Full Text AI-92-14 AIDS CLINICAL TRIALS UNITS AT MINORITY INSTITUTIONS NIH GUIDE, Volume 21, Number 39, October 30, 1992 RFA: AI-92-14 P.T. 34, FF Keywords: AIDS Clinical Trial Treatment, Medical+ National Institute Of Allergy And Infectious Diseases Letter of Intent Receipt Date: November 16, 1992 Application Receipt Date: January 21, 1993 The National Institute of Allergy and Infectious Diseases (NIAID) invites applications for establishing adult AIDS Clinical Trials Units (ACTUs) at minority institutions. o Institutions that have more than 50 percent minority student enrollment and award the M.D., D.D.S., D.V.M., or other doctoral degree in the health professions. PURPOSE The Division of AIDS (DAIDS) of the NIAID, administers a major clinical trials program to evaluate therapeutic interventions for the treatment of Human Immunodeficiency Virus disease (HIV), Acquired Immunodeficiency Syndrome (AIDS), and associated sequelae resulting from HIV infection. These objectives are accomplished through the AIDS Clinical Trials Group (ACTG) which consists of adult and pediatric ACTUs, the Statistical and Data Analysis Center (SDAC) and the DAIDS research programs. Appendix I, "Structure and Function of the ACTG", describes the cooperative model. Applicants are encouraged to read this section of the RFA before preparing an application. The purpose of this Request for Applications (RFA) is to encourage applications from minority institutions to establish Adult AIDS Clinical Trials Units and become part of the AIDS Clinical Trials Group (ACTG). The adult ACTG currently is composed of 35 institutions. Minority institutions are in a unique position to access and serve minority populations, and contribute to the overall ACTG effort to identify new therapeutic interventions for the treatment of HIV infection and its associated sequelae. These units could assume a leading role to specifically focus on research questions of particular relevance for HIV infected minorities and underrepresented populations. Applicants will be required to demonstrate expertise in conducting clinical trials to evaluate interventions for the treatment of HIV infection and for the treatment and prophylaxis of opportunistic infections associated with immunosuppression. Optional areas for proposed clinical studies include oncological and neurological complications of AIDS. Additional areas covered by this RFA include clinically relevant laboratory studies in virology, pharmacology, immunology. HEALTHY PEOPLE 2000 The Public Health Service (PHS) is committed to achieving the health promotion and disease prevention objectives of Healthy People 2000, a PHS led national activity for setting priority areas. This RFA, AIDS Clinical Trials Units At Minority Institutions, is related to the priority area of HIV infection. Potential applicants may obtain a copy of "Healthy People 2000" (Full Report: Stock No. 017-001-00474-0) or "Healthy People 2000" (Summary Report: Stock No. 017-001-00473-1) through the Superintendent of Documents, Government Printing Office, Washington, DC 20402-9325 (telephone 202- 783-3238). ELIGIBILITY REQUIREMENTS This competition is limited to domestic universities or colleges that possess the capabilities to conduct clinical research on HIV infection and AIDS. Applications may not contain an international component. Preference will be given to institutions that have more than 50% minority student enrollment. MECHANISM OF SUPPORT Awards funded under this RFA will be supported through National Institutes of Health Cooperative Agreements (U01). Assistance provided through the cooperative agreement differs from the traditional research grant in that the Government component (NIAID) anticipates substantial programmatic involvement during the performance of the award. The interaction of NIAID staff with the investigators is expected to facilitate the research. There is no intent, real or implied, for staff to direct an ACTUs activities or to limit the freedom of investigators. The nature of staff interaction is described below. All policies and requirements that govern the grant program of the U.S. Public Health Service and the National Institutes of Health apply to these cooperative agreements. This RFA is a one-time solicitation with a specified deadline for receipt of applications. Reissuance of this initiative is uncertain. If by the end of the third year of award NIAID has not announced an intention to reissue the RFA, awardees who plan to apply for continuing support should contact NIAID program officials for advice on how to recompete. FUNDS AVAILABLE Approximately $3,800,000 (total costs) will be available for the first year of funding. This level of support is dependent on the receipt of a sufficient number of applications of high merit and the availability of funds. Approximately three to four applications will be funded under this RFA. Awards will be made for a project period of four years. The anticipated award date is September 1, 1993. Funding beyond the first and subsequent years of the award will be contingent upon satisfactory performance during the preceding years, including meeting research objectives and patient accrual targets, and the continuing availability of funds for this purpose. RESEARCH OBJECTIVES Background: Infection with HIV and progression to AIDSis an increasing health risk for minority and underrepresented populations. Epidemiological data indicate that minorities are disproportionately affected by AIDS in comparison to the overall population. According to census figures, African Americans (12 percent), and Hispanics (8 percent) together account for approximately 20 percent of the U.S. population. The Centers for Disease Control has reported that as of March 1992 African Americans and Hispanics account for 29 percent and 16 percent, respectively, of the 218,307 AIDS cases in the United States. Of the AIDS cases reported among adult females, 52 percent are African Americans, 21 percent are Hispanic, and 25 percent are white. AIDS has become a major health problem for American citizens with a special impact on minority men and women. o For purposes of this RFA, minority and underrepresented populations are defined as individuals belonging to a particular group, gender, or subculture that has been determined by the NIAID to be underrepresented in AIDS clinical trials research. These include racial and ethnic minorities, injection drug users, and women. In awarding grants under this RFA, the NIAID will give priority to minority institutions that serve patient populations that are African American, Hispanic, Native American, and Asian/Pacific Islanders. Research Scope: Consistent with the objectives of the adult AIDS clinical trials program, all applicants will be required to demonstrate the capability to conduct efficacy trials on therapeutic interventions for the treatment of HIV infection; and both efficacy and prophylaxis trials on experimental interventions for opportunistic infections. Optional areas for which an applicant may choose to demonstrate capabilities include: (1) Phase I/II evaluation of interventions to establish safety, tolerance and pharmacokinetic behavior; (2) evaluation of interventions for the treatment of malignancies associated with immunosuppression; and (3) evaluation of therapeutic interventions for the neurological complications of HIV infection. Additionally, all applicants will have the option to apply for laboratory funding in support of the clinical trials. SPECIAL REQUIREMENTS o Terms of Award The current structure of the ACTG is tripartite: (1) adult and pediatric ACTUs, (2) the Division of AIDS, and (3) data and operations supports contracts (e.g., the Statistical and Data Analysis Center (SDAC) and the Operations Office). These three components comprise the ACTG system and cooperatively perform a wide