AIDS and Behavior An Integrated Approach (1994) / Chapter Skim
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5 THE CONTEXT OF AIDS PROGRAMS AT NIAAA, NIDA, AND NIMH
5 THE CONTEXT OF AIDS PROGRAMS AT NIAAA, NIDA, AND NIMH
Pages 157-185
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From page 157... ...
housed in the office of the NIH director new budgetary authority over the AIDS programs of all NIH institutes. These two major legislative events occurred while the committee's assessment of the ADAMHA AIDS programs was untler way, anti, although they were not intended to be the focus of this report, they are an important part of the overall context in which AIDS research at NIAAA, NIDA, and NIMH was conducted in the recent past and will be conducted in the future.
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From page 158... ...
This is largely because, unlike the rest of the Public Health Service, ADAMHA included research, service, public health, and training activities all in one agency. The debate about the advantages and disadvantages of various options for administering all of these components continued {with periods of greater and lesser intensity until Congress passed the ADAMHA Reorganization Act in 1992, which for the first time separated services and research into different agencies.
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From page 159... ...
Act led to a major shift in NIMH budgetary priorities establishing community-based psychiatric treatment and developing separate community-based treatment centers for alcohol and drug abuse. The National Center for Prevention and Control of Alcohol ism (which included research, training, and services programs)
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From page 160... ...
The Drug Abuse and Treatment Act mandated the establishment of NIDA within NIMH. Although NIAAA and NIDA were part of NIMH, a 1972 internal management study concluded that all three institutes should become separate institutes working on equal terms under one administrative umbrella.
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From page 161... ...
The Anti-Drug Abuse Act mandated the establishment of the Office for Substance Abuse Prevention (OSAP) to award demonstration grants to community agencies for preventing substance abuse among youth and for preventing AIDS among drug abusers.
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From page 162... ...
The Anti-Drug Abuse Act raised OSAP to an institute level in ADAM HA and led to the administrative creation of the Office for Treatment Improvement. Congress began to appropriate increasing amounts of money for ADAMHA prevention and treatment activities.
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From page 163... ...
Box 5.2 highlights the programs and activities that were transferred from ADAMHA to SAMHSA as a result of the reorganization. Of these 24 programs, only three are clirectly related to AIDS: AIDS health care worker training Moved from NIMH to CMHSJ; AIDS health care worker training/AIDS hotline {movect from NIDA to CSAT)
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From page 165... ...
Primary prevention of the spread of HIV, including transmission via drug abuse Sexual behavior in the case of NIMHi; {2) drug abuse services research Mental health services research for NIMHi; and {A other matters determined appropriate by the Director.
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From page 166... ...
Mental Health Services Block Grant Center for Substance Abuse Prevention (CSAP)
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From page 168... ...
{Further discussion of the institute's AIDS offices appears in chapter 6.J AIDS RESEARCH AND THE NIH REAUTHORIZATION Simultaneous with the ADAMHA reorganization, NIH underwent changes in its leadership, and under the NIH reauthorization bill passed in 1993 developed a much more centrally managed AIDS research effort. The NIH reauthorization bill, which was signed into law June 10, 1993, contains a number of provisions concerning AIDS research supported by NIH.
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From page 169... ...
information is shared and coordinated between HIV and other research endeavors by determining an overall AIDS research budget level as part of the overall budget process. The legislation continues on a path of greater central coordination that began in 1982 with the creation of an inter-institute coordinating group to track NIH AIDS research activities and to share information among the institutes involved in AIDS research.
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From page 170... ...
The second major change in the budgetary process created by the NIH reauthorization bill is the emergency discretionary fund from which the director of OAR, in consultation with the AIDS Advisory Council, may make expenditures to support the AIDS research activities authorized by the legislation. This fund is designed to allow the NIH to respond to rapidly changing research problems and priorities, and grew out of concerns that inflexible budget rules may prohibit important and time-sensitive research {such as research on multi-drug resistant tuberculosis)
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From page 171... ...
The director of OAR is required to submit to Congress annually a report describing how and why the funds were used during the previous fiscal year. THE BUDGET PROCESS Funding of ADAMHA and NIH AIDS activities over time has taken place within the larger context of the overall federal budget process and has been ~lirectly affected by it.
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From page 172... ...
