ARCHIVED - Federal Initiative to Address HIV/AIDS in Canada Implementation Evaluation Report

Annexes II.1 – II.4
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Annex II-1 – Self-Assessment

This template has been included with the permission of CIHR. It is included as an example of a comprehensive and complete response.

RC – Canadian Institutes of Health Research (CIHR)
RC description and objectives

As the Government of Canada’s agency for health research, the Canadian Institutes of Health Research (CIHR) was created in 2000 “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” (Bill C-13, April 13, 2000).  Today, CIHR supports more than 11,000 researchers and researchers in training as part of the federal government's investment in health research.  Research funded by CIHR spans the following four pillars of health research: biomedical; clinical; health systems and services; and population and public health.

Within the context of CIHR’s overall mandate and strategic priorities, the CIHR HIV/AIDS Research Initiative is responsible for the management and oversight of the research components of the two major Government of Canada initiatives in HIV/AIDS, namely the: Federal Initiative; and the Canadian HIV Vaccine Initiative (CHVI). 

The CIHR HIV/AIDS Research Initiative’s mission is as follows:

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.

The strategic research priorities of the CIHR HIV/AIDS Research Initiative are as follows:

• 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 strategic goals of the CIHR HIV/AIDS Research Initiative are as follows:

• 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 required to effectively address HIV/AIDS;
• promote translation of HIV/AIDS research results into action; and
• develop partnerships that engage stakeholders and advance the CIHR HIV/AIDS Research Initiative agenda and Canada’s response to the HIV/AIDS epidemic, nationally and globally.

Alignment with the Federal Initiative

The target populations of the CIHR HIV/AIDS Research Initiative are identical to those outlined in the Federal Initiative.  Furthermore, the CIHR HIV/AIDS Research Initiative is responsible for the Community-Based Research Program, which contributes significantly toward providing effective services and engaging people affected by HIV/AIDS. Of note, rates of HIV/AIDS among Canada's Aboriginal population are on the rise and, compared to their non- Aboriginal counterparts, Aboriginal peoples are becoming infected at a younger age.  Accordingly, a key feature of the Community-Based Research Program is the involvement of Aboriginal communities and organizations in the design and implementation of research projects. This approach provides study populations with control of the research they are involved in and helps to disseminate the knowledge created back to the community to help them in their fight against HIV/AIDS.

In addition, to ensure its alignment with Federal Initiative priorities, CIHR created the CIHR HIV/AIDS Research Advisory Committee to advise the CIHR HIV/AIDS Research Initiative on the strategic development of its research agenda.  The committee is composed of individuals with in-depth knowledge of all aspects of Canadian HIV/AIDS research; an understanding of the complex dynamics of the HIV/AIDS community; an ability to make recommendations on research policies and programs that would be supported by all of CIHR; and a capacity to act as a champion for HIV/AIDS researchers and individuals living with, and/or vulnerable to, HIV/AIDS.  Of particular note, a seat on the committee is designated to a member of the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada.

Through support of Federal Initiative funding, combined with further ongoing support from CIHR, HIV/AIDS-related research expenditures totalled approximately $37.1 million in 2007-2008.  As Table 1 clearly indicates, an increase in Federal Initiative support has directly led to the growth of CIHR HIV/AIDS-related research expenditures over the same time period.

Table 1: CIHR Yearky Estimated Expenditures related to HIV/AIDS Research

CIHR Logic Model

CIHR does not have a Logic Model and a RMAF specific to the Federal Initiative. As CIHR activities related to the Federal Initiative are the same as the other activities for which CIHR already has a logic model and an RMAF, and as the activities answer to the same Terms and Conditions of its accepted Treasury Board Submission, there is no need to develop a new one.

Note: A copy of the CIHR RMAF/RBAF can be provided on request.

The unique nature of the contributions of CIHR to the Federal Initiative is well captured by the fact that the CIHR HIV/AIDS Research Initiative has been integrated into CIHR MRRS under the Strategic Objective 1 (Advances in Health Knowledge) and under PAA level 1.2 (Strategic Priority Research).

Enlarge CIHR Logic Model

Performance Measurement Framework (PMF)

No specific PMF was developed as it falls under the CIHR RMAF.   However, one specific performance indicator has been introduced in the CIHR MRRS:

• Outputs and impacts of funded research and success against objectives
  • Data source: Annually, Research Reporting System starting 2009-2010 
  • Outputs can be provided annually (number of applications funded, scope of the applications funded); Possibility of comparing between years but as the specific objectives of the Requests for Applications are different from one year to the other, comparisons cannot really be made.

CIHR Funding Allocation Framework

As stipulated in the terms and conditions of its Federal Initiative support, the CIHR HIV/AIDS Research Initiative budget is used to fund grants and awards; and support operating costs.  Approximately 92% of Federal Initiative funding directed to CIHR is directed to support HIV/AIDS researchers. 

Grants and Awards Funding
The CIHR HIV/AIDS Research Initiative has the following four funding streams within which HIV/AIDS research will be supported utilizing funds from the Federal Initiative:

• biomedical/clinical research;
• health services/population health research;
• community-based research; and
• HIV/AIDS clinical trials network.

