Evaluation of CIHR's HIV/AIDS Community-Based Research Program - Final Report
2.0 Background to HIV/AIDS in Canada
HIV/AIDS emerged in Canada in the 1980s, with the first confirmed case of AIDS occurring in 1982 (CBC, 2008). Early infections were prevalent in the gay male population and among those who received contaminated blood transfusions. This section describes the Canadian HIV/AIDS community-based movement, provides an overview of the federal response to HIV/AIDS, outlines CIHR's involvement in HIV/AIDS research, and provides an overview of CIHR's HIV/AIDS CBR Program.
2.1 Canadian HIV/AIDS community-based movement
Initial efforts to respond to HIV/AIDS originated within communities. The Canadian HIV/AIDS community-based movement began in the 1980s when the gay community founded the first community-based AIDS organizations: AIDS Vancouver and AIDS Committee of Toronto. The first national community-based organization, the Canadian AIDS Society (CAS), was created in 1986. Today there are many national HIV/AIDS community-based organizations in Canada. In addition to CAS (a coalition of over 125 community-based AIDS organizations), examples of other national community-based organizations (CBOs) are the Canadian Association for HIV Research (CAHR), the Canadian AIDS Treatment Information Exchange (CATIE), and the Canadian Aboriginal AIDS Network (CAAN).
Community-based programs and services are available in all Canadian provinces and territories. Although most programs are open to everyone, some cater to specific populations such as women, at-risk youth, recent immigrants to Canada, or specific cultural groups such as Aboriginal, Asian, or African people. Community-based programs offer a diverse range of services such as advocacy, counselling and support groups, drop-in centres, food banks, needle exchange programs, telephone hotlines, housing and housing services, peer support, rural outreach services, and resource libraries.
Community-based research is an integral component of the Canadian community-based HIV/AIDS movement. Organizations such as the Ontario HIV Treatment Network (OHTN), AIDS Committee of Toronto (ACT), and CAAN, promote capacity building through the community-based research process, which involves community members and academics in all stages of research including developing the research questions, conducting the research, and disseminating the results.
2.2 Federal response to HIV/AIDS
As the threat of HIV/AIDS grew, governments, non-governmental organizations, researchers, and other sectors of society also began to respond. The Government of Canada's primary response to the epidemic focused on stopping the transmission of HIV; searching for effective vaccines, drugs, and therapies; and treating, caring for, and supporting people infected with HIV, as well as their caregivers, families, and friends (PHAC, 2002). As the epidemic progressed, the Government of Canada began to recognize that social, economic, and political factors as well as biological conditions influenced the spread of HIV (and its impact on individuals). Therefore, in 1998, it launched the Canadian Strategy on HIV/AIDS (CSHA) in an effort "to create an ongoing nationally shared approach to HIV/AIDS, with increased collaboration across all sectors of society … [that] focuses on legal, ethical, and human rights issues, as well as continuing to support the work of local national and non-governmental organizations, HIV/AIDS researchers, and epidemiologists" (PHAC, 2008).
In 2005, to renew and strengthen the federal government's response to HIV/AIDS, and building on the CSHA, the Government of Canada launched the Federal Initiative to Address HIV/AIDS in Canada (FI). The FI, which supports Leading Together, an HIV/AIDS Action Plan for All of Canada, employs both social justice and determinants of health approaches, and works toward "a Canada free from HIV and AIDS and the underlying conditions that make Canadians vulnerable to the epidemic" (Minister of Public Works, 2004).
The FI is a partnership between the Public Health Agency of Canada, Health Canada, Canadian Institutes of Health Research, and Correctional Service Canada. Its goals are to:
- prevent the acquisition and transmission of new infections
- slow the progression of the disease and improve quality of life
- reduce the social and economic impact of HIV/AIDS
- contribute to the global effort to reduce the spread of HIV and mitigate the impact of the disease (Minister of Public Works, 2004).
