AIDS Research at the NIH: A Critical Review

targets." OAR guesses that when the "AIDS actuals" for FY 1993 come in two years hence, they'll be
smaller than what the ICDs promised. ICDs didn't have that leeway when AIDS was a separate
earmark by Congress, but for the last two years AIDS hasn't had its own budget line anymore. Every
institute has its own budget line.
* NIH AIDS research should have its own line item in the Federal budget.
* OAR/OD should have the power to reallocate AIDS resources across Institute lines.
* Congress should fund the full $1.3 billion requested for AIDS research projects by the
ICD directors for FY 1993.
Institute AIDS Science Report (IASR). Every half year the ICDs tell OAR what they've done, but the
quality and quantity of reporting varies between institutes. NIAID lists the ACTG trials (in development,
pending, open, closed, completed, deferred, withdrawn) for scores of pages ad nauseam without
signifying which ones matter, how much they cost, or how they contribute to the standard of care.
Other ICDs report small initiatives as though they were major contributions to the field. OAR lacks a
clear picture of NIH's intramural AIDS research.
Mason Categories. In 1988, Assistant Secretary for Health James Mason demanded that PHS set up
an accounting system to track its AIDS dollars, to ensure they were only counted once, and to assess
which program areas were being funded. This resulted in the "Mason Categories," activity codes which
define an award (or intramural activity) as basic, clinical, epidemiological, training, virology, immunology,
etc. Awards are placed arbitrarily in one category when others might do. For example, if a foreign
post-doctoral student were being trained to assess the cytokine response of macrophages to SIV in the
vertically-infected pigtailed macaque model, this could be categorized as IA2 "Immunology," IA4 "Animal
Models," IA5 "Training', or IIB2e "Transmission: perinatal." The Mason Categories and their code
abbreviations are listed in Section III. They should be thought of as a range or approximation rather
than as exact figures.
AIDS Research Information System (ARIS). In order to track the dollars, OAR set up a database
whose inputs include the Division of Research Grants CRISP system, which tracks most NIH extramural
awards. This ARIS database, unlike CRISP, must be complete on extramural AIDS awards by the end
of the fiscal year, so OAR can report back to PHS and Congress about NIH AIDS activities. Thus,
while CRISP includes perhaps 75% of the AIDS awards, ARIS must have them all: PI, site, title,
amount, abstract. The ARIS system is new, and still has some bugs to be worked out, but it is
fantastically useful, and its staff have been extraordinarily helpful to us during this project.
Types of Awards. There are many types of NIH research awards. Each has a code. Basically,
grants (R01s and other R-codes) are investigator-initiated and have few strings attached. Come back
in five years if you find something. Your basic scientist working in glorious obscurity at his lab bench is
sustained by R01 grants. Contracts (N01s) give the funding institute more power to direct the work,
and sometimes to revoke the contract if the recipient is remiss. Data analysis for large clinical cohorts
(SDAC, EMMES, CAMACS) is usually funded by contracts, as is the CPCRA. Cooperative agreements
(U01s) are intermediate between grants and contracts. They give lip service to "investigator initiation"
and provide some control for NIH. The ACTU sites are funded by UOls. P01s and P30s are program
project grants, which are large, long-term, multidisciplinary projects. The NIAID-funded CFARs
(Centers for AIDS Research) are P30s. F-awards are fellowships; T-awards are training grants. Sawards are "special" small instrumentation grants (SIG), small business grants, minority training grants,
In the "Annual Report to Congress" mandated by the HOPE act of 1990.