National Advisory Mental Health Council discusses HIV/AIDS behavioral research
The Advisory Council to the National Institute of Mental Health (NIMH) met on January 20. The meeting agenda included presentations on several of the Institute’s research areas, including suicide prevention and HIV/AIDS research, which is predominantly behavioral research. NIMH Director Tom Insel also provided an update on the FY2012 budget, which resulted in a .2 percent increase for the Institute and leaves the NIMH budget at $1.48 billion.
The flat NIH budgets for the past few years have taken their toll on NIMH’s support for Research Project Grants (RPG). In FY 2011, NIMH awarded only 465 new and competing grants, a 16 percent reduction from FY 2010 and the lowest number since 1998. In FY 2012, Insel projected that the Institute will support new and competing RPGs at a level equivalent to the 15th percentile for established investigators and at a level equivalent to the 18th percentile for new and early stage investigators. The Institute intends to continue the practice of investing 15 percent of its competing RPG funds towards Requests for Applications that target research gaps in areas where the Institute is not receiving unsolicited grant applications.
NIMH Deputy Director Phil Wang provided the overview of the NIMH’s HIV/AIDS research portfolio, which makes up $196 million of NIMH’s overall budget. He noted that in 2011, NIMH held a summit with the National Institute of Allergy and Infectious Diseases (NIAID) with goals to expand the integration of behavioral and biomedical science, increase intervention efficacy and durability, personalize and target interventions for high risk groups, optimize reach but avoiding redundancy and disseminate interventions widely with fidelity. Noting that there is a lack of coordination across the infectious disease and behavioral health communities, Insel explained that NIH’s own structure might be part of the problem, given that separate Institutes with unique agendas are addressing HIV from different perspectives. Insel explained that in the area of AIDS research, NIMH wants to fully integrate with NIAID and it would make sense for the program to be integrated in the same institute. According to Insel, the HPTN trial, a study of sero-discordant couples that showed immediate use of Anti-retroviral Therapy (ART) by HIV-infected individuals reduced transmission of HIV to their HIV-uninfected partners by 96 percent, has been instrumental in convincing the director of NIAID Tony Fauci "that AIDS is a behavioral problem."
New NIMH initiatives and recently completed Requests for Applications have supported research that addressed the following subjects: HIV prevention for men who have sex with men, integration of behavioral science into biomedical interventions for HIV prevention, promoting engagement in care and reducing time to ART initiation following HIV diagnosis, and advancing HIV prevention through transformative behavioral and social science research. Wang noted that a recently cleared concept addresses community level approaches to prevention in high risk populations, and he reiterated that addressing behavior is critical to success.