Department of Health and Human Services
	Research, Demonstration, and Evaluation Activities FY 2003 Plan and Budget February 2002

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RESEARCH AND DEMONSTRATIONS

(by HHS Strategic Plan Objective)

INCREASE THE AVAILABILITY AND EFFECTIVENESS OF SERVICES FOR THE TREATMENT AND MANAGEMENT OF HIV/AIDS (OBJECTIVE 3.7)

FY 2003 Priorities

SPECIAL PROJECTS OF NATIONAL SIGNIFICANCE - RYAN WHITE (HRSA)

Research: The SPNS, authorized in Part F of the Ryan White CARE Act, advance knowledge and skills in the delivery of health and support services to underserved populations diagnosed with HIV infection. SPNS grants stimulate the design of innovative models of care and support the development of effective delivery systems for these services. SPNS is considered the research and developmental arm of the Ryan White CARE Act and provides the mechanisms to: 1) assess the effectiveness of particular models of HIV/AIDS care and support; 2) support innovative program design; and 3) promote replication of effective models. In order to meet program goals, funded organizations necessarily contain a strong evaluation component and will disseminate information necessary for effective replication.

Specific new priorities include:

• understanding access to HIV pharmaceuticals across various population groups.
• developing methods to estimate unmet need.
• end-of-life care and palliation.
• assessing existing treatment education/adherence efforts.
• establishing and assessing HIV integrated care networks.
• assessing innovation in serving those with chemical dependencies.

Evaluations: FY 2003 priorities include:

• evaluating the quality of care for HIV substance abusers, and continuinity of care for incarcerated individuals.
• evaluating the effectiveness of initiatives in HIV migrant/border health.
• Examining to what extent CARE Act grantees and Titles I and II providers are identifying HIV infected populations who are not in primary health care (not accessing available services) and the extent to which grantees are identifying HIV-infected populations who are not remaining in primary health care and the reasons for this lack of continued service utilization.
• Examining whether grantees are determining the specific reasons why individuals are not in care and removing barriers to their care and what grantees and their providers are doing to enroll and retain identified underserved populations in primary health care.
• Evaluating whether CARE Act grantees identified the most effective combinations or models of integrated services that improve the use of primary health care, taking into account the characteristics of local health care delivery systems and affected populations.
• Evaluating the extent to which CARE Act grantees and their providers providing quality care to clients as defined by Public Health Service and other care standards, and whether this is care having optimal effects on morbidity and mortality, and is it improving health- related quality of life.
• Evaluating the extent to which CARE Act grantees are adapting their service priorities and allocations to a changing and sometimes chaotic health delivery and reimbursement environment.

HEALTH SERVICES RESEARCH (NIH)

Research: In FY 2003, NIH funds will be used to support the assessment of interventions to improve health outcomes in persons with HIV and the ways to improve their access to health care services. Priorities include:

Research supported by the National Institute of Nursing Research (NINR) will:

• test the effectiveness of an intervention to improve health outcomes in persons with human immunodeficiency virus who are receiving antiretroviral medications through a program managed by a state health department and evaluate the cost effectiveness of the intervention.
• test a model of health related quality of life and evaluate how the relationships among the model variables change over time.
• examine the health experiences of women living with HIV, the obstacles they face, and the resources and support they need in order to inform the provision of health care and social services in identifying how structural and interpersonal factors in care delivery and social welfare systems support or hinder accessing resources.

The National Institute of Child Health and Human Development (NICHD) will continue to support the Adolescent Medicine HIV/AIDS Research Network in order to meet several research objectives of the Public Health Service’s “Healthy People,” by focusing on HIV-infected, low income, minority adolescents. The Network strives to improve and standardize health care management of this unique patient population by:

• developing a standardized treatment protocol that addresses the unique biological and behavioral features of adolescents, as well as disease progression and the effects of co- morbidity with other STDs and pregnancy among adolescents.
• developing and evaluating clinical management and policy guidelines for treating adolescents infected with HIV.
• increasing access for adolescence to appropriate clinical drugs and vaccine trials.

(This research is also related to Objective 4.1: Enhance the Appropriate Use of Effective Health Services 6.3 Financing, and Cost-effectiveness of Health Services.)