NCI’s Center for Global Health Funded Research Portfolio Implications for Future Dissemination and Implementation Research James R. Alaro, Ph.D. December 5, 2017
NIH Dissemination and Implementation Research in Health DIRH PAR is a trans-NIH funding opportunity for D&I - First issued in 2006, renewed 2009, 2013, 2016 PAR-16-238, R01 Research Project Grant PAR-16-236, R21 Exploratory/Developmental Grant PAR-16-237, R03 Small Grant Program Current NIH participants: 16 Institutes and Centers, ODP and OBSSR Eligibility: US Institutions, Foreign Institutions Cycle I Cycle II Cycle III Applications Due Dates Jan 25- May 7 May 25-Sept 7 Sept 25-Jan 7 Scientific Review Jun - Jul Oct - Nov Feb - Mar Advisory Council Review Aug Jan May 2
NIH DIRH PAR Portfolio: 2008 - 2017 Total Dollars 84 84 83 81 Number of Awards 69 59 44 34 33 $41 $40 $39 27 $34 $25 $25 $19 $14 $13 $10 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 598 Research Grants funded: 433 R01, 132 R21, 31 R03 NIH funding levels has increased from $10M - $41M 3
NCI DIRH PAR Portfolio: 2008 - 2017 NCI: 145 R01, 43 R21, 12 R03 Foreign Components 200 10 R01, 2 R21,1 R03 Number of Awards 151 Direct Foreign Grants 1 R01 64 51 51 28 13 10 7 6 4 4 4 3 2 Neta G. et al. Implementation science (2015) 10:4 4
NCI’s Center for Global Health Established in 2011 to support and accelerate NCI’s mission to reduce the global burden of cancer CGH collaborates with: NCI Divisions, Offices and Centers and NIH NCI-designated Cancer Centers U.S. government agencies Research Institutions Foreign governments Non-governmental organizations Pharmaceutical and biotechnology companies 5
NCI’s Center for Global Health Research Programs Program Funding Opportunity (Number of Awards) Administrative 1. Admin Supp. to promote cancer prevention and control research in LMICs (n=10) Supplements 2. Admin Supp. to promote clinical research studies on pediatric Burkitt Lymphoma in LMICs (n=6) 1. Pilot global cancer research collaborations between NCI-designated cancer centers and LMICs Research (n=13) Programs 2. Affordable cancer technologies for global health - develop/test/adapt cancer technologies to (RFP/RFAs) address the rising burden of cancers in LMICs (n=21) 3. Planning grants for regional centers of excellence in non-communicable diseases in LMICs (n=11) Research contracts to support pilot projects to stimulate specific areas of research and foster research Small Grants careers of young investigators in LMICs: Research 1. Beginning Investigator Grant for Catalytic Research (BIG Cat) in Africa with AORTIC (n=18) Program 2. Awards for Cancer Research in the Caribbean with Caribbean Public health Association (n=6) 3. U.S.- Mongolia Liver Cancer grants (n=3) 6
NCI’s Center for Global Health D&I Activities Global D&I Training: • In-country training - Argentina (2014); Morocco, AORTIC (2015); India (2017) • D&I Masters Course at World Cancer Congress in Melbourne (2014); Paris (2016) • Collaboration with USAID PEER Health Program: SE Asia (2015) and MENA (2016) • Support for LMICs trainees to TIDIRH • We see increased requests for D&I Training globally Global D&I Research: • The center is exploring how to best support/promote D&I research globally 7
Analysis of the NCI’s Center for Global Health’s Research Portfolio Purpose of Analysis 1. Identify projects that sought to address D&I research questions 2. Identify projects that employed D&I research frameworks and methodologies to address the D&I research questions 3. Identify opportunities to advance D&I research in global settings Note: None of the CGH funding opportunities was a direct call for D&I research applications 8
Methods Research Programs Administrative 1. Grants that sought to address D&I questions Supplements (n=16) Trans-NIH Codebook for A. Employed D&I frameworks/methodologies D&I Research Portfolio Research Programs B. Did not employ D&I frameworks/methodologies Analysis (Adapted) (RFP/RFAs) (n=45) 2. Grants that did not seek to address D&I questions A. Presented clear opportunity for D&I Small Grants (n=27) B. Did not present clear opportunity for D&I n=88 Study Settings Strategies Outcome measures Implementation Phase Study Designs Frameworks Each grants was independently reviewed by 2-3 NCI program staff and conflicts resolved by consensus Neta G. et al. Implementation science (2015) 10:4 9
Results 1. 34% (30) of grants sought to address D&I research questions 2. 66% (58) of grants did not seek to address D&I research questions 1. Grants that sought to address D&I questions A. Employed D&I frameworks and methodologies 34% (30) B. Did not employ D&I frameworks and methodologies 66% (58) 2. Grants that did not seek to address D&I questions A. Presented clear opportunity for D&I B. Did not present clear opportunity for D&I Grants that sought to address D&I questions Grants that did not seek to address D&I questions 10
1A. Grants that Sought to Address D&I Questions and employed D&I Frameworks and Methodologies Proposed to identify (n=1), develop (n=2), A. Employed evaluate (n=5) and test (n=8) implementation D&I Tools strategy Mentioned D&I frameworks (n=2) 40%(12) All studies measured implementation outcomes, 58 30 most commonly feasibility, acceptability, B. Did not appropriateness, and cost effectiveness Employ D&I Tools Study designs: pre-post (n=3), observational (n=3), experimental (n=2), quasi-experimental 60%(18) (n=3), mixed methods (n=1) Majority conducted in healthcare settings (8/12) Grants that sought to address D&I questions Grants that did not seek to address D&I questions 11
1B. Grants that Sought to Address D&I Questions and DID NOT employ D&I Frameworks and Methodologies Majority of the studies were in the pre- A. Employed implementation phase (15/18) D&I Tools All but one study were in healthcare settings 40%(12) None of the studies mentioned D&I frameworks 58 30 All studies measured at least one B. Did not implementation outcome, commonly, feasibility, Employ acceptability, appropriateness, cost D&I Tools considerations 60%(18) Study designs included pre-post, Observational, Experimental, Quasi-Experimental Grants that sought to address D&I questions Grants that did not seek to address D&I questions 12
2. Grants that Presented Clear Opportunity for D&I A. Presented clear A. 48% of the grants that did not seek opportunity for to address D&I research question D&I presented clear opportunities for D&I studies 48% (28) 58 30 Many were trying to adapt/improve an B. Did not intervention present clear Majority were conducted in healthcare opportunity for settings D&I 52%(30) B. The other 52% did not present clear opportunities for D&I studies Grants that sought to address D&I questions Grants that did not seek to address D&I questions 13
Summary Investigators seeking to address cancer control priorities in global settings are asking questions that seek to adapt evidence from research to benefit communities and bring improvements and efficiencies to delivery of cancer prevention and control services This is not always done using tools developed by the D&I research community There is need to advance sustainable D&I training and mentored-research opportunities to improve the capacity of both the established and early-stage investigators in global settings to generate context-specific data that informs evidence translation 14
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