range of scientific planning and coordinating functions related to the conduct of clinical trials. Included among those functions are: assessment of treatment research needs, establishment of scientific priorities, development of new research protocols, implementation and analyses of these studies, and the establishment of quality control programs to ensure that the data are of the highest quality. The scientific investigators at the ACTUs, through scientific committees and the Executive Committee, with assistance from TROP and CRP, develop a scientific agenda, set priorities for clinical trials, and initiate the development of protocols. The majority of ideas for clinical trials are initiated by ACTU investigators. Most Phase III protocols are open to participation by any ACTU. Phase I/Phase II protocols are usually conducted at a limited number of ACTUs. o Awardee Rights and Responsibilities The ACTU investigators will be responsible for the overall conduct of the research including developing concept sheets for studies, protocol development, accrual to protocols, production of high quality data, and the timely dissemination of the research results. All awardees must be capable of enrolling a minimum of 60 to a maximum of 150 new patients annually for four years after award. The Principal Investigator of each ACTU is responsible for the proper functioning of the main unit and any subunits, including all scientific and administrative aspects. ACTU performance in each budget period will determine the base budget award, release of increments of the base budget, and the amount of incentive funding (See Fiscal Managemnent) awarded during that budget period. The Principal Investigator will submit interim progress reports, due at the end of five months after the beginning of each budget period. This report will include a summary of expenditures and obligations to date and give the investigator the opportunity to comment on any circumstances at the ACTU that may compromise their ability to achieve their objectives. The level of support in future award years will be contingent upon performance. Inadequately justified performance, such as not meeting minimum accrual goals without justification or poor quality of data during a budget period, may result in reduction of future year awards or interruption of support. The Principal Investigators and other key ACTU personnel will attend regularly scheduled ACTG meetings in the Washington, DC area (or at a site designated by the NIAID). Investigators may form a clinical trials unit through consortium arrangements with other institutions or health care agencies. The goals of such arrangements are: (1) to contribute substantially to the capability of the awardee institution for recruiting and retaining patients on clinical trials; (2) to provide increased access to special patient populations (e.g., minorities and substance abusers, and adolescents); and (3) to provide special clinical or scientific expertise not available at the Main Unit. These collaborating institutions would be designated as Subunits, although ultimate financial and scientific responsibility would reside with the Main Unit. o NIAID Rights, Responsibilities, and Authorities NIAID Treatment Research Program (TRP) Substantial programmatic assistance is provided by the TROP and the CRP to ensure that ACTG clinical trials address questions of the highest scientific priority. The two programs support clinical trials research by providing scientific, technical, and administrative advice; facilitating protocol development and implementation; andreviewing protocols to ensure consistency, scientific soundness, and conformance with FDA requirements for Investigational New Drug (IND) trials. TROP and CRP coordinate the activities required to develop new agents from initial human trials to their final FDA approval. In addition, these programs facilitate the transfer of effective therapies from the research setting to routine patient care. Fiscal Management Clinical base funding consists of those resources required to maintain an infrastructure and ancillary services sufficient to accrue a projected minimum number of new patients each year. Clinical base funding includes costs support for protocol-mandated assays, ancillary services, and administrative costs. Clinical base funding is based on the projected number of new patients to be accrued each year. Each ACTU prepares a clinical base budget sufficient to accrue a minimum number of patients per year. The budgets are constructed using the costs of individual ACTG protocols to which patients may be enrolled and the number of patients projected to be accrued to those protocols. Clinical base funding to ACTUs will be administered in the following manner: the majority of clinical base funding will be released at the beginning of the budget year. At mid-period, the performance of the unit will be assessed by NIAID staff, using accrual, quality of data, and other measures of performance. This assessment will be based on an Interim Progress Report submitted by the Principal Investigator. If unit performance is satisfactory, the remaining increment of funding will be released. In the event of unsatisfactory ACTU performance (e.g., failure to meet accrual goals, poor data quality), the remaining funds will be reduced or withheld. Continued inadequately justified poor performance during the remaining months of the budget period may result in reduction of clinical core funding for the following budget period or interruption of support. A portion of the total ACTG budget may be set aside each year for Incentive Funding. These funds will be used to support activities such as: o funding of NIAID/ACTG designated high priority protocols not anticipated at the beginning of the budget period o increasing focus on a scientific area during a budget year for which resource needs exceed the funding of the individual ACTUs; o funding to supplement costs incurred as a result of substantial uncompensated participation by investigators in ACTG activities (e.g., travel or other program work, such as chairing an ACTG scientific committee). Incentive funding will be awarded either as administrative supplements after review by TROP and DEA staff, or as competing supplements. NIAID Staff Assistance The NIH will assist the AIDS Clinical Trials investigators through the NIAID staff. The NIAID scientific and program staff will provide assistance to recipients of cooperative agreements by advising and coordinating ACTG activities. The role of NIAID will be to facilitate and not to direct the activities. The terms described in this section are in addition to, and not in lieu of, otherwise applicable OMB administrative guidelines, HHS Grant Administration Regulations in 45 CFR Part 74, and other HHS, PHS, and NIH grant administration policy statements. NIAID staff, as designated, will be responsible for the following functions: o The Associate Director, TROP, and the Associate Director, CRP, will assist the ACTG Executive Committee in establishing the scientific priorities of the ACTG. o The Chief, Medical Branch, CRP, will assist in protocol development and assist the Chief, Clinical Research Management Branch, TROP, with review of protocols and advise on appropriate utilization of resources. o The Chief, Clinical Research Management Branch, TROP, will assist in promoting the timely implementation and completion of clinical trials designated as priority studies by the ACTG Executive Committee and the NIAID, and provide technical advice and assistance. o The Associate Director, TROP, as a member of the ACTG Executive Committee, will facilitate the early termination of a protocol (i.e., for insufficient accrual, patient safety and noncompliance with 45 CFR Part 46, inconclusive results, when it has been determined that further accrual will