Community-Based Research Program Evaluation: Update - Scientific Director Message

The completion of the most recent funding competition offered through the Canadian Institutes of Health Research (CIHR) HIV/AIDS Community-Based Research (CBR) Program provides an excellent opportunity to examine its performance. The CBR Program, which is managed through the CIHR HIV/AIDS Research Initiative and under the direction of the CIHR Institute of Infection and Immunity, engages communities in all stages of research, including at the definition of the research question, during the research process and at the dissemination of research results. With a budget of approximately $2.7 million per year, the program delivers its funds through two streams: Aboriginal research and General (non-Aboriginal) research, each with their own distinct budget and review committee.

Since this unique program was transferred to CIHR in 2004, great effort was taken to adapt CIHR processes and systems to meet its particular needs. Today, the CIHR HIV/AIDS CBR Program offers leading roles for non-academics (now known as knowledge-users) who have defined roles in the CIHR system and who can now hold funds offered through the program. A merit review system – which rates proposals on both their potential impact as well as scientific merit and which engages knowledge users on the review panel – is used to adjudicate various CIHR funding opportunities. Together, these changes which were once nearly impossible to fathom, have ensured that knowledge transfer and research uptake are central to the HIV/AIDS research process.

In 2009, an evaluation of the HIV/AIDS CBR program concluded that the Program was helping communities and academia respond to the HIV/AIDS epidemic, and that research capacity was being built at the community level and in academic circles. As noted in a 2010 report, Canadian HIV CBR research constitutes 8% of the world's output of CBR publications, two times Canada's average health research proportion.

At the same time, the evaluation outlined several key recommendations to consider going forward, each of which has been -- or is in the final stages of being -- addressed over the last 18 months under the guidance and direction of the HIV/AIDS CBR Steering Committee and the CIHR HIV/AIDS Research Advisory Committee. While wide-ranging in scope, these responses focussed mainly on streamlining the program, providing tools and skills-building for first time applicants and a steadfast effort to promote the program to new audiences.

Of critical importance has been the series of CBR grantscrafting presentations that have taken place at numerous conferences and meetings over the last year.  Several virtual presentations were given across Canada as well in conjunction with the CIHR-funded training program Universities Without Walls.

Funding partnerships were developed with Health Canada's First Nations Inuit Health Branch, through which travel grants were provided allowing over 30 on-reserve community representatives to attend a three day grantscrafting workshop in Ottawa. This session also included key partner contributions from the Pauktuutit Inuit Women of Canada, the Assembly of First Nations, the Canadian Aboriginal AIDS Network and the Ontario HIV Treatment Network. Other partnerships were developed including: a combined effort with the CIHR Centre for REACH in HIV/AIDS (Research Evidence in Action for Community Heath) to provide travel grants for out of province participants to attend an Ontario-led CBR grantscrafting session; and an innovative effort with OHTN to develop a series of CBR grantscrafting DVDs which will soon be developed.

What has been the cumulative impact of these efforts, along with the ongoing work of the aforementioned CIHR-funded Universities Without Walls and CIHR Centre for REACH in HIV? If one is to compare where we are today (April 1, 2010 – March 31, 2011) to where we were two years ago (pre-Evaluation response April 1, 2008 – March 31, 2009), the following positive trends are noted:

• the number of CBR applications received increased by 500% in the General funding stream and by 900% in the Aboriginal funding stream;
• the number of fundable applications increased by 350% in the General funding stream and by 600% in the Aboriginal funding stream; and
• the number of funded applications increased by 350% in the General funding stream and by 600% in the Aboriginal funding stream.

Furthermore, fiscal year 2010-11 (April 1, 2010 – March 31, 2011) was the first year that the CBR Program utilized its entire $2.7 million grants and awards budget envelope.

These improvements and the vastly increased application pressure across all the funding tools has effectively "raised the bar" on the HIV/AIDS CBR research funded through the Program. Just as important, the CBR community (both academics and knowledge-users) have expressed great satisfaction with the direction of the Program (as expressed verbally and as documented in a recent independent consultation).

As noted recently by Dr. Robb Travers (Wilfred Laurier University and co-chair of the CIHR HIV/AIDS CBR Steering Committee) in the CIHR Institute of Infection and Immunity International Review Panel Report:

"The CIHR HIV/AIDS CBR Program has become a model for enabling communities to play a central role in HIV/AIDS-related health research that produces action-oriented outcomes. Whether it is people living with HIV/AIDS, Aboriginal groups, newcomers to Canada, or members of other at-risk communities, this innovative program supports research that provides solutions to knowledge users impacted by this epidemic, including people living with HIV/AIDS, policy-makers and service providers. As such, it is a model of research that ensures 'knowledge to action' strategies for change".

These important steps forward would not have been possible without the dedication of the members of the HIV/AIDS CBR Steering Committee, the support of the CBR research community, the valued input of our partners, and the hard work of CIHR staff.

Of course, there are challenges that remain. While progress has been made, a continued focus must be maintained on the Aboriginal funding stream of the Program. While application pressure and the number of funded projects have risen, there is still a long way to go. More Innovative partnerships like that with Health Canada's First Nations Inuit Health Branch need to be developed. It is because of this need that a special effort was made this past year to expand CBR efforts in the North, an effort that led directly to the Institute of Circumpolar Health (Yellowknife) becoming the first CIHR eligible institution in the North (with two funded CBR grants now being supported).

Finally, we must finish addressing the last component of the evaluation: a review of the Program's funding tools. With this focus, a two part consultation (web-based survey and key informant interviews) was undertaken in Summer 2010 to review the current suite of funding mechanisms available in the Program with a specific emphasis on capacity building. Approximately 50 people responded to an online survey and 26 key informants were interviewed, with an excellent cross-section of community, academic, Aboriginal and General stream members participating.
 
Armed with this information, a Report was drafted in December 2010 which is now being reviewed by the members of the CIHR HIV/AIDS CBR Steering Committee. Over the coming months, the Steering Committee will guide the implementation of recommendations in keeping with the goal of continually meeting the changing needs of the community. As these changes are implemented over the coming years, it should be noted the primary elements of the current CBR funding program – catalyst and operating grants to support new research, programs to support the next generation of CBR academics, and supports for community capacity-building – will remain an integral part of the Program moving forward.

It is clear that the CIHR HIV/AIDS CBR Program is now more readily able to support the excellent partnered work of Community Leaders and Researchers in identifying issues, collecting and interpreting data, and deciding how to use the results to inform policy, change practice and improve the lives of people living with HIV. We know that our efforts to improve the Program must be a continual one, and as such, we continue to welcome your input on how to improve the CIHR HIV/AIDS CBR Program moving forward and encourage you to send us your thoughts at HIVAIDS-VIHSIDA@cihr-irsc.gc.ca

Sincerely,
Marc Ouellette
Scientific Director
Institute of Infection and Immunity
Canadian Institutes of Health Research