The increased number of Clinical Trials taking place in Africa as well as the complexity of Clinical Trials designs require that the countries have the regulatory capacity to review, monitor and utilize data generated from the research. Research Ethics Committees/Institutional Review Boards, Institutional Animal Care and Use Committees and National Regulatory Agencies (NRAs) are required to be abreast with the evolving landscape thus require continuous capacity building as well as have platforms to share Clinical Trials information with both the public and private sector. The 11th Annual National Research Ethics Conference held in 2021 in Uganda highlighted challenges in the low and middle income countries for research ethics and open science specifically, the lack of infrastructure for open data sharing and fair data management. Specifically, i) lack of the national and regional guidelines and codes of conduct for scientific integrity ii) limited training and education in responsible conduct of research and pharmacovigilance. This proposal focuses on strengthening ethics and responsible conduct of Clinical Trials in East and Sub-Saharan Africa project through the establishment of a research ethics and integrity framework, open data access framework for Clinical Trials, E-learning platform for the Good Research Regulatory Research Practice Course and establishing Research Ethics Committees in National Regional Hospitals. The consortium will leverage on the legal establishment of the institutions, collaborative efforts with the partner institutions, East African Health Research Commission (EAHRC), African Vaccine Regulatory Forum (AVAREF). Having a robust regulatory system, encompassing research integrity and open science will ensure that Clinical Trials is conducted to the highest ethical standards and in compliance with existing polices and laws, hence protection of safety, rights and welfare of the individual participants, community, researcher and sponsors.

Gene therapy advancements have shown promise in treating chronic conditions like HIV and Sickle cell Anaemia and have the potential to greatly reduce the burden of disease in Sub-Saharan Africa which is plagued with a double burden of communicable and non-communicable diseases. These treatments have the potential to reduce the burden of disease for the populations for which they are targeted and the cost of treatments for governments. In Sub-Saharan Africa, there are largely no or unclear regulatory frameworks for clinical trials using Gene Therapy products. As pioneers setting up frameworks for regulatory oversight of clinical trials using Gene and cell-based therapy products, Uganda and Tanzania will be able to share this knowledge through regional platforms to support other countries in the region to put in place similar regulatory frameworks. Additionally researcher workshops and course developed on Gene Therapy Products will build capacity among researcher, regulators and the public. Pharmacovigilance in clinical trials for safety of trial participants and to accurately characterize the safety profile of the drug for the targeted patient population. Safety monitoring in clinical trials in the region, currently faces challenges associated with health system challenges, investigator awareness, poverty and limited access to diagnostic tools. Additionally, there is limited investigator awareness of of their responsibility to the patients with regard to monitoring and treating and accurate reporting of serious adverse events during clinical trials. The results of this project will also provide a basis to sensitize investigators/sponsors and engage policymakers on the requisite health systems reforms to create a safe environment for the conduct of clinical trials with the ultimate goal of accelerating research, registration and access to these new medicine technologies.

There is an increase in the number of drug development clinical trials conducted in Sub-Saharan Africa (SSA), including vaccine development studies for poverty-related diseases (PRDs) underway in SSA. These increases have not been matched with increase in regulatory support and ethical review for such studies in SSA. Specific gaps exist in skills and knowledge in providing adequate regulatory oversight, ethical review and pharmacovigilance for such studies, efficiency of the regulatory and ethical review processes. With sequential processes of review requiring a prolonged period before approvals are granted, there is dissatisfaction with the the time interval from submission to decision, within the research community. Additionally, mechanisms for reporting adverse events to both the ethics committees and national regulators are not well developed. The Aim of AccessAfrica 2 is to improve ethical review and regulatory capacity for clinical trials in two Sub-Saharan Africa (SSA) countries, with specific focus on the review and oversight of reported adverse events during clinical trials, improve efficiencies of the NECs and NRAs, and equip them with skills and knowledge for oversight for novel research designs. AccessAfrica 2 is a embedded in the Eastern Africa Consortium for Clinical Research (EACCR), and EDCT funded network, and is continuation of AccessAfrica project which was funded by EDCTP. We propose to address the identified gaps through the three objectives and four work packages. We will establish a consensus driven consortium with partners leveraging each others strength to achieve the objectives. We propose to incorporate the AVAREF guidelines in the regulatory and ethical review guidelines of the partners, and work with the Kenya Pharmacy and Poisons board to improve the pharmacovigilance for research capacity in the partner countries.

BACKGROUND There are few research ethics committees (RECs) with capacity to review and provide oversight for clinical trials in Sub-Saharan Africa (SSA), and hardly any national accreditation systems used to evaluate the quality of review by these RECs. Although digital protocol submission systems improve RECs efficiency, up to 48% RECs in SSA still use paper-based systems. Additionally, many (single country) clinical trials in SSA are not registered with any internationally recognized clinical trials registry. The SECRET project seeks to address these challenges in Uganda and Ethiopia, by establishing national RECs accreditation systems, building capacity of RECs to review clinical trials (including during outbreaks and emergencies), establishing national clinical trials registries linked to the Pan African Clinical trial registry (PACTR), and developing digital protocol submission systems. METHODOLOGY The SECRET project includes partners that have worked together in other EDCTP-funded projects, to address the identified gaps through four objectives and six work packages. We will leverage the experience of the Uganda National accreditation system to establish a national accreditation system for Ethiopia and accredit at least two RECs in Ethiopia and two in Uganda. We will also leverage the expertise of the PACTR to set up the Uganda National Clinical Trial Registry. Nuvoteq that have experience in digital solutions for health care services will support Ethiopia to set-up the digital protocol submission systems. We shall also leverage the expertise of Makerere University bioethics training unit and the National Drug Authority of Uganda to build capacity for clinical trial review and oversight for the RECs to be accredited. The Uganda National Health Research Organisation and Institute of Tropical Medicine in Antwerp, which are the coordination institutes, have worked together on ALERRT, an epidemics preparedness consortium funded by EDCTP.