not add information of scientific value, when the emergence of new information makes the study question less relevant, when program objectives have been met, or when the limitations on the program budget require that ACTG funds be re-directed to higher priority areas). o The Associate Director, TROP, will coordinate activities among other areas of NIH-sponsored research and assist in dissemination of results of clinical trials to the scientific and medical communities. o The Chief, Operations and Data Management Branch, TROP, will assist in providing operational and data management support. The NIAID will serve as the sponsor for Investigational New Drug (IND) applications required for conducting studies of agents under evaluation by the ACTG, provide updated information on the safety and efficacy of investigational new agents supplied to ACTUs under an IND Application sponsored by the NIAID (Note: NIAID will not provide investigational agents or guarantee expenditure of NIAID funds for a study after requesting termination of the study); o The Chief, Pharmaceutical and Regulatory Affairs Branch, TROP, will conduct site visits to monitor the conduct of studies involving the use of investigational agents, compliance with regulations for Institutional Review Board (IRB) approval and informed consent (compliance with 45 CFR, Part 46), accuracy of data recording, completeness of reporting adverse drug reactions, and quality control (including periodic audits for quality assurance, investigational drug handling, and drug accountability). o The Chief, Clinical Research Management Branch, TROP, will conduct on-site visits to review progress of the research, and issues concerning administrative, technical, and fiscal management. For activities described herein that require approval by NIAID staff during performance of this cooperative agreement (e.g., protocol review and approval, early termination of a protocol, reports intended for inclusion in IND applications and clinical brochures, distribution of investigational agents from the government), the NIAID will establish an arbitration process to resolve major differences of opinion. An arbitration panel, composed of one ACTU designee, one NIAID designee, and a third designee with expertise in the relevant area and chosen by the other two will be formed to review any scientific or administrative issue and to recommend an appropriate course of action to the Director, DAIDS. In the event that the NIAID is the holder of the IND, any action taken by NIAID under its responsibility for the safety of the trial should not be subject to arbitration. The arbitration process in no way affects the right of an award recipient to appeal an action in accordance with PHS regulations in 42 CFR Part 50, Subpart D, and HHS regulations in 45 CFR, Part 16. o Cooperative Rights and Responsibilites of NIAID and the Awardee Committees of the ACTG There are nine ACTG Scientific Committees: Primary Infection, Opportunistic Infection, Oncology, Pharmacology/Pharmacokinetics, Neurology, Pediatrics, Immunology, Virology, and Women's Health. The scientific committees form the scientific nucleus of the ACTG. Each committee has a chair, vice chair, core member, and additional members with relevant expertise and interest in the committee's research area. Each committee also has representatives from TROP and CRP, SDAC, and HIV-infected persons and their advocates. Each standing committee has at least 10-15 members from awardee institutions and one to two members representing the NIAID. The role of each Scientific Committee, together with TROP and CRP, and the Executive Committee, is to develop a research agenda and establish research priorities in a particular scientific area and continually reassess those priorities relative to new research opportunities; and to evaluate the conduct and status of active studies. In addition to providing general expertise, the Immunology, Virology, and Pharmacology Committees also have responsibility for developing and recommending laboratory quality assurance policies in the areas of flow cytometry, viral assays, marker evaluation, and pharmacological assays. The Committees meet during each ACTG meeting. In addition, committees meet and/or are in contact at times other than ACTG meetings. Resource Committees were formed to provide technical expertise and practical advice to the ACTG. There are three ACTG Resource Committees: Site and Data Management, Patient Care, and the Community Constituency Group. The Executive Committee, in consultation with TROP and CRP, develops general ACTG policies concerning committee structure and membership, committee operations, publications, access to data, interim data monitoring, and agendas for the group meetings. In addition, the Executive Committee, with assistance from TROP and scientific committees, and establishes scientific priorities for the ACTG. The majority of the members of the Executive Committee are ACTU investigators. Representatives from TROP and CRP, persons from the Community Constituency Group (including HIV infected individuals), and the SDAC also sit on the Executive Committee. Protocol Development Ideas for individual studies may be introduced from any source, although most come from ACTU investigators. Proposed studies are summarized in the form of a "concept sheet", which includes the study's rationale, objectives, design, eligibility criteria, treatment regimen, sample size estimates, and cost impact projections. The concept sheets are reviewed by TROP and CRP staff members comprising a Clinical Trials Review Committee (CTRC). The appropriate Scientific Core Committees and the Executive Committee review, approve, and prioritize concept sheets. Approved concept sheets are developed into protocols by a team composed of a protocol chair (an ACTU investigator); TROP and CRP representatives; an SDAC statistician; an Operations Office representative; and immunologist, virologist, pharmacologist, as required. Because most ACTG clinical trials are conducted under an IND held by the DAIDS/NIAID, regulatory requirements mandate review and approval of protocols by the NIAID CTRC prior to their initiation. After FDA approval of the final protocol it is opened for enrollment. Once a protocol has been activated, the protocol chair is responsible for its ongoing performance and is expected to take the lead in dissemination of study results, including publication of results. Access to Data, Ownership of Data, and Publication Policies In addition to the reporting requirements currently in existence for awardees of traditional NIH research project grants, the following apply: Reports of data generated by the ACTG or any of its member ACTUs that are required for the NIAID to fulfill its role as sponsor of an investigational agent must be submitted by the Principal Investigator upon request of the Chief, Pharmaceutical and Regulatory Affairs Branch, TROP. These include: data required for inclusion in IND Applications, Clinical Brochures, and similar documents, as well as, periodic reports to the FDA and other regulatory agencies. The NIAID will have access to all data generated under this cooperative agreement and will periodically review the progress reports. Information obtained from the data may be used by the NIAID for the preparation of internal reports on ACTG activities and to fulfill regulatory requirements. However, the awardees will retain rights to the data (see below). Publication of findings is the responsibility of the investigators in accordance with the publication policies established jointly by the ACTG investigators and the Associate Director, TROP. Publication or oral presentation of work performed under this agreement is the responsibility of the Principal Investigator and will require appropriate acknowledgement of NIAID support. ACTG member