In addition, the National AIDS Program Office [NAPO] assumed responsibility for reviewing the AIDS budget requests of all PHS agencies beginning in FY 1990.J With this general overview of the budget process and its complexity in mince, one can now look at the more specific experiences of ADAMHA and NIH budgeting as they relate to AIDS funding.
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From page 173... ...
Within the guidelines that may have resulted from that meeting, individual institutes and offices began their budget process in lanuary {approximately 21 months before the fiscal year) by outlining major themes and proposing new program concepts or initiatives.
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From page 174... ...
The administrator, with advice from the senior staff, would decide on an overall budget request {AIDS and nonAIDSJ to submit to the Public Health Service. The ADAMHA budget process recognized that the agency was unique in its mix of research and services programs, and the budget attempted to implement the concept of an integrated ADAMHA mission, where progress clepended on linking research and services with national leadership and advocacy on substance abuse and mental health issues.
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From page 175... ...
Thus, while the three institutes had been organizationally part of NIH since October 1, 1992, the FY 1995 budget was the first NIH budget to include NIAAA, NIDA, and NIMH. The institutes joined in the FY 1994 NIH budget process after the major internal HHS decisions about the NIH AIDS budget had been made.
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From page 176... ...
In addition to considering issues of overlap and duplication, appropriate use of mechanisms, program balance, and scientific opportunities, the OD also considered the specifics of projects or project areas, the quality of the science, and the likelihood of progress when determining the NIH AIDS budget allocations. In FY 1994, as in all preceding years, once the institute received its budget allocation, the determination of which specific projects to fund was mostly a function of the grant review process, which is clescribed next.
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From page 177... ...
In most ways, the review procedures utilized by the former ADAMHA research institutes are very similar to the procedures at NIH. Both NIH and ADAMHA have used a dual review system that separates technical and scientific assessment of projects from subsequent policy decisions concerning programmatic, scientific areas in which projects will be supported.
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From page 178... ...
Funding decisions are baser! not only on scientific merit and policy consideration, but may also consider administration policy, funding availability, and other factors.
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From page 179... ...
In general, data for all institutes indicate that success rates for all research are declining, which is more likely a result of shrinking budgets and rising per-grant costs than of declining quality among grant proposals submitted. NIH advisory committees include any committee, council, task 1 ooze goon 80/ 70% Its 60% a: on 50% Coop 3ooJo 20% 10% o% 1989 1990 1991 1992 1993 FIGURE 5.6 NIMH AIDS and Non-AIDS Applications, 1989-1993.
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From page 180... ...
Source: Office of Planning and Resource Management, NIDA. 1 00% 90% 80% 7OO/O ~ 60% tar an an 50% 30% 20% 10% 0% 1989 1990 1991 1992 1993 FIGURE 5.8 NIAAA AIDS and Non-AIDS Applications, 1989-1993.
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From page 181... ...
All AIDS applications are reviewed by a subcommittee of the Biomedical Review Committee, called the Immunology and AIDS Subcommittee, which has twelve committee members with scientific expertise in medicine, microbiology/immunology, pathology, sociology, psychology, public health, behavioral science, cellular biology, and psychoimmunology. NIDA has five research review committees, one of which is the Drug Abuse AIDS Research Review Committee.
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From page 182... ...
be maintained through 1996, it is not yet clear how AIDS research applications at the three institutes will be reviewed when this period ends. {As this report was being written, it was reported that the NIH director hati requested that the former ADAMHA institutes enter into negotiations with the NIH Division of Research Grants earlier than 1996 anti that the institutes agreed Federation of Behavioral, Psychological and Cognitive Sciences, 1994~.)
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From page 183... ...
AIDS PROGRAMS AT NIAAA, NIDA, AND NIMH / 183 this study's finding about the extent of cross-disciplinary research at NIAAA, NIDA, and NIMH, the committee believes that this concern deserves particular consideration. Under current NIH procedures, described above, each member of a review pane} assigns to a proposal a score from 1 (bests to 5 {worst)
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From page 184... ...
Also, such proposals would have to be in accord with the scientific principles of evaluation {often called psychometricsJ. As this report was being written, the current NIH director established a series of inter-NIH Panels to examine the ways in .
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From page 185... ...
These changes were superim ~ r ~ posed on the already complex budget process that governs ace teaeral spending and together produced a climate of uncertainty for the management of the AIDS research programs at NIAAA, NIDA, and NIMH. To maintain some stability, the institutes were allowed to retain their existing grant review procedures for four years {through FY 1996~.
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