VA Central IRB

K. Lynn Cates, MDAssistant Chief Research & Development OfficerOffice of Research & DevelopmentDepartment of Veterans Affairs

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Human Research Has Changed

• New opportunities• Electronic age• Larger, more complex studies• Faster translation to clinical care

• New risks• Database Research (e.g., Medicare,

PTSD, TBI)• Genomics Research• Health Services Research

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VA Central IRBPurpose

Improving veterans lives• Enhancing the quality of human

research protection in VA-funded multi-site studies by ensuring • Expert ethical & scientific review• Local issues are addressed

• Enhancing efficiency of IRB reviews

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VA Central IRBLogistics

• Office of Research & Development (ORD)-funded studies only• ORD funding Service will determine if a study should

be reviewed by the VA Central IRB

• No charge to the field for using the VA Central IRB

• Staffed by PRIDE in ORD

• IRB members from all over the country

• Expert ad hoc advisors

• Monthly meetings

• VA Central IRB Web site

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VA Central IRB Reviews

• Full

• Expedited

• Exempt

• Continuing

• Waiver of HIPAA-compliant authorization

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IRB Composition

• @ 18 members

• 2 Co-chairs

• Mostly VA appointments• Without compensation (WOC) appointments

for non-affiliated members

• Compensation• @ 1/8 for members• @ 2/8 for co-chairs

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Nonvoting Members

• Regulatory affairs

• Legal

• Privacy & HIPAA

• Information security

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VA Central IRBProcess

• PI enlists sites

• PI submits protocol to VA Central IRB, including list of participating VA facilities

• Each participating VA facility submits a local site application

• VA Central IRB performs review

• Local VA facilities provide comments

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VA Central IRBProcess

• VA Central IRB is final arbiter

• Local VA facilities decide whether or not to participate

• Local R&D Committee must approve before research is initiated at that facility

• Other sites may be added later

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Federalwide Assurance (FWA)

• VHA Central Office (VHACO) will seek an FWA for the VHACO Human Research Protection Program (HRPP)• Institutional Official (IO) – PDUSH• Human Protections Administrator (HPA) – CRADO

• Local VA facilities that plan to use the VA Central IRB will amend their FWAs to include it as one of their IRBs of record

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MOU Between Local Facility & VHACO HRPP

• Memoranda of Understanding (MOUs) will be “crisp” agreements with clear delineation of respective• Roles• Responsibilities• Authorities

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VA Central IRBLocal Accountability

• Concept of Human Research Protection Program (HRPP) vs. IRB• Every VA facility that performs human

research has ultimate responsibility for its HRPP, even if it uses an external IRB (e.g., affiliate’s, another VA’s or the VA Central IRB)

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Local AccountabilityWho is Responsible?

• The local Institutional Official (IO) is the medical center director (MCD)• MCD & ACOS/R&D have ultimate

responsibility

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Local AccountabilityWho is Responsible?

• Who should be designated to provide local accountability & to provide local comments to the VA Central IRB? • IRB or designee• R&D Committee or designee• Other IO designee• Combination of the above

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Local AccountabilityLocal Roles & Responsibilities

• Knowledge of local research context• Community culture & attitudes (e.g.,

ethnicity, race, language, etc.)• Needs of differing subject populations• Research culture (e.g., depth & breadth of

local research program)• Professional & community standards• Research infrastructure (e.g., space,

equipment, etc.)• State & local laws (e.g., who can be legally

authorized representative)

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Local AccountabilityLocal Roles & Responsibilities

• Resources for local Research Office & HRPP

• Investigator oversight• Investigator responsibilities (e.g., hiring

qualified research personnel)• Research misconduct/impropriety (e.g.,

investigations of misconduct)

• Local R&D Committee Review

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Local AccountabilityLocal Roles & Responsibilities

• Training & credentialing (must keep documentation on file)

• Monitoring & auditing of projects

• Local handling of adverse events & unanticipated problems

• Other reviews (e.g., local R&D Committee, IACUC, Radiation Safety, etc.)

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VA Central IRBMeasures to Ensure High Quality

• Well-trained staff

• Qualified IRB chair & members

• Expert ad hoc advisors

• Formal peer-reviewed evaluation

• Routine ORO auditing & monitoring

• AAHRPP accreditation

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VA Central IRBMeasures to Ensure High Quality

• Work closely with • 4 ORD Services• ORO• OGC• Ethics • Privacy• OI&T

• Input from other Federal agencies (e.g., OHRP)

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VA Central IRBAdvantages

• Consistent expert ethical & scientific review

• More training & experience for IRB in reviewing multi-site studies

• Centralized investigator accountability

• Earlier identification of trends in adverse events

• Eliminates local conflict of interest

• Model for local VA IRBs

• More efficient IRB review of multi-site studies

• Gets research results to veterans faster

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VA Central IRBChallenges

• Ownership by local IRBs

• Assurance of review quality

• Expectations that it will solve everyone’s problems

• Affiliate relationships

• Conflict of interest

• Communication

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Contact InformationLynn Cates, MDAssistant Chief Research & Development OfficerDirector, PRIDE202-254-0282; lynn.cates@va.gov

Marisue Cody, PhDDirector, COACH202-254-0271; marisue.cody@va.gov

Annette AndersonVA Central IRB Administrator202-254-0204; annette.anderson3@va.gov

Lorna KamberVA Central IRB Coordinator202-254-0291; lorna.kamber@va.gov