Further funding is also provided by the CIHR HIV/AIDS Research Initiative through the CHVI. 

Operating Funding
The CIHR HIV/AIDS Research Initiative has five dedicated staff and a small operating budget, which covers costs such as peer review committee expenses and development activities.  Additional support for the CIHR HIV/AIDS Research Initiative is provided by the CIHR Institute of Infection and Immunity, as well as Research Portfolio and other central CIHR staff. 

Federal Initiative Implementation Results

Outputs

Overall, the goals and objectives of the Federal Initiative support the achievement of CIHR’s goals:

• undertaking outstanding research - to advance health knowledge through excellent and ethical research, across disciplines, sectors and geography;
• employing outstanding researchers in innovative environments - to develop and sustain Canada's health researchers in vibrant, innovative, and stable research environments; and
• transforming health research into action - to catalyze health innovation to strengthen the health system and contribute to the growth of Canada's economy.

In support of these objectives, and in alignment with the input of Canada’s HIV/AIDS stakeholder communities, the CIHR HIV/AIDS Research Initiative has implemented a wide cross-section of Grants and Awards Programs in support of its research priority themes on HIV/AIDS.

In addition, in 2005 the CIHR HIV/AIDS Research Advisory Committee undertook the task of identifying strategic priorities for CIHR HIV/AIDS research that would enable CIHR to systematically invest in HIV/AIDS research in a manner reflective of the priorities and values of the full range of stakeholders involved and to ensure there was minimal duplication with activities being undertaken outside CIHR.  As a result, a number of targeted strategic initiatives were developed and implemented. 

In 2007-2008, the CIHR HIV/AIDS Research Initiative invited its stakeholder community to play a leading role in shaping its strategic plan that will ultimately define the CIHR HIV/AIDS Research Initiative’s goals and objectives and guide its activities and investments over the next five years.  Moving forward, the final document will position Canada’s strategic HIV/AIDS research priorities in the context of an overarching strategic plan that will serve as a useful guide for future CIHR HIV/AIDS Research Initiative investments.  

Examples of funding opportunities include:

• Seed Grant: HIV/AIDS – Community-Based Research (CBR)
• Operating Grant: HIV/AIDS (CBR)
• Capacity Building through Enhanced Operating Grants in HIV/AIDS
• Pilot Projects in HIV/AIDS
• Emerging Team Grant: HIV/AIDS
• Operating Grant: HIV Prevention
• Interdisciplinary Capacity Enhancement Grants – Reducing Health Disparities and Promoting Equity for Vulnerable Populations
• Interdisciplinary Capacity Enhancement Grants – Social and Behavioural Issues in HIV/AIDS and Hepatitis C
• Operating Grant: Partnerships for Health System Improvement (PHSI)
• Workshop: HIV/AIDS (CBR)
• Graduate Training Award – Doctoral: HIV/AIDS (CBR)
• Graduate Training Award – Master’s: HIV/AIDS (CBR)
• Facilitator Grant: HIV/AIDS (CBR)
• Operating Grant Priority Announcement: HIV/AIDS
• Randomized Controlled Trials Priority Announcement: HIV/AIDS
• Equipment Grants Priority Announcement: HIV/AIDS
• Maintenance Grants Priority Announcement: HIV/AIDS
• Clinician Scientist Priority Announcement: HIV/AIDS
• Canada Graduate Scholarships (CGS) Master’s Award Priority Announcement: HIV/AIDS
• Fellowship Priority Announcement: HIV/AIDS
• Graduate Training Award – Doctoral Priority Announcement: HIV/AIDS
• New Investigator Salary Priority Announcement: HIV/AIDS
• Bridge Grant Priority Announcement: HIV/AIDS
• Synthesis Grant: Knowledge Translation
• Knowledge to Action
• Meetings, Planning and Dissemination Grant
• Seed Grant: Gender, Globalization and Health
• Team Grant: Teasdale-Corti Global Health Research Partnership Program
• Clinical Trials Network in HIV/AIDS
• Centres for Population Health and Health Services Research Development in HIV/AIDS
• Training Grant: Strategic Training Initiative in Health Research (STIHR)

Canada’s health research community has responded positively to these funding opportunities.  As such, today Canada has a thriving HIV/AIDS research community.

Outcomes

Complete success can only be achieved when the goal of a world free of HIV/AIDS is attained.  However, until that day comes, a number of activities and indicators suggest the CIHR HIV/AIDS Research Initiative is successfully meeting its mandate. 

The CIHR HIV/AIDS Research Initiative has made an important contribution to the short-term outcomes of increased availability of evidence and building HIV/AIDS research capacity through the implementation of the various grants and awards programs.  The CIHR HIV/AIDS Research Initiative has also made a contribution to the short-term outcomes on increased and improved collaboration and networking and increased awareness in HIV/AIDS, in general, and on the research agenda.