2.3 Canadian Institutes of Health Research
The Canadian Institutes of Health Research (CIHR), created on June 7, 2000 and comprising 13 institutes, is Canada's main health research funding agency. Its mandate is "to excel, according to internationally accepted standards of scientific excellence, in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products and a strengthened Canadian health care system" (CIHR, 2007).
In 2003, the federal government transferred primary responsibility for HIV/AIDS research from Health Canada to CIHR. Thereupon, CIHR's role in the FI is to "set priorities for and administer the Federal Initiative's extramural research program in partnership with the Public Health Agency of Canada" (Minister of Public Works, 2004). To fulfill this role, the CIHR Institute of Infection and Immunity (III) manages the CIHR HIV/AIDS Research Initiative.
The CIHR HIV/AIDS Research Initiative's mission is to "provide national leadership in the support and facilitation of HIV/AIDS research, research capacity building, research partnerships and knowledge translation that contributes to ending the spread of HIV and improves the lives of people living with or susceptible to HIV/AIDS" (CIHR HIV/AIDS Research Initiative Strategic Plan, 2008). Its priority research themes are health systems, services, and policy; resilience, vulnerability, and determinants of health; prevention technologies and interventions; drug development, toxicities, and resistance; pathogenesis; and issues of co-infection and co-morbidity. The research conducted through the CIHR HIV/AIDS Research Initiative supports the following five strategic goals:
- "Support world-class research in HIV/AIDS that creates important knowledge and new insights relevant to a national and global response to the HIV/AIDS epidemic"
- "Attract, train and retain outstanding HIV/AIDS research personnel across a wide range" of disciplines
- "Promote the translation of HIV/AIDS research results into action"
- "Develop partnerships that engage stakeholders and advance the Federal Initiative agenda and Canada's response to the HIV/AIDS epidemic, nationally and globally"
- "Maintain and enhance operational excellence" (CIHR HIV/AIDS Research Initiative Strategic Plan, 2008).
The CIHR HIV/AIDS Research Advisory Committee (CHARAC), a subcommittee of the III Advisory Board, "has a mandate to make recommendations to the Institute of Infection and Immunity and to the Research Priorities and Planning Committee (RPPC) of CIHR regarding research priorities for HIV/AIDS" (CIHR, 2009). The CHARAC membership comprises representatives of the Institute of Infection and Immunity; Institute of Aboriginal Peoples' Health; Institute of Health Services and Policy Research; Institute of Neurosciences, Mental Health and Addiction; Institution of Population and Public Health; Ministerial Council on HIV/AIDS; Public Health Agency of Canada; the community; and researchers from across the research disciplines.
2.4 Overview of the HIV/AIDS CBR Program
The HIV/AIDS Community-Based Research (CBR) Program, transferred to CIHR from Health Canada in 2004, "supports research and capacity-building initiatives of relevance to communities engaged in the fight against HIV/AIDS" (Institute of Infection and Immunity, n.d.). With an annual budget of $3.3 million, the HIV/AIDS CBR Program funds two streams of research: a general stream and an Aboriginal stream. Each stream can access six funding tools, as described in Table 2. The suite of funding tools helps communities develop the capacity to participate in CBR through workshops and contribute to the development of CBR expertise in academic institutions through Masters Awards and Doctoral Awards. It also encourages the development of partnerships and proposals through catalyst grants and provides operating grants for conducting the research and disseminating results. In addition, the program funds Community-Based Research Facilitators, which are available to assist communities and academic researchers with CBR activities such as capacity-building, developing partnerships and research questions, preparing funding applications, and disseminating research results.
