research purposes in the way the identifiable info or specimens are stored, there are adequate provisions to protect the privacy of subjects and maintain the confidentiality of their data. Exempt Category 8: Determine that the research is within the scope of the broad consent and that adequate provisions exist to protect the privacy of subjects and maintain the confidentiality of their data. 24

25. Limited IRB Review Q9: Do you have suggestions on what a limited IRB review form should look like? What specific questions need to be answered (especially if we are transitioning an expedited project to exempt like a simple chart review study)? 25

26. Broad Consent Revised Common Rule Proposed VHA Directive 1200.05 Broad consent can only be used when data or biospecimens are collected solely for research purposes VHA Directive 1200.05 does not allow IRBs to waive documentation of consent when broad consent is being obtained VHA Directive 1200.05 required elements for Broad Consent are aligned with the Revised Common Rule for research subject to the 2018 Requirements Broad consent form can be a separate form or combined with a traditional ICF If combined, information provided to subjects for broad consent must be clearly discernable from the research-specific consent Specific to storage, maintenance, and secondary use of identifiable data/biospecimens (collected for research or non-research purposes) Can be used as an alternative to general informed consent requirements 12 required elements that cannot be waived by the IRB if use of Broad Consent is approved 38 CFR 16.116(d) 26

27. Broad Consent Q10: Please define Broad Consent Q11: Can facilities decide NOT to adopt Broad Consent as long as it is documented in their SOPs? Q12: For VA-approved research, can Broad consent be used for the collection of samples/info for research purposes? Q13: If Broad Consent is combined with a traditional ICF, does the Broad Consent need its own signature block for the participant to sign (separate from the signature block for the traditional ICF)? 27

28. General Requirements for Informed Consent Revised Common Rule Proposed VHA Directive 1200.05 With the exception of Broad Consent, inclusion of a concise summary at the beginning of the ICF presenting key information that subject should know about the research study 8 basic elements and 6 additional elements of informed consent unchanged New basic element: For all studies that involve the collection of identifiable private information or identifiable specimens, include a statement on whether specimens if subsequently de-identified will be used for future research or not 3 new additional elements required when research involves biospecimens: Statement whether specimens may be used for commercial profit and if subject will share in the profit Statement whether clinically relevant research results will be disclosed to subjects and if so under what conditions Statement whether research might include whole genome sequencing VHA Directive 1200.05 requirements have been aligned with the Revised Common Rule for research subject to the 2018 Requirements The following required VA-specific elements have been eliminated: Any payments the subject is to receive for participating in the study Any real or apparent conflict of interest by investigators where the research will be performed 28

29. Informed Consent Q14: Will there be clarification re. what needs to go in the key information section for informed consent under the revised common rule? Preamble to the Final Rule suggests that the key information would include the following: 1. The fact that consent is being sought for research and that participation is voluntary; 2. The purposes of the research, the expected duration of the prospective subject s participation, and the procedures to be followed in the research; 3. The reasonably foreseeable risks or discomforts to the prospective subject; 4. The benefits to the prospective subject or to others that may reasonably be expected from the research; and 5. Appropriate alternative procedures or courses of treatment, if any, that might be advantageous to the prospective subject. 29

30. HIPAA Authorizations CURRENT VHA Handbook 1200.05 Proposed VHA Directive 1200.05 VA Form 10-0493, Authorization for Use & Release of Individually Identifiable Health Information for VHA Research, must be used to document the authorization. The authorization may not be embedded in the consent form. The written HIPAA authorization may either be a standalone document or combined with the research informed consent approved by the IRB. VHA Handbook 1200.05, Paragraph 23(a)(1) If a standalone document is used as the written HIPAA authorization, VA Form 10- 0493: Authorization for Use and Release of Individually Identifiable Health Information Collected for VHA Research must be used. 30

31. Informed Consent and HIPAA Q15: For all practical cases, it doesn t matter for the vast majority of research studies whether the informed consent form and HIPAA Authorization Form are combined or not they are usually handled as a group of documents requiring signatures in different places. 31

32. Collaborative Research Q16: The proposed 1200.05 has removed the language that states collaborative research involving non-VA institutions may not be undertaken without a signed written agreement that addresses such issues as the responsibilities of each party concerning ownership and reuse of data. Does this requirement for collaborative studies no longer exist? Or will this requirement be included in another handbook or directive? 32

33. Policy Q17: If revised 1200.05 contradicts another handbook (e.g. 1200.12 Data Repository Handbook) which handbook do we follow? 33

34. Resources 34

35. Important Links Final Rule for the Delay (published June 19, 2018) Revised Common Rule (published January 19, 2017) Pages 7259 to 7274 contain the Text of the Final Rule Current Common Rule VHA Handbook 1200.05 ORD Policies and Guidance Documents 35

36. ORD/ORO Cyberseminars on the Revised Common Rule Date Topic Records Management Engagement in Human Subjects Research MyhealtheVet and Secure Messaging Continuing Review Expedited Review Overview of the Revised Common Rule Working with the VA CIRB Final Rule: Delay Until January 21, 2019 of General Compliance of the Revised Common Rule and Use of Three Burden Reducing Provisions: What it Means for VA Research Lead Office ORD ORD ORD ORD ORD ORO ORD 30-Jan-18 20-Feb-18 20-Mar-18 24-Apr-18 15-May-18 16-May-18 19-Jun-18 27-Jun-18 and 02-Jul-18 ORD/ORO 17-Jul-18 18-Jul-18 Waivers: Common Rule, Privacy Rule, and FDA Regulations Informed Consent: ICFs; Broad Consent; and Posting of ICFs ORD ORO 18-Sep-18 19-Sep-18 Overview of the Revised Common Rule and its Impact on the IRB Exempt Review and Limited IRB Review ORD ORO 16-Oct-18 Q&A on the Revised common Rule The Revised Common Rule, Proposed VHA Directive 1200.05, and the IRB: Focus on Significant Changes External IRBs and FWAs ORPP&E Workshop: Studies that Must Follow the 2018 Requirements PART 2: The Revised Common Rule, Proposed VHA Directive 1200.05, and the IRB: Focus on Significant Changes ORD 26-Nov-18 4-Dec-18 14-Dec-18 ORD ORO ORD 18-Dec-18 ORD 36

37. ORD/ORO Recorded Trainings on the Revision of the Common Rule Series Cyberseminars conducted by ORD and ORO as part of the Revised Common Rule series can be found on the PRIDE cyberseminar webpage: https://www.research.va.gov/pride/cyberseminars/default.cfm 37

38. Questions? 38