title: Researchers', Regulators', and Sponsors' Views on Pediatric Clinical Trials: A Multinational Study.
abstract: The last decade has seen dramatic changes in the regulatory landscape to support more trials involving children, but child-specific challenges and inequitable conduct across income regions persist. The goal of this study was to describe the attitudes and opinions of stakeholders toward trials in children, to inform additional strategies to promote more high-quality, relevant pediatric trials across the globe.
  
  
  
  Key informant semi-structured interviews were conducted with stakeholders (researchers, regulators, and sponsors) who were purposively sampled from low- to middle-income countries and high-income countries. The transcripts were thematically analyzed.
  
  
  
  Thirty-five stakeholders from 10 countries were interviewed. Five major themes were identified: addressing pervasive inequities (paucity of safety and efficacy data, knowledge disparities, volatile environment, double standards, contextual relevance, market-driven forces, industry sponsorship bias and prohibitive costs); contending with infrastructural barriers (resource constraints, dearth of pediatric trial expertise, and logistical complexities); navigating complex ethical and regulatory frameworks ("draconian" oversight, ambiguous requirements, exploitation, excessive paternalism and precariousness of coercion versus volunteerism); respecting uniqueness of children (pediatric research paradigms, child-appropriate approaches, and family-centered empowerment); and driving evidence-based child health (advocacy, opportunities, treatment access, best practices, and research prioritization).
  
  
  
  Stakeholders acknowledge that changes in the regulatory environment have encouraged more trials in children, but they contend that inequities and political, regulatory, and resource barriers continue to exist. Embedding trials as part of routine clinical care, addressing the unique needs of children, and streamlining regulatory approvals were suggested. Stakeholders recommended increasing international collaboration, establishing centralized trials infrastructure, and aligning research to child health priorities to encourage trials that address global child health care needs.
authors.affiliation: Centre for Kidney Research and pathma.joseph@health.nsw.gov.au.|The Pharmacy Department, The Children's Hospital at Westmead, Sydney, Australia; and.|Discipline of Adolescent and Child Health and.
authors.forename: Pathma D
authors.initials: PD
authors.lastname: Joseph
authors.affiliation: Centre for Kidney Research and.|School of Public Health, The University of Sydney, Sydney, Australia.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.affiliation: Centre for Kidney Research and.|School of Public Health, The University of Sydney, Sydney, Australia.
authors.forename: Allison
authors.initials: A
authors.lastname: Tong
authors.affiliation: Centre for Kidney Research and.|Discipline of Adolescent and Child Health and.
authors.forename: Patrina H Y
authors.initials: PH
authors.lastname: Caldwell
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D002986:Clinical Trials as Topic / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D005260:Female; D006292:Health Priorities; D006801:Humans; D007391:International Cooperation; D038622:Internationality; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010372:Pediatrics