The Good Clinical Practice guideline and its interpretation - perceptions of clinical trial teams in sub-Saharan Africa.
OBJECTIVE
To explore the advantages and challenges of working with the Good Clinical Practice (GCP)-International Conference of Harmonization (ICH) E6 guideline and its interpretation from the perspective of clinical trial teams based in sub-Saharan Africa.


METHODS
We conducted 60 key informant interviews with clinical trial staff at different levels in clinical research centres in Kenya, Ghana, Burkina Faso and Senegal and thematically analysed the responses.


RESULTS
Clinical trial teams perceived working with ICH-GCP as highly advantageous and regarded ICH-GCP as applicable to their setting and efficiently applied. Only for informed consent did some clinical trial staff (one-third) perceive the guideline as insufficiently applicable. Specific challenges included meeting the requirements for written and individual consent, conditions for impartial witnesses for illiterates or legally acceptable representatives for children, guaranteeing voluntary participation and ensuring full understanding of the consent given. It was deemed important to have ICH-GCP compliance monitored by relevant ethics committees and regulatory authorities, without having guidelines applied overcautiously.


CONCLUSIONS
Clinical trial teams in sub-Saharan Africa perceived GCP as a helpful guideline, despite having been developed by northern organisations and despite the high administrative burden of implementing it. To mitigate consent challenges, we suggest adapting GCP and making use of the flexibility it offers.
Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
N
N
Vischer
Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
C
C
Pfeiffer
Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
A
A
Joller
European Forum for Good Clinical Practice, Brussels, Belgium.
I
I
Klingmann
Département de Sociologie, Université Cheikh Anta Diop de Dakar, Dakar, Senegal.
A
A
Ka
Department of Sociology, University of Ghana, Legon, Ghana.
S K
SK
Kpormegbe
Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.
C
C
Burri
Africa South of the Sahara; Afrique subsahararienne; Ensayos clínicos; bonnes pratiques cliniques; buenas prácticas clínicas; clinical trials; directive; essais cliniques; good clinical practice; guideline; guías; investigación cualitativa; qualitative research; recherche qualitative; África al sur del Sahara