Site Initiation Visit (SIV): Clinical Trial Basics

What is an SIV in clinical research?

SIV Definition: Site initiation visit

An SIV (clinical trial site initiation visit) is a preliminary inspection of the trial site by the sponsor before the enrollment and screening process begins at that site. It is generally conducted by a monitor or clinical research associate (CRA), who reviews all aspects of the trial with the site staff, including going through protocol documents and conducting any necessary staff training.[¹],[²]

Also known as a study start-up visit, the sponsor can only request an SIV after the site has been selected and formal agreements such as the CTA have been signed.

What is the purpose of an SIV?

Clinical trial SIVs are necessary to ensure that all personnel of a given site who will be involved in the clinical trial, such as investigators and study staff, thoroughly understand the trial protocol and are trained appropriately so as to handle their role and responsibilities. Furthermore, the site initiation visit has the aim of ensuring the trial site is operationally ready, with working infrastructure, tools, and any study materials needed.[¹]

Given the scope of the SIV, clinical trial sponsors should schedule this visit well before enrollment so that there is plenty of time to comprehensively inspect all relevant processes, and to conduct further training or rectify any issues, if necessary.

Can the SIV be conducted before IRB approval?

IRB approval is generally necessary before the SIV is carried out. Clinical trial sponsors should select sites that are compliant with all applicable regulatory requirements, and after the site receives IRB approval for the research, the sponsor can conduct the SIV.

SIV checklist for thorough site initiation visits

Given the importance of the SIV, clinical trial sponsors should make the most of this inspection visit by coming fully prepared with a detailed checklist of what is to be confirmed during the SIV.

Clinical trial sites might receive a copy of this checklist so they can ensure that all relevant staff are present for the visit. Specific tasks to include in the SIV checklist include the following:[¹],[²],[³],[⁴]

Discussing the clinical trial’s objectives with study staff
Educating the research team on Good Clinical Practices
Reviewing the operation schedule for the protocol
Discussing the enrollment and screening process, including clarifying the inclusion and exclusion criteria
Reviewing the informed consent documents and procedure
Clarifying procedures for storing, dispensing, and managing the investigational product (IP)
Checking inventory for all required medical supplies and equipment
Ensuring secure access to all digital platforms, i.e., correct usernames and passwords
Touring the clinical trial site to ensure facilities are in proper condition
Reviewing and discussing all clinical trial documentation, such as forms, surveys, SOPs, etc.
Reviewing the data management system and any other technological solutions forming part of the site’s or sponsor’s workflow
Ensuring that site staff are up to date on training and understand how to maintain essential documentation
Reviewing the site/trial budget financial protocols, including any processes related to compensating trial participants
Verifying and testing reporting procedures possible adverse events
Leaving room for an open discussion of any specific concerns that trial staff may have

This checklist provides basic guidelines only, and should be built upon and customized for each individual study according to risk areas and specific protocols.