institutions will generate clinical trials data that will be submitted to the SDAC. In most cases, these institutional data will represent only a small subset of the total database for a given clinical trial and therefore, will have limited scientific value. The investigators, with the assistance of the Associate Director, TROP, will establish policies limiting publication of such institutional data. These institutional data will remain the property of the awardee from which they originated, even following submission to the SDAC. The entire database for a particular trial will usually come from more than one institution. While physically located at the SDAC, the use and publication of the data will be governed by policies established by the ACTG investigators and the Associate Director, TROP. The Associate Director, TROP, and the Associate Director, CRP, will have access to the data and will require periodic special reports of data generated by the ACTG or any of its members as described above. As required for safety monitoring of clinical protocols, the Associate Director, TROP, and the Associate Director, CRP, will have access to the data. In the event of a collaboration with a pharmaceutical company for the evaluation by the ACTG of an investigational agent, a memorandum of understanding among the Associate Director, TROP, participating ACTU Principal Investigators, and the company will set forth the details providing for access by the company to necessary data. Failure to abide by these terms of the award may result in withholding of funds by the NIAID. STUDY POPULATIONS SPECIAL INSTRUCTIONS REGARDING INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH STUDY POPULATIONS NIH policy is that applicants for NIH clinical research grants and cooperative agreements will be required to include minorities and women in study populations so that research findings can be of benefit to all persons at risk of the disease, disorder or condition under study; special emphasis should be placed on the need for inclusion of minorities and women in studies of diseases, disorders and conditions which disproportionately affect them. This policy is intended to apply to females of all ages. If women or minorities are excluded or inadequately represented in clinical research, particularly in proposed population-based studies, a clear compelling rationale should be provided. The composition of the proposed study population must be described in terms of gender and racial/ethnic group, together with a rationale for its choice. In addition, gender and racial/ethnic issues should be addressed in developing a research design and sample size appropriate for the scientific objectives of the study. This information should be included in the form PHS 398 in the Research Plan and summarized in Item 5, Human Subjects. Applicants are urged to assess carefully the feasibility of including the broadest possible representation of minority groups. However, NIH recognizes that it may not be feasible or appropriate in all research projects to include representation of the full array of U.S. racial/ethnic minority populations (i.e., Native Americans, including American Indians or Alaskan Natives, Asian/Pacific Islanders, African Americans, Hispanics/Latinos). The rationale for studies on single minority population groups should be provided. For the purpose of this policy, clinical research includes human biomedical and behavioral studies of etiology, epidemiology, prevention (and preventive strategies), diagnosis, or treatment of diseases, disorders or conditions, including but not limited to clinical trials. The usual NIH policies concerning research on human subjects applies to ACTUs and subunits. Basic research or clinical studies in which human tissues cannot be identified or linked to individuals are excluded. However, every effort should be made to include human tissues from women and racial/ethnic minorities when it is important to apply the results of the study broadly, and this should be addressed by applicants. If the required information is not contained within the application, the application will be returned. Peer reviewers will address specifically whether the research plan in the application conforms to these policies. If the representation of women and minorities in the study design is inadequate to answer the scientific question(s) addressed AND the justification for the selected study population is inadequate, it will be considered a scientific weakness or deficiency in the study design and will be reflected in assigning the priority score to the application. All applications for clinical research submitted to NIH are required to address these policies. NIH funding components will not award grants or cooperative agreements that do not comply with these policies. LETTER OF INTENT Prospective applicants are asked to submit, by November 16, 1992, a letter of intent including the components for which an application will be submitted, the name and institution of the Principal Investigator. Names of prospective co-investigators should be included. The letter of intent is requested in order to provide an indication of the number and scope of applications to be reviewed and to promote early interactions between applicants and NIAID staff. The letter of intent does not commit the sender to submit an application, nor is it a requirement for submission of an application. The letter of intent should be sent to Dr. Frederick Batzold (see INQUIRIES below.). APPLICATION PROCEDURES Structure And Composition Of The Application All applications are to be submitted on the form PHS 398(rev. (9/91). The application should be assembled and paginated as one complete document. A separate narrative and itemized budget with justification must be prepared for each component for which support is requested. Detailed instructions for the preparation of budgets are given in Item II B: "Budget Requirements, pp.15 to 17. Part A Adult Clinical Trials Unit (REQUIRED) Part B Laboratory Support o Virology (REQUIRED) o Pharmacology (OPTIONAL) Part C Developmental Research (ALL OPTIONAL) o Virology o Pharmacology o Immunology o Other (Clinically Relevant Areas) I. COMPONENTS OF THE RESEARCH PLAN PART A: ADULT CLINICAL TRIALS UNIT ITEM C, RESEARCH PLAN (PHS 398), SHOULD ADDRESS THE FOLLOWING AREAS STUDY AREAS Applicants are required to describe their proficiency in conducting clinical trials and proposed plans for research in the areas of antiretroviral interventions and the treatment/prophylaxis of opportunistic infections. Optional areas for which past experience and proposed plans may be submitted include the evaluation of interventions for AIDS related malignancies and neurological complications of HIV infection. o PROFICIENCY Describe previous experience in conducting clinical trials, particularly HIV research. Include the types of studies (Phase I/II/III), the size of the studies, the source of study participants, and the demographic features of the population. Describe prior participation in the design and development of clinical trials protocols. Applicants that were funded under the Minority Infrastructure initiative (RFA AI-90-04) should describe their accomplishments in establishing a clinical trial infrastructure. o PROPOSED STUDIES A list of currently open ACTG protocols for adult patients is given in Appendix III. Describe the plan for participation in types of studies (Phase I/II/III) and kinds of studies (antiretroviral interventions, treatment and prophylaxis of opportunistic infections). Estimate the total number of patients to be accrued in the first year and a projection as to the types and kinds of studies in which the ACTU plans to participate. Provide the same information that is requested in B.1. if optional studies in oncology and neurology are proposed. Describe the