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FY 2013 Trans-NIH AIDS Research By-Pass Budget Estimate and Trans

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FY 2013 Trans-NIH AIDS Research By-Pass Budget Estimate and Trans FY 2013 National Institutes of Health TRANS-NIH AIDS RESEARCH BY-PASS BUDGET ESTIMATE and TRANS-NIH PLAN FOR HIV-RELATED RESEARCH Prepared by the Office of AIDS Research Jack Whitescarver, Ph.D. NIH Associate Director for AIDS Research and Director, Office of AIDS Research The cover photo shows a 3-D model of HIV, depicted as orange threads, attacking and fusing with an immune cell, depicted as the gray surface. Constructed by a Russian team of scientists, the image won first place for illustrations in the 2010 International Science and Engineering Visualization Challenge sponsored by the journal Science and the National Science Foundation. ©Visual Science Company www.visualsciencecompany.com F Y 2013 National Institutes of Health TRANS-NIH AIDS RESEARCH BY-PASS BUDGET ESTIMATE and TRANS-NIH PLAN FOR HIV-RELATED RESEARCH Dr. Edward Handelsman at the Liquid Camp for HIV-positive teens, where he served each summer as the camp’s Medical Director. Dedicated to the memory and legacy of DR. EDWARD LOUIS HANDELSMAN Chief of the International Maternal, Adolescent, and Pediatric Branch Division of AIDS National Institute of Allergy and Infectious Diseases National Institutes of Health His intelligence, passion, commitment, and heart made him a champion for maternal, pediatric, and adolescent AIDS research, prevention, and care. FY 2013 Trans-NIH AIDS Research By-Pass Research AIDS Trans-NIH FY 2013 FY 2013 Trans-NIH AIDS Research By-Pass Budget Estimate CONTENTS 1 Legislative Mandate 3 Introduction 7 HIV/AIDS Pandemic 11 NIH AIDS Research Program 13 NIH Office of AIDS Research Budget 14 Trans-NIH Strategic Plan 15 OAR Budget Development Process Estimate 16 National and International Impact and Need 17 New Scientific Advances and Opportunities 25 AIDS Research Benefits Other Diseases 31 FY 2013 Trans-NIH AIDS Research Priorities 32 PRIORITY: Investing in Basic Research Etiology and Pathogenesis 34 PRIORITY: Reducing New Infections Vaccines Microbicides Behavioral and Social Science Treatment as Prevention 38 PRIORITY: Improving Disease Outcomes for HIV-Infected Individuals Drug Discovery, Development, and Treatment 39 PRIORITY: Reducing HIV-Related Disparities Training, Infrastructure, and Capacity Building 41 PRIORITY: Translating Research From Bench to Bedside to Community Natural History and Epidemiology Information Dissemination 43 Conclusion 45 BUDGET TABLES Table 1: NIH AIDS Research Funding by Scientific Area of Emphasis Table 2: NIH AIDS Research Funding by Mechanism FY 2013 Trans-NIH AIDS Research By-Pass Budget Estimate Legislative Mandate AUTHORIZING LEGISLATION BY-PASS BUDGET Section 2353 of the Public Health Service Act requires that “the Director of the Office of AIDS Research (OAR) establish a comprehensive plan for the conduct and support of all AIDS activities of the agencies of the National Institutes of Health (NIH).” It also requires that the Director “shall prepare and submit directly to the President, for review and transmittal to the Congress, a budget estimate for carrying out the Plan for the fiscal year....” That budget “shall estimate the amounts necessary for the agencies of the National Institutes of Health to carry out all AIDS activities determined by the Director of the Office to be appropriate, without regard to the probability that such amounts will be appropriated.” STRATEGIC PLAN Section 2353 of the Public Health Service Act requires that the Director of OAR shall: (1) establish a comprehensive plan for the conduct and support of all AIDS activities of the agencies of the NIH; (2) ensure that the Plan establishes priorities among the AIDS activities that such agencies are authorized to carry out; (3) ensure that the Plan establishes objectives regarding such activities; (4) ensure that all amounts appropriate for such activities are expended in accordance with the Plan; (5) review the Plan not less than annually, and revise the Plan as appropriate; and (6) ensure that the Plan serves as a broad, binding statement of policies regarding AIDS activities of the agencies, but does not remove the responsibility of the heads of the agencies for the approval of specific programs or projects, or for other details of the daily administration of such activities, in accordance with the Plan. The law also specifically requires that the Plan provide for basic research, applied research, research conducted by the NIH, research supported by the NIH, proposals developed pursuant to solicitations by the NIH and investigator-initiated proposals, and behavioral and social sciences research. In accordance with the law, the NIH Office of AIDS Research, a component of the NIH Office of the Director, has developed