| Table 2: CIHR HIV/AIDS CBR funding tools | |||
|---|---|---|---|
| Funding tool | Objectives | Total funding available in 2008-2009 | Maximum funding for a single grant |
| Catalyst grants |
|
$125,000 for one year including:
|
$25,000 (one-time grant) |
| Operating grants |
|
$2.6 million over three years including:
|
$100,000 per annum for up to three years |
| Capacity building workshop in HIV/AIDS |
|
$150,000 over one year including:
|
$25,000 (one-time grant) |
| Research facilitators in HIV/AIDS |
|
$1.16 million over two years including:
|
|
| Master's research awards |
|
$140,000 over two years including:
|
$17,500 per annum for up to two years (stipend) |
| Doctoral research awards |
|
$264,000 of funding over three years including:
|
$22,000 per annum for up to three years (including a trainee stipend of $21,000 and a research allowance of $1,000) |
| Source: CIHR. (2008). Most recent request for applications for each of the six CIHR HIV/AIDS CBR Program tools. Note: The amount of funding available through each tool may vary from year to year. | |||
2.5 Application review process
An HIV/AIDS CBR Program-specific CIHR Merit Review Committee reviews all funding applications. There is a separate committee for each of the general and Aboriginal funding streams. Committee membership is based on suggestions from institutes/portfolios, partners, and applicants. Selected members are invited to serve on the committee for one round of request for applications (RFAs).1
The CIHR Merit Review Committee assesses the scientific merit and potential impact of each application. Four committee members, including two reviewers and two readers, review each application. One of the reviewers considers the scientific merit of the proposed research and the other considers its potential impact on the community. The reviewers present the application to the Merit Review panel and the readers act as discussants at the presentation.
Following feedback from the reviewers and readers and discussion at the Merit Review meeting, the two reviewers assign the application a consensus rating for scientific merit and potential impact (which receive equal weight in the application review process). Once the initial rating is specified, the Merit Review panel provides individual confidential votes within +/- 0.5 of the consensus ratings. To be funded, research applications must score at least 3.5 on both scientific merit and potential impact, based on the following merit review scale (see Table 3).
| Potential for funding | Potential Impact | Range | Scientific Merit |
|---|---|---|---|
| May Be Funded | Enormous | 4.5 - 4.9 | Outstanding |
| Extremely Significant | 4.0 - 4.4 | Excellent | |
| Very Significant | 3.5 - 3.9 | Very good | |
| Not Fundable | Significant | 3.0 - 3.4 | Acceptable, but low priority |
| Moderate | 2.5 - 2.9 | Needs revision | |
| Limited | 2.0 - 2.4 | Needs major revision | |
| Negligible | 0.0 - 1.9 | Seriously flawed | |
| Source: CIHR most recent requests for application (2008). | |||
Following the ratings determination, the Merit Review panel considers the amount of funding requested and recommends an appropriate budget for the proposed research. Then, for each funding tool, all applications considered fundable are placed in a priority ranking, which is determined by averaging each application's scientific merit and potential impact scores.
CIHR institute, portfolio, and partner representatives receive the final anonymous ranking lists of projects for each funding tool, final merit review ratings, and the Merit Review committee's recommended funding levels. CIHR issues funding to applicants for each funding tool from the top-ranked down as far as the amount of available funding will allow in both the general and the Aboriginal streams.
2.6 Program activity
Between 2004 and 2007, the HIV/AIDS CBR Program had $12,166,000 of funding available, including $6,199,500 for general projects and $5,966,500 for Aboriginal projects. It allocated $9,827,556 to projects including $6,625,734 to general projects and $3,201,822 to Aboriginal projects.
Since 2004, the Program received 104 applications for the general stream and 53 applications for the Aboriginal stream. About half of those applications received funding. Table 4 presents a summary of the total number of applications for HIV/AIDS CBR Program funding by year.
| Table 4: Applied and received HIV/AIDS CBR Program funding (2004–2007) | ||||
|---|---|---|---|---|
| Year of award | General Stream | Aboriginal Stream | ||
| Applied for funding | Received funding | Applied for funding | Received funding | |
| 2007 | 22 | 11 | 12 | 8 |
| 2006 | 24 | 13 | 10 | 5 |
| 2005 | 25 | 12 | 10 | 5 |
| 2004 | 33 | 16 | 21 | 11 |
| Total | 104 | 52 | 53 | 29 |
The following tables show the amount of funding available for and committed to projects by funding tool, year, and stream as well as the number of applications received and approved.
[ Previous Section | Next Section ]
1. Existing members may be eligible to serve for additional terms.