experience and responsibilities of key staff necessary for each area of emphasis. Describe the special scientific expertise, patient populations, and other unique features that the proposed site would bring to the ACTG effort. o ADMINISTRATIVE AND ORGANIZATIONAL STRUCTURE Describe the administrative and organizational features that will be implemented to support the proposed studies. The following areas should be addressed. The proposed administrative structure of the clinical trials unit. The administrative relationship of the clinical trials unit to patient care clinics that serve the proposed population for the ACTG research studies. Indicate whether or notthe clinical trials unit will be a integrated with the primary care activities. The qualifications, experience and responsibilities of key administrative personnel including the nurse coordinator and co-investigators. Include other personnel that may be available to the ACTU through institutional or other agreements. o FACILITIES Describe the facilities available for both inpatient and outpatient studies at the main ACTU and any subunits. Describe the location(s), relative to the ACTU, where the study participants receive their primary care and whether any common space will be used for both purposes. o OUTREACH AND RECRUITMENT Provide a clear, concise plan for outreach and recruitment of clinical trials participants. This plan must document the capability to enroll a Minimum Of 60 New Patients To A Maximum Of 150 On An Annual Basis into ACTG protocols. The plan should address the following: The primary source of study participants such as primary care clinics, consultative services, HIV testing sites, referral from community-based clinics/physicians or other sources. The demographic features of the patient population in the catchment area including the number of AIDS cases, HIV seroprevalence, gender, race/ethnicity, and risk transmission categories. Data on prior success in accruing patients to clinical studies or data from clinic records from which an estimate can be made of the number of patients that may be available for ACTG studies. If referral sources are to be utilized, describe the policies and procedures for communication and the arrangements that will be implemented for continued primary care of study participants. o ANCILLARY SERVICES AND LINKAGES Provide a plan for the delivery of ancillary services. The resources should include language interpretation, as applicable, child care, patient transportation, and other services necessary for the recruitment and retention of patients. Describe the types of personnel, and their responsibilities that are being requested or will be provided through other sources. Culturally sensitive individuals representative of the patient population must be included. Linkages are intended to foster the provision of multidisciplinary services and support in a collaborative environment with the patient community. The listing of support linkages given below are either REQUIRED or strongly ENCOURAGED, as indicated. Letters of agreement in support of these linkages and definitive plans to implement the arrangements should be included. A list of government funded projects with which linkages are encouraged or required is given in Appendix IV. o Community Advisory Board (CAB) [REQUIRED]. A Community Advisory Board must be established at each ACTU. The purpose of this interaction is to inform the patient community about the availability of ACTU studies and provide input about study design and other factors that might affect patient acceptance of, or compliance with, ACTG protocols. Describe the proposed composition of the CAB and functions to be performed for the ACTU. Inclusion of women and minorities on the CAB is required and should reflect the demographics of the HIV infected population in the catchment area. o Community Program for Clinical Research on AIDS (CPCRA) [REQUIRED] Establish a formal communication linkage with NIAID funded CPCRA sites located in the same SMSA. The purpose of this relationship will be to make certain that the most appropriate clinical trials programs are available to patients in the catchment areas and that there is no competition for study participants. A letter of agreement should be included that has been co-signed by the CPCRA Principal Investigator. The letter should describe procedures for screening, recruitment, and assignment of patients to protocols and whether any staff or facilities will be shared by the two programs. o General Clinical Research Center (GCRC) [ENCOURAGED] Institutions that have a GCRC funded by the National Center for Research Resources may identify the GCRC as a resource for conducting studies. A letter of agreement from the GCRC should be included if this resource is to be utilized. o HRSA AIDS Demonstration Projects [ENCOURAGED] If a HRSA project is in the same SMSA, it is strongly encouraged that a working relationship be established as evidenced by a letter of agreement. o National Institute on Drug Abuse (NIDA) Treatment and Research Centers [ENCOURAGED] In order to increase the number of HIV infected drug users or former users in ACTG protocols, applicants are encouraged to establish agreements with NIDA Centers located in the community from which patients will be accrued. o Describe any other linkages that will be established in support of the ACTU including, but not limited to: community based organizations, designated state AIDS centers, and the NCI lymphoma network. o DATA MANAGEMENT PLAN A list of required computer equipment is found in Appendix V and may be requested in the application. o Describe a plan for managing the clinical trials data. The plan should take into account that Federal Regulations require the retention of research records for investigational drugs for two years after a marketing application is approved. Additionally, if a drug is disapproved or all studies are terminated the record must be retained for two years following the discontinuation of shipment and delivery. o The data management plan should describe: the expertise and duties of the data manager relative to data management, oversight and supervision procedures for staff training on the protocol requirements procedures for the transcription of data to the primary research record and the time to data entry into the data base the design, maintenance, and security of the filing and storage of patient charts and records the quality assurance procedures that will be implemented at the ACTU to ensure the accuracy and completeness of all research records and compliance with Federal Regulations regarding clinical trials in human subjects o PHARMACY PLAN Applications must provide a pharmacy plan that addresses the development and implementation of investigational drug control systems for the ACTU and any subunits where investigational drug will be dispensed. o The plan must conform with the guidelines of the ACTG Pharmacy Manual (available upon request from the ACTG Operations Office, (301) 230-3150) and FDA regulations on the use of investigational drugs. The plan must address the following: experience of the key staff in managing investigational studies procedures for dispensing procedures for drug accountability and record keeping drug storage provide documentation of the commitment of pharmacy staff and their duties and responsibilities. adequate staff number of must be identified to ensure time for patient education activities. o IMMUNOPHENOTYPING All ACTUs must have the capability for performing flow cytometric immunophenotyping either on site or through an agreement with another ACTG certified laboratory. The laboratory must have the capability to perform two- and three-color flow cytometric immunophenotyping on whole blood samples using a laser-based instrument on a minimum annual number of 500 samples. Minimum