The main contribution of the CIHR HIV/AIDS Research Initiative grants and awards programs is clearly the creation of new knowledge and research capacity building in HIV/AIDS.  Currently, in the areas of HIV/AIDS, CIHR funds 182 grants, 139 awards and 17 Canada Research Chairs.  This funding goes directly to HIV/AIDS researchers in universities and research institutions across Canada.  While research is a long-term endeavour, as noted above, many of the funded projects have already demonstrated tangible outcomes.  This new knowledge will ultimately lead to better evidence-based decision making in the area of HIV/AIDS.

Overall, CIHR has established an international reputation for research excellence, including HIV/AIDS research.  All research funded through CIHR (and the CIHR HIV/AIDS Research Initiative) must meet peer-reviewed international standards of excellence, a system universally recognized as the scientific gold standard, and as a means of ensuring research excellence, transparency and fairness. Peer review is the mechanism of scientific self-regulation, a method used to ensure appropriateness of research procedures, and to evaluate the scientific merit and plausibility of research results.  Peer reviewers are accountable to the wider research community and ultimately, to the Canadian public. They help to ensure that CIHR is accountable to the federal government  for the money it invests in health research.  

As part of its overall accountability to Canadians, CIHR is committed to demonstrating the impact of Canada's investment in health research.  An end-of-grant reporting mechanism now requires CIHR-funded researchers to provide a progress report at the end of the funding term.  Impacts from research projects funded through CIHR will eventually be tracked in all CIHR programs.

Specifically, HIV/AIDS researchers supported by the CIHR HIV/AIDS Research Initiative have made significant achievements in addressing the HIV/AIDS epidemic both in Canada and globally.  Many of these achievements are captured in reports, such as the Institute of Infection and Immunity Annual Reports and the World AIDS Day Report, as well as other various CIHR HIV/AIDS Research Initiative publications, which can be located on the CIHR website. CIHR-supported outcomes in this area included:

• an international research study that found that male circumcision is an effective way to reduce the incidence of HIV among young men - The study was named the top medical breakthrough of 2007 by Time Magazine, after two clinical trials of male circumcision were halted early after analysis of early data showed their dramatic success.

• the identification of immune cells that give rise to a fungal infection commonly found in HIV patients called candidiasis - This new knowledge will help in the development of more powerful and effective treatments for the fungal infection, which can limit food consumption, leading to weight loss that threatens patients' general health and well being.
• the definition of a new and unexpected pattern of gene expression in HIV-1, which has the potential to produce a new protein - The discovery of this protein and identification of its function might provide a new target for Highly Active Anti-retroviral Therapy (HAART) and in addition, due to its proposed membrane-associated characteristics, could provide new possibilities for vaccine design.
• the development of a tool to measure patients' readiness to adhere to HAART - The Antiretroviral Readiness and Motivation Scale (ARMS) could allow physicians and other caregivers to better predict which patients will adjust quickly to HAART and take steps to help those who will face more challenges in adhering to the regimen.
• important findings that suggest that people at risk of HIV become less worried about it the longer they test negative, believing the high-risk behaviour they engage in is safe -  The results underscore the need for enhanced counselling for those who repeatedly test negative for the virus and continue to engage in high-risk behaviour.
• clinical trials that have led to the development and use of HAART that have allowed many HIV-infected people to live longer, healthier lives - With funding from CIHR, the Canadian HIV Trials Network has been able to work with over 9000 trial participants; review 232 trials; approve 121 trials; implement 95 trials; and currently undertake nearly 20 ongoing trials.  

Next Steps – Areas for Improvement

The CIHR HIV/AIDS Research Initiative continually works to evaluate and improve its funding mechanisms to ensure its alignment with the Federal Initiative and with the needs of Canada’s health research community, as well as to maintain the excellence of its programs.  For example, the CIHR HIV/AIDS Research Initiative:
 

• invited its stakeholder community in 2007-2008 to play a leading role in shaping its strategic plan that will ultimately define the CIHR HIV/AIDS Research Initiative’s goals and objectives and guide its activities and investments over the next five years -  The final document now positions Canada’s strategic HIV/AIDS research priorities in the context of an overarching strategic plan that will serve as a useful guide for future CIHR HIV/AIDS Research Initiative investments.
• is undertaking an evaluation of its HIV/AIDS Community-Based Research Program (CBR) Program in 2009 - The evaluation will contribute to better decision-making regarding how best to deliver the CBR Program to meet the needs of stakeholders and will also provide objective information to assist with decisions regarding future funding tools for the Program's funding streams.
• re-launched a call for applications for the Canadian HIV Trials Network (CTN) in 2007, an initiative committed to developing treatments, vaccines, and a cure for HIV and AIDS, through the conduct of scientifically sound and ethical clinical trials - The application submitted by the previously supported network scored highly in all the following areas reviewed: governance; importance and relevance; excellence of team and the network’s research strategy; KT; networking and partnerships; and capacity building.  The evaluation noted that the CTN has played a key role in Canada’s response to the HIV/AIDS epidemic and further funding will help ensure continued Canadian strength and expertise in conducting important and high-quality clinical trials in HIV.
• participated in CIHR’s five-year international review of all its programs in 2006 - In the end, the review validated CIHR's role in building and maintaining research programs and capacity.