# Presentation: 111831

## NIH International AIDS Research Activities

- 2005 NIDA International Forum
- Orlando, Florida C June 18, 2005

## U.S. Department of      Health and Human Services

**Administration**** for**
**Children and Families**
**(ACF)**

**Food and Drug**
**Administration**
**(FDA)**

**Health Resources**
**and Services**
**Administration**
**(HRSA)**

**The Secretary**
**Deputy Secretary**

**Administration on**
**Aging**
**(AoA)**

**Centers for Medicare**
** ****and Medicaid **
**Services **
**(CMS)**

**Indian Health**
**Services**
**(IHS)**

**National Institutes**
**of Health**
**(NIH)**

**Centers for **
**Disease Control**
**and Prevention**
**(CDC)**

**Substance Abuse and**
**Mental Health Services**
**Administration**
**(SAMHSA)**

**Program Support**
**Center**
**(PSC)**

**Agency for Toxic**
**Substances and**
**Disease Registry**
**(ATSDR)**

**Agency for **
**Healthcare Research**
**and Quality**
**(AHRQ)**

## National Institutes of Health

**National Institutes of Health**

- Office of AIDS Research

## NIH Office of AIDS Research

- Unique role and legislative authorities
- Coordination of scientific, budgetary, legislative, and policy elements of the NIH AIDS research program, the largest public investment in AIDS research in the world
- Annual comprehensive plan and budget
- Annual Presidential by-pass budget
- Allows NIH to pursue a unified research front against the AIDS pandemic

## DHHS/NIH/OD/OAR

## NIH Funding for HIV-Related Research FY 2006 

**NIH Funding for HIV-Related Research FY 2006**** **

**Behavioral and Social Science** $412M 14%

**Training and Infrastructure **
- $148M  5%

**Information Dissemination**
-  $38M  1%

**Natural History and Epidemiology**
- $313M  11%

**Etiology and Pathogenesis**
-  $703M  24%

**Vaccines**
-  $607M  21%

**Therapeutics**
-  $712M  24%

**Total: $2.93 Billion**

## AIDS Research Priorities

- A strong foundation of basic science
- Prevention research, including development of vaccines, microbicides, and behavioral interventions; prevention of MTCT
- Therapeutics research
- International research, particularly in developing nations
- Research targeting racial and ethnic minorities in the U.S.

## NIH AIDS Scientific Research Areas

- Natural History and Epidemiology
- Etiology and Pathogenesis
- Therapeutics
- Vaccines
- Behavioral and Social Science

##  AIDS Cross-Cutting Research Areas of Special Interest

- Microbicides
- Prevention
- Women and Girls
- Racial and Ethnic Minorities
- International Research
- Training, Infrastructure, and Capacity Building
- Information Dissemination

## Slide 10

## Slide 11

## Global AIDS Research Principles

- Leadership of foreign scientists in all stages of the research process
- Improve and sustain basic and clinical research capability
- Transfer sustainable technologies
- Ensure ethical conduct of research
- Conduct culturally relevant research

## Key Institutes and Centers that Support International AIDS Research

- NIAID
- NICHD
- NHLBI
- FIC

- NINDS
- NIA
- NIAAA
- NINR

- NIDCR
- NIMH
- NIDA
- NCI

## Therapeutics Research Agenda

**Drug discovery and development**
**Pre-clinical studies**
**Clinical trials**
**Prevention of perinatal transmission**
**Prevention and treatment of co-infections and malignancies**
**Side effects and complications**
**Immune restoration**

## Clinical Evaluation of Therapies in International Settings

- Expand therapeutic studies into international sites
- Develop research capacity and infrastructure
- Design studies to improve and facilitate delivery of therapeutic interventions
- Evaluate clinical and public health impact of antiretroviral treatment
- Integrate therapeutic regimens and prevention interventions
- Study gender and racial/ethnic differences

## Co-infections

- Tuberculosis (TB) and Multi-Drug Resistant-TB
- Hepatitis B Virus
- Hepatitis C Virus
- Sexually transmitted infections
- Microsporidia
- Azole-resistant fungi
- Malaria and other endemic diseases

## Behavioral and Social Science Strategies for HIV Prevention

- Psychosocial, behavioral and social change interventions for reducing sexual, drug, and alcohol use risk by:
- Delaying sexual debut;
- Reducing number of sex partners;
- Increasing protective behaviors;
- Referral to drug and alcohol addiction treatment; and
- Developing supportive policies and programs.

## Risk Reduction: Behavioral and Social Science Research Approaches

- Individual counseling about risk behaviors and protective strategies (including VCT)
- Small group counseling (including couples)
- Popular opinion, peer-based, and network interventions to change social norms about risk behaviors
- Evaluating the effectiveness of programs that provide access to sterile needles and syringes and/or addiction treatment

## Approaches Based on Behavioral and Social Science Research That Emphasize:

- Knowledge about HIV/AIDS transmission risk;
- Motivation to protect oneself and one’s partners;
- Outcome expectancies;
- Skills for engaging in protective behaviors;
- Ability to maintain protective behaviors over time;
- Social support for protective actions; and
- Social movements and collective/community action.

## Challenges in Behavioral and Social Science Research

- Difficulty in directly measuring HIV risk and protective behaviors
- Lack of consensus about most appropriate outcome measures:  behavioral and/or biological; skepticism about self-report data
- Lack of consensus about the randomized controlled trial as the “gold standard”

## Challenges in Behavioral and Social Science Research (cont’d.)

- Maintenance of intervention effects over time
- Lack of basic knowledge about interactions of sexual behavior, sexuality, gender, in HIV risk
- How best to achieve public health implementation of effective interventions

## Current NIH Priorities in Behavioral and Social Science Research

- Psychological, social, economic, and cultural factors that affect HIV transmission and prevention.
- Changing patterns, contexts, and kinds of drug and alcohol use, and their links with sexual behaviors that contribute to HIV transmission risk.
- Initiation and sustainability of prevention efforts at individual- and community-levels
- Operations and health services research for implementation of science-based interventions.
- Prevention/Treatment interface.

## Fiscal Year 2006 HIV Behavioral and Social Science Research Priorities

- Understanding HIV transmission and acquisition
- Comprehensive models for HIV risk
- Patterns of drug and alcohol use; direct or mediating effects
- Intervening to reduce transmission and acquisition
- Sexual (on several levels-- individual, group, structural)
- Drug and alcohol use (on several levels—community, care)
- Ameliorate Consequences of HIV infection
- Co-morbid medical and social conditions
- Disparities among population groups (e.g. racial minorities)
- Leverage existing research (use approaches from management studies, economics, psychotherapy, reproductive health research)

## Additional Information

**Additional information is available **
**on the National Institutes of Health**
**Web site**
**http://www.nih.gov**