required immunophenotypes include: CD4, CD8, CD3, CD19, CD45, and CD14. Other phenotypes that may be required include: CD25, CD38, CD45RA, CD45RO, DR, CD56, AND CD16. The use of existing ACTG-certified laboratories is strongly encouraged when possible. Laboratories conducting ACTG analyses shall be required to adhere to the methodological guidelines set forth by the DAIDS Flow Cytometry Advisory Committee and to participate in the DAIDS immunophenotyping quality assessment program. o Describe the available instrumentation and the analytical methodologies used for the enumeration of the immunophenotypes. o Describe the qualification and experience of key personnel. o Describe the internal quality control/quality assurance programs, including references ranges, for the laboratory. Provide the specifics of any QC/QA or proficiency testing programs in which the laboratory has participated. PART B: LABORATORY SUPPORT FOR CLINICAL TRIALS A major goal of the ACTG is to maintain the capability to address all aspects of clinical drug evaluation. ACTG virology and pharmacology laboratories will evaluate clinical specimens as required by the ACTG protocols and develop new methodologies in support of these protocols. The number of comprehensive virology and pharmacology laboratories will be sufficient to meet the demands of the ACTG; however, the present need is less than the number of ACTUs. These laboratories may be required to accept specimens for analysis from other ACTUs on a fee-for-service basis. o 1. VIROLOGY (REQUIRED) Applicants must submit a plan describing the capability to perform and/or obtain virology laboratory services as required by ACTG protocols. In order to meet the protocol mandated virology requirements, each applicant will have three options Option 1: As a comprehensive virology laboratory, perform all protocol mandated determinations (e.g., p-24 antigen, PBMC quantitative HIV culture, resistance assays, DNA/RNA PCR) on site, and implement new methods/assays as needed. Option 2: Perform only HIV p-24 antigen assays and HIV PBMC cultures on site and have another ACTU laboratory perform the other protocol required virological assays on a fee-for- service basis. Option 3: Arrange for all virological assays to be performed by another ACTU laboratory on a fee-for-service basis. All ACTUs performing virologic assays must: (1) use Dataworks TM software for data transmission, (2) adhere to ACTG consensus protocols, and (3) participate in the DAIDS virology QA programs. The following information should be provided when applying for Option 1: o prior experience in the development and application of virologic assays relevant to HIV disease o experience in, and procedures for, culturing HIV from clinical samples (PBMC and plasma) and for HIV p-24 determinations o procedures for antiviral drug resistance assays o procedures for performing HIV DNA/RNA PCR o intra- or interlaboratory QC/QA procedures o procedures for the storage and inventory of specimens o estimated number of assays/year to be performed and the total cost/assay Option 2: Elements 2, 5, 6, and 7 from Option 1. Option 2/3: Applicants having some or all of their virology performed at another ACTG laboratory should provide the following information: o a letter of agreement from the ACTU laboratory that will be performing the assays o procedures for processing and shipping samples o the total cost/sample/assay (e.g., labor, supplies, data analysis etc) o estimated number of assays/year o 2. PHARMACOLOGY (OPTIONAL) ACTU pharmacology laboratories will perform protocol mandated therapeutic drug monitoring, and develop new assays to monitor drug levels using a variety of methodologies. All ACTUs performing therapeutic drug monitoring must adhere to ACTG consensus protocols and participate in DAIDS administered QA programs. Applicants should provide the following information: o prior experience in the development and application of methodologies for therapeutic drug monitoring with specific reference to drugs used in the treatment of HIV disease o capability to perform a minimum annual number of 500- 1000 drug level assays for an agent such as a nucleoside analog o procedures for the storage and inventory of specimens o intra- or interlaboratory QC/QA procedures o estimated cost/sample (e.g., labor, supplies, data analysis) for assays currently being performed PART C: DEVELOPMENTAL RESEARCH (OPTIONAL) Access to clinical samples from patients with detailed medical histories provides a unique resource to support research leading to improved diagnosis, monitoring, and treatment of individuals with HIV infection. The primary objective of the developmental research is to provide investigators with resources to answer clinically relevant questions with emphasis on utilizing specimens generated from ACTG protocols. The research may be broad in scope but must be of high clinical relevance and includes: o 1 Developmental Virology o 2 Developmental Pharmacology o 3 Developmental Immunology o 4 Other (e.g., mycology, neurology, patient compliance Applicants for components C.1 - C.4 should follow the instructions in the form PHS 398 (rev. 9/91) including an abstract, specific aims, background and significance, preliminary studies, and research design and methods. Research projects are encouraged but not limited to the following areas o 1: Developmental Virology o identification and validation of virological markers (phenotypes/genotypes) correlating with clinical disease o quantitation of viral burden and infectivity in body fluids and tissues o development of improved methodologies to screen for antiviral drug resistance and evaluate strategies to overcome resistance o characterization of drug resistant phenotypes o 2: Developmental Pharmacology o drug-drug interactions in combination therapies o pharmacokinetics and pharmacodynamics in diverse patient populations o improved methodologies for therapeutic drug monitoring o drug levels in target tissues/cells/subcellular compartments o effect of disease state on drug toxicity, pharmacokinetics and metabolism o 3: Developmental Immunology o characterization of immune cell phenotypes and functions o characterization of soluble products of immune activation o evaluation of the immune response to AIDS-associated opportunistic pathogens o 4: Other Developmental Areas o interaction of human host and opportunistic pathogens o development and validation of rapid, sensitive diagnostic methods for opportunistic pathogens o resistance of opportunistic pathogens to therapeutic agents o issues relevant to acceptance of and compliance with ACTG protocols by study participants II. ORGANIZATION OF THE APPLICATION AND BUDGET REQUIREMENTS o ORGANIZATION OF APPLICATION All applicants must apply for Part A, AIDS Clinical Trials Unit, and Part B (1) Virology Component Part B (2) and Parts C 1-C.4 are optional. Awards for Parts B and/or C will be contingent on receiving an award for Part A. Awards for Developmental Research in Virology (C.1) or Pharmacology (C.2) will be contingent upon receiving an award as a comprehensive virology laboratory (Option 1) or as a comprehensive pharmacology laboratory, respectively. Requests for support for Parts B and C may be made through a subcontractual agreement with another institution. GENERAL INSTRUCTIONS FOR PARTS A, B, AND C. Page 1 (Face Page) of PHS 398 Complete items 1 - 18 as instructed. This should be the first page of the application and all succeeding pages should be numbered consecutively. Items 7 & 8: The requested budget should be the total amount for all components for which support is requested (Parts A, B & C). Page 2 of PHS 398 The abstract should contain a brief description of the proposed work and objectives. Under "Key Personnel Engaged on the Project" List the Principal Investigator of the ACTU and the Program