this document that includes both the Fiscal Year (FY) 2013 Trans-NIH AIDS Research By-Pass (Professional Judgment) Budget Estimate and the FY 2013 Trans-NIH Plan for HIV-Related Research. FY 2013 Trans-NIH AIDS Research By-Pass Budget Estimate 1 Introduction The Office of AIDS Research (OAR) is the only NIH Office that is legislatively mandated to develop an annual Presidential by-pass budget estimate. Only the National Cancer Institute has a similar authority. This by-pass budget estimate is based solely on the current scientific opportunities and the commitment and urgent need to support the highest quality research to carry out the Trans-NIH Plan for HIV-Related Research. The HIV/AIDS pandemic will remain the most serious to evaluate prevention interventions that can public health crisis of our time until better, more be used in combination in different populations, effective, and affordable prevention and treatment including adolescents and older individuals. regimens—and eventually a cure—are developed and IMPROVING DISEASE OUTCOMES: OAR will universally available. The by-pass budget request: target funding for NIH research focused on Addresses critical scientific needs; developing better, less toxic treatments and Addresses gaps in our understanding through an investigating how genetic determinants, sex, emphasis on basic science; gender, race, age, nutritional status, treatment during pregnancy, and other factors interact to Capitalizes on emerging scientific opportunities affect treatment success or failure and/or disease by providing additional funds for new, exciting progression. Studies will address the increased areas of investigation; incidence of malignancies, cardiovascular and Restores vital resources that have been drained metabolic complications, and premature aging by the dual effects of inflation and a flat budget; associated with long-term HIV disease and Establishes the biomedical and behavioral antiretroviral therapy. research foundation necessary to implement the ADVANCING TRANSLATIONAL SCIENCES: OAR major goals of the President’s National HIV/AIDS will ensure adequate resources for research on Strategy; and the feasibility, effectiveness, and sustainability Addresses the key themes of the Director of the NIH. required to scale up interventions from a struc- tured behavioral or clinical study to a broader This by-pass request and strategic Plan establish the “real world” setting. critical priorities for trans-NIH AIDS research. These include: The FY 2013 by-pass budget request for NIH AIDS research is $3.598 billion, which represents a INVESTING IN BASIC RESEARCH: OAR will 17 percent increase over the FY 2012 enacted level. increase support for basic research that will The total for AIDS research is reported in a different underpin further development of critically manner than NIH funding for other disease research, needed vaccines and microbicides. as this level includes the total trans-NIH support for ENCOURAGING NEW INVESTIGATORS AND intramural and extramural research; research manage- NEW IDEAS: OAR will provide additional support ment support; research centers; training; and basic, for innovative multidisciplinary research and clinical, behavioral, social science, and translational international collaborations to develop novel research on HIV/AIDS, as well as the wide spectrum of approaches and strategies to eliminate viral reser- AIDS-associated malignancies, opportunistic infections, voirs that could lead toward a cure for HIV. coinfections, and clinical complications. ACCELERATING DISCOVERY THROUGH TECHNOLOGY: OAR will increase funds to support This increase represents an investment that must be critical studies in the area of therapeutics as a sustained and enhanced to take advantage of critical method to prevent infection, including treatment to emerging scientific advances and to restore lost prevent HIV infection after exposure; pre-exposure opportunity. This amount also is essential to address prophylaxis (PrEP); a potential prevention strategy the impact of the erosion of buying power on critical known as “test and treat,” to determine whether research programs. The total AIDS budget at the 2012 a community-wide testing program with treat- enacted level is approximately equivalent in constant ment can decrease the overall rate of new HIV dollars to the FY 2001 appropriation. Further, there is infections; and improved strategies to prevent projected to be a 19.3 percent loss in buying power mother-to-child transmission. A key priority is for NIH AIDS research between 2003 and 2013. 4 FY 2013 Trans-NIH AIDS Research By-Pass Budget Estimate Impact of Inflation on NIH HIV/AIDS Research Dollars (Current and Constant) 3100 2900 2700 HIV/AIDS Current HIV/AIDS Constant Dollars 2500 (in millions) (in 2300 2100 20132012201120102009200820072006200520042003 FISCAL YEAR
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