ECRAID-Prime and Oxford’s Primary Care Trials Unit Take Randomised Controlled Trials to the People
The breakthrough ECRAID-Prime trial recently launched remote participant recruitment in the UK, marking a significant step toward making clinical research more accessible, inclusive and community patient-centred in the context of infectious diseases outbreaks.
The ECRAID-Prime trial is the first adaptive platform trial in primary care actively evaluating multiple treatments for respiratory infections.
In partnership with the Primary Care Clinical Trials Unit at the University of Oxford, the trial launched remote participant recruitment in the UK and recruited its first participant remotely in December 2025. Since then, overall enrolment in the UK has increased sharply, reaching 86 participants as of 26 February 2025, particularly following the introduction of the trial’s online registration form.
This approach builds on the trial’s existing decentralised procedures – including participant e-diaries and follow-up phone calls – which enhance accessibility and reduce barriers to participation.
Emma Harper, the trial’s national coordinator in the UK, said: “Recruitment through the decentralised pathway is going really well! In just two months, we’ve enrolled twice as many participants as we did in a whole year through our general practitioner sites. This proves that the approach works, and we’re looking forward to scaling up and adding more compounds to our platform trial.”
Despite the strong early results, Emma emphasised that decentralised approaches are not designed to replace site-based recruitment, but complement it. She added, “While traditional sites remain essential, remote methods allow us to expand reach and strengthen inclusivity by bringing research closer to patients.”
“While traditional sites remain essential, remote methods allow us to expand reach and strengthen inclusivity by bringing research closer to patients.”
– Emma Harper, Trial Manager at the Primary Care Clinical Trials Unit, University of Oxford
How the Decentralised Pathway Works
Decentralised recruitment allows participants to take part in a trial remotely, without the need to travel to traditional clinical trial sites. By eliminating the need to visit a trial site, this approach broadens access to more diverse populations and enables recruitment earlier in the illness trajectory, including individuals living far from research centres or those too unwell to attend in-person appointments.
Trials that rely solely on site-based recruitment risk excluding people who do not regularly access healthcare at participating sites or who live too far away to travel. In infectious disease research, these are often the very individuals we most need to include – particularly those who are too sick to attend clinics or who are being managed remotely in the community. As a result, those who have the most to contribute to research – and potentially benefit from it – are frequently underrepresented in traditional primary care trial models.
Given the trial’s short three-day window for recruiting participants after symptom onset for treatments, and the fact that many patients do not visit their GP so soon after infection, decentralised recruitment helps to overcome key recruitment and participation barriers; many of which were experienced during the COVID-19 pandemic.
Right: The ECRAID-Prime UK team printed and put up recruitment posters across the University of Oxford campus to encourage individuals experiencing cold and flu symptoms to visit the online registration site.
Photographed from left to right: Becca Edeson, Rukiye Karadal Erdogan, Nicky Maeder, Alike van der Velden (UMCU) and Emma Harper.
Interested patients can register online and complete a short online screening form, making the process simple and accessible. The trial also supports participants through convenient and flexible options, including:
- Online informed consent
- Delivery of trial medication to participants’ homes
- Self-collected samples (or swabs) that can be returned by regular post for analysis
Operational Advantages of Decentralised Trials
Additionally, the decentralised approach provides multiple operational and participant-focused advantages:
- Allows signposting from a variety of locations (e.g. pharmacies, GP practices)
- Enables large-scale rapid recruitment
- Centralises trial management, making resource allocation and team coordination simpler
- Eliminates the need for site set-up for centrally organised trials and preserves GPs’ time for activities directly relevant to them
- Ensures research continuity during future pandemics or periods of restricted movement
- Reduces carbon footprint compared with traditional on-site trials
- Makes participation easier for patients, who can take part without leaving their homes
- Expands access to marginalised and underserved populations, giving more people the opportunity to contribute to research
Increasing Patient-Centricity
According to Emma, participants in the UK learn about the trial through the trusted National Institute for Health and Care Research’s (NIHR) “Be Part of Research” initiative, which connects more than 600,000 registered volunteers with research opportunities. The team sends targeted email invitations at least twice weekly to randomly selected registrants. Additional recruitment channels include social media outreach, posters in community settings, and word-of-mouth referrals from friends and family.
She shared, “This approach also places our trial participants at the centre of the research experience by enhancing convenience, comfort, and engagement – factors shown to improve both recruitment and retention.”
Impact on Infectious Disease Research
The importance of decentralised trials has been further reinforced by the European Medicines Agency (EMA), which recently released updated recommendations encouraging flexible trial designs that incorporate remote assessments, digital monitoring, and home-based data collection.
Such approaches have the potential to reshape infectious disease research, enabling remote recruitment, data collection, and monitoring, while reducing travel and in-person visits – a critical consideration during outbreaks.
ECRAID-Prime Co-Coordinator Chris Butler said: “Europe had to respond quickly when COVID-19 broke. When people in the community started getting ill, early treatments could have made a real difference. Now, we are in the position to help identify new treatments quickly and stop the spread of respiratory pathogens. ECRAID-Prime is the only adaptive platform trial that is actively recruiting, fully operational, and adapting in real time.
“And because of our trial’s design and logistics, people are asking us to help them to set up similar trials. This is a key part of the European Commission’s long-term vision to strengthen Europe’s pandemic preparedness, and our role in helping to deliver it.”
– Chris Butler, ECRAID-Prime Co-Coordinator and Clinical Director of the Primary Care Clinical Trials Unit, University of Oxford
ECRAID-Prime Co-Coordinator and Trial Lead Alike van der Velden added: “The current status of the ECRAID-Prime trial – evaluating three treatments across eight countries – and the implementation of its decentralised elements have shown that that we are doing something unique in primary care research.”
“ECRAID-Prime has proven that clinical trials can continue even when healthcare systems are under strain, making research more accessible, inclusive, and resilient. I’m excited to scale up, add new treatments to the trial, and implement decentralised recruitment in the other countries, extending our trial activities beyond its current funding period.”
– Alike van der Velden, ECRAID-Prime Trial Lead and Assistant Professor at University Medical Center Utrecht
More information
- Visit the ECRAID-Prime trial registration site. For UK residents only.
- Learn more about the University of Oxford’s Primary Care Clinical Trials Unit
- Read the European Medicine Agency’s Recommendation Paper on Decentralised Elements in Clinical Trials (Version 02, 1 October 2025)