Directors of each component. Page 3 of PHS 398 Prepare a detailed Table of Contents that will allow reviewers to readily locate specific information for each component. Page 4 of PHS 398 The application should contain a Composite Budget for the first twelve month budget period. The Composite Budget should include the subtotals for the individual detailed budgets for each component in the application. The subtotals for each category (personnel, equipment supplies etc) on the Composite Budget page should be identified by the component (Part A, B.1, C.1 etc). Justification for budget elements should be presented in the individual component budgets. Page 5 of PHS 398 A summary total budget for all components applied for should be presented for all years for which support is requested. Note: For more detailed instructions on the budget see "B. BUDGET REQUIREMENTS," below. Page 6 and 7 of PHS 398 Biographical sketches and information on Other Support for all professional personnel for all components should be placed at the end of the application with the Principal Investigator first followed by other key personnel in alphabetical order. B. BUDGET REQUIREMENTS ORGANIZATION OF BUDGET PAGES For each individual first-year budget (A) prepared for a given component, a corresponding four-year summary budget (B) should also be prepared. Page 4 of the PHS Form 398 should be used for all "A" budgets. Page 5 of PHS Form 398 should be used for all "B" budgets. o (A) 12-month budget for Part A (AIDS Clinical Trials Unit) o (B) Four year summary budget for Part A o (A) 12-month budget for Part B.1 (Virology) o (B) Four year budget for virology o (A) 12-month budget for each optional component applied for (B.2 Pharmacology; C.1 Developmental Virology; C.2 Developmental Pharmacology; C.3 Developmental Immunology; C.4 Other o (B) Four year budget for each optional component o (A) Composite 12-month budget: total of all (A) budgets above o (B) Composite summary four year budget: total of all (B) budgets above All budgets must be placed following Page 3 of the overall application, with the composite budgets (7. and 8. above) being first, followed by the budgets for Part A, then Part B.1 etc. The 12-month budget for each component must be immediately follwoed by the applicable four-year budget. These budget pages should be numbered consectively and appropriately referenced in the "Table of Contents." Each budget page must have the appropriate title corresponding to the specific component, in the upper margin of the page. CLINICAL BASE FUNDING - PART A That portion of the ACTU budget specifically related to the accrual of patients and conducting protocols is designated Clinical Base funding. It will include the resources necessary to maintain a clinical trials infrastructure. Clinical base funding will include: Protocol Specific Costs: All resources necessary for the study of a projected number of patients on to ACTG protocols for the duration of the protocol. Costs Not Directly Related to A Specific Protocol: Costs necessary for the recruitment, screening and retention of patients, ancillary services, and administrative costs. Clinical budgets will be constructed by projecting the cost of performing clinical trials protocols to a projected number of patients to be accrued on an annual basis. These costs will represent a major portion of the Clinical Base budget and are the protocol specific costs. CONSTRUCTION OF DETAILED CLINICAL BASE BUDGET The clinical base budget will provide support for all aspects necessary for conducting clinical studies. Specifics that may be requested in addition to essential elements for the functioning of the ACTU, include, but are not limited to are: Personnel: Specialized personnel for the recruitment and retention of study participants, subspeciality clinical staff (e.g., neurologist, neuropsychologist, oncologist, gynecologist). Equipment: Computer equipment and software may be requested. Supplies: Clinical, administrative, pharmacy and those necessary for performing flow cytometry. Travel: Limited to a total of 24 trips annually to ACTG sponsored meetings. Scientific meetings are limited to $2000/year and foreign travel, if applicable, to $3000/year. Patient Care: Include the projected costs for performing clinical laboratory tests and charges for in-patient care that will be required by clinical trials protocols. The amount requested should be justified based on the number of patients the ACTU projects to accrue annually. Additional Information: Appendix VI contains a list of the specific laboratory tests that may be required by ACTG protocols. Applicants are required to provide the research costs for performing these tests at their institution. If multiple performance sites are proposed which have signicantly different costs, the cost/test may be provided for the individual sites. The costs for the laboratory tests should be attached as an APPENDIX to the application. These costs will be used to evaluate reasonableness of the patient care costs being requested. Other Expenses: Patient travel vouchers, to and from scheduled protocol visits, child care, and other support at the ACTU to enhance participation by individuals who otherwise may not be able to participate. Applicants that were funded as Minority Infrastructure Sites under RFA 90-AI-04 should include a separate detailed budget for ACTG protocol patients projected to be on study as of 9/93. If an award is made, this request may be negotiated to adjust for the actual number of patients continuing on study at that time. LABORATORY SUPPORT FOR VIROLOGY AND PHARMACOLOGY - PART B A detailed budget must be prepared for each laboratory component for which funding is requested. The budget for components B.1 (Option 1) and B.2 are limited to $140,000 in direct costs/budget period exclusive of equipment. If applying for B.1 (Option 2 or 3), the total direct costs are limited to $70,000/budget period. Part B.1: Virology Option 1: As a comprehensive virology laboratory, include all personnel, equipment, supplies etc in the budget. Option 2: Include all personnel, equipment, supplies etc for performing p-24 antigen and PMBC cultures as part of the ACTU. Additionally, include the costs of processing (personnel and supplies) and shipping the other virology samples to another ACTG laboratory. The total costs for the samples that will be assayed on a fee-for-service basis should be included in the "Other Expenses" category. OPTION 3: The costs of processing (personnel, supplies) and shipping the samples should be included. The total costs for all the tests performed on a fee-for-service basis should be included in the "Other Expenses" category. Part B.2: Pharmacology No special instructions. PARTS C.1 - C.4: DEVELOPMENTAL RESEARCH Detailed budgets must be prepared for each Developmental Research component for which funds are requested. Total budget requests for developmental research are limited to $100,000 in direct costs/budget period. Application Preparation and Submission: The research grant application form PHS 398 (Rev. 9/91) is to be used in applying. These forms are available at most institutional offices and from the Office of Grants Inquiries, Division of Research Grants, National Institutes of Health, Westwood Building, Room 449, 5333 Westbard Avenue, Bethesda, MD 20892, telephone: (301) 496-7441. It is important to follow the instructions for preparing the application as described in both the PHS 398 form and in this RFA. Failure to do so may result in an application with insufficient information for appropriate scientific review. For purposes of identification and processing, the RFA number and title, "RFA AI-92-14", "AIDS CLINICAL TRIALS UNITS AT MINORITY INSTITUTIONS", respectively, should be typed on line 2a of the face page of the application form and the "YES" box should be