The AIDS Research Program of the National Institutes of Health (1991) / Chapter Skim
Currently Skimming:
1 AIDS: The Research Challenge
1 AIDS: The Research Challenge
Pages 19-34
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 19... ...
First, however, this chapter discusses the reasons why NIH should continue to make AIDS research a high priority and convert it into a long-term program. It also reviews the latest epidemiological trends and discusses the problems for NIH's clinical research effort caused by inadequacies in the nation's health care delivery and financing system.
|
From page 20... ...
NIH'S RESPONSE TO THE EMERGING EPIDEMIC In response to the epidemic, NIH has developed an extensive program of AIDS research that involves every institute at the agency and every type of activity traditionally supported by NIH, ranging from basic research to clinical trials to public information campaigns. In fact, the AIDS program constitutes an unprecedented attempt to address a disease with an NIH-wide program rather than through a single institute.
|
From page 21... ...
, in the Office of the Assistant Secretary for Health, coordinates PHS activities related to HIV infection and AIDS; it also provides leadership in developing PHS policy related to the epidemic, reviews PHS agency budget requirements, and sponsors a wide range of conferences and forums on AIDS issues. lithe structure of the NIH AIDS research program evolved incrementally as the agency responded to emerging scientific opportunities, and it reflects NIH's role as a biomedical research agency.
|
From page 22... ...
HIV infection is a lethal infectious disease that warrants a well-planned, well-organ~zed long-term research program leading to the control and eventual eradication of the disease. The committee concludes that NIH should continue to give AIDS research high priority because HIV infection and AIDS constitute a major public health threat and because they provide substantial opportunities for greater scientific understanding of the human immune system and of other viral diseases that affect mankind.
|
From page 23... ...
AIDS' impact ranks higher in terms of years of potential life lost (YPLL) before age 65 because HIV infection and AIDS disproportionately affect the younger segments of the population.
|
From page 24... ...
CDC estimates that more than one-quarter of all AIDS cases are associated with IV drug abuse (PHS, 1988:66~. The PHS also estimates that in communities with large illicit-drug-using populations, such as New York City, the prevalence of HIV infection is between 30 and 40 percent among IV drug users aged 15 through 24 (PHS, l990a:479~.
|
From page 25... ...
HEALTH CARE FINANCING As noted earlier, the shift in demographics in the HIV/AIDS epidemic also represents a shift toward populations who have poor access to the health care delivery system and thus already carry a disproportionately heavy burden of ill health and disease—to which AIDS is being added. The committee is very concerned that inadequacies in the financing of health care in the United States threaten the research program at NIH, in particular, the conduct of clinical trials for AIDS therapies, as discussed later in this section.
|
From page 26... ...
On one level, it is much more difficult to recruit patients for participation in clinical trials when those patients do not normally receive health care from the hospitals conducting the trials; as a result, certain patient groups are excluded from trials because they lack health insurance or access to a tertiary care center. On a second level, once a patient who lacks health insurance or a primary care provider is recruited for a trial, he or she places great demands on the clinical trials staff for social work services and health care that are often not directly related to the trial protocol.
|
From page 27... ...
The Lasagna committee looked at the approval process for new drugs for life-threatening diseases for which existing therapies are inadequate, including AIDS, and concluded that the medical care costs associated with such research should be covered by Medicare, Medicaid, and private insurers (NCI, 1990:14-15~. The Lasagna committee also recommended that investigational drugs, marketed drugs prescribed for unlabeled indications, and ancillary medical care costs be covered by insurers If they were approved by expert government agencies for therapeutic use (such as NCI approval of Group C cancer drugs and FDA approval of drugs under treatment INDs)
|
From page 28... ...
28 THE AIDS RESEARCH PROGRAM OF THE NIH Recommendation 1.3: The administration and Congress should immediately address and resolve financial barriers to the receipt of appropriate medical care by persons with HIV infection.
|
From page 29... ...
_ ~ Deaths (High and Lear Estimates) FIGURE 1.1 Projected annual number of AIDS cases, deaths attributable to AIDS, and living pemons with AIDS, United States, 1989-1993.
|
From page 30... ...
aCDC, l990c. bNationa1 Center for Health Statistics, 1990a:Table 10.
|
From page 31... ...
31 In of of ~3 t: .
|
From page 32... ...
National Commission on Acquired Immune Deficiency Syndrome.
|
From page 33... ...
. Washington, D.C.: National AIDS Program Office.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.