marked. The type of grant program (2b) is U01. The RFA label available in the PHS 398application form must be affixed to the bottom of the face page of the application. Failure to use this label could result in delayed processing of the application such that it may not reach the review committee in time for the review. Submit a signed, typewritten original of the application and three exact, single-sided photocopies (including the Appendices), in one package to: Division Of Research Grants National Institute of Health Westwood Building, Room 240 Bethesda, MD 20892** AT THE TIME OF SUBMISSION, TWO (2) ADDITIONAL COPIES OF THE APPLICATION, INCLUDING APPENDICES, EACH CROSS-REFERENCED WITH RESPECT TO WHICH COMPONENT OF THE APPLICATION THE APPENDIX PERTAINS, MUST ALSO BE SENT DIRECTLY TO: Dr. Dianne Tingley Scientific Review Branch Division of Extramural Activities National Institute of Allergy and Infectious Diseases Solar Building, Room 4C16 6003 Executive Boulevard Bethesda, MD 20892 Applicants who use express mail or courier service should substitute Rockville, MD 20852 for the city, state, and zip code The deadline for receipt of applications is January 21, 1993. Applications received after this date will be returned to the applicant without review. REVIEW CONSIDERATIONS A. Review Procedures Upon receipt, applications will be reviewed by the DRG staff for completeness and the NIAID staff for responsiveness. Incomplete applications and those judged to be unresponsive to the RFA will be returned to the applicant without further consideration. Examples that will result in the application being considered nonresponsive include, but are not limited to: (1) failure to address all required items of the RFA, and (2) submission of optional components that are not presented as separate narratives with separate budgets. Those applications that are complete and responsive may be subjected to triage by a Special Review Committee (SRC) to determine their scientific merit relative to other applications received in response to this RFA. The NIH will administratively withdraw from competition those applications judged to be noncompetitive, and notify the applicants and the institutional business officials. Those applications judged to be competitive will undergo further evaluation for scientific merit by a Special Review Committee consisting primarily of non-Federal scientific experts. To the extent possible, those reviewers comprising the triage group also will participate in this review. The second level of review will be provided by the National Advisory Allergy and Infectious Diseases Council. The overall priority score for the application assigned by the Special Review Committee will be based on the technical merit of the required components and any optional clinical components contained in Part A. The technical merit of the optional laboratory components will evaluated independently from the required components. B. Review Criteria The following factors will be considered in the scientific and technical review of: AIDS Clinical Trials Unit, PART A: o Expertise and experience in conducting clinical trials research; o Adequacy of scientific understanding of the problem as evidenced by the plan for proposed studies to evaluate interventions for HIV infection, opportunistic infection, and other optional clinical specialties (Phase I studies, oncology, neurology); o The qualifications and expertise of the Principal Investigator and key personnel as evidenced by past experience in conducting clinical trials; o Adequacy of the proposed administrative and organizational structure of the ACTU; o Administrative experience of the Principal Investigator and key staff in managing clinical trials programs; o Adequacy of the physical facilities available to the proposed clinical trials unit, including subunits, and the physical/administrative relationship of the proposed ACTU to primary care clinics; o Quality of the outreach/recruitment plan for the accrual of patients; o Quality of the plan for the recruitment of underrepresented groups to AIDS clinical trials; o Strength of the ancillary services and linkages that will enhance the functioning of the proposed ACTU; o Quality of the data management plan; o Quality of the pharmacy plan; o Quality of the laboratory capability for immunophenotyping. Laboratory Support for Clinical Trials, PART B (Virology, and Pharmacology Laboratory Support): o Adequacy of the scientific/technical approach; o Evidence of an understanding of the scope of scientific issues; o Ability to perform the minimum number of required assays; o Prior participation or experience in quality control programs; o Adequacy of the procedures for storage and handling of samples; o Qualifications, expertise, experience and time commitment of the Laboratory Director and key personnel; o Adequacy of the available resources and facilities. o Developmental Research, PART C: o Originality and uniqueness of proposed research o Adequacy of the scientific/technical approach o Relevance of the research to the clinical objectives of the ACTG o Availability of required clinical samples o Qualifications, expertise, experience and time commitment of the Project Director and key personnel o Adequacy of the available resources and facilities. CRITERIA FOR AWARD The predominant criterion for funding priorities will be the scientific and technical merit of the application as judged by peer review. After the applications have been approved by the NIAID Advisory Allergy and Infectious Diseases Council, staff reserves the right to give consideration to the following additional factors in the final selection of applications to be funded: (1) inclusion of populations currently underrepresented in clinical trials; (2) HIV prevalence/geographic distribution; (3) cost effectiveness of conducting clinical trials; (4) the overall capacity of funded institutions, in aggregrate, to carry out the research objectives of the group. Funding decisions for Part A will be made independent of funding decisions for the optional laboratory components B.2, and C.1 - C.4. INQUIRIES Written and telephone inquiries concerning this RFA are encouraged. Direct inquiries on programmatic issues to: Frederick Batzold, Ph.D. Clinical Research Management Branch Division of Acquired Immunodeficiency Syndrome National Institute of Allergy and Infectious Diseases Solar Building, Room 2A09 6003 Executive Boulevard Bethesda, MD 20892 Telephone: (301) 496-82148 Direct inquiries concerning budgetary issues to Ms. Mary Kirker Grant Management Branch National Institute of Allergy and Infectious Diseases Solar Building, Rm. 4B22 6003 Executive Boulevard Bethesda, MD 20892 Telephone: (301) 496-7075 Direct inquiries regarding review requirements and issues to Diane Tingley, Ph.D. Scientific Review Branch Division of Extramural Activities National Institute of Allergy and Infectious Diseases Solar Building, Room 4C16 6003 Executive Boulevard Bethesda, MD 20892 Telephone: (301) 496-0818 Schedule Letter of intent receipt date: November 16, 1992 Application Receipt Date: January 21, 1993 Special Review Committee: March 15, 1993 NIAID Advisory Council Review: June 23, 1993 Anticipated Award Date: September 1, 1993 AUTHORITY AND REGULATIONS This program is described in the Catalog of Federal Domestic Assistance Nos. 93.856 - Microbiology and Infectious Diseases Research and 93.855 - Allergy, Immunology and Transplantation Research. Awards are made under authorization of the Public Health Service Act, Title IV, Part A, Public Law 78-410 as amended, and administered under PHS grants policies and Federal Regulations 42 CFR 52 and 45 CFR Part 74. This program is not subject to the intergovernmental review requirements of Executive Order 12371 or Health Systems Agency Review. .
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