Meeting Summation and Analysis

Meeting Summation and Analysis

Mentor Network Planning Meeting

Indigenous HIV/AIDS Research Training (IHART) Program

Indigenous Wellness Research Institute

University of Washington

Clearwater Resort, Poulsbo, Washington

May 24, 2010

Participants: Alison Boyd-Ball, Tom Ball, Jami Bartgis, Dedra Buchwald, Fransing Daisy, Sharon M. Day, Theresa “Tiny” Devlin, Geri Donenberg, Bonnie Duran, Cissy Elm, Spero M. Manson, Meg Meneghel MacDonald, Kory Montoya, Elton Naswood, Lisa Tiger, Irene S. Vernon, Karina L. Walters.

Karina Walters, principal investigator for the IHART program, and Bonnie Duran, co-director of the IHART program, welcomed the meeting participants. Each participant gave a self-introduction and greeting to the group.

The meeting commenced after the participant introductions. The meeting agenda consisted of a presentation by co-director Karina Walters followed by discussion and a break, overview of NIH research presented by David Stoff of the National Institute of Mental Health and followed by discussion. Tom Ball of the University of Oregon opened the meeting with prayer and Sharon Day closed the meeting with an Ojibway prayer. The first section reports on the two presentations. The second section provides an analysis of the themes and values that emerged from discussions.

SECTION ONE: MEETING PRESENTATIONSREPORT

Presentation One: Overview of IHART Program by Karina Walters PhD

Karina Walters provided an overview of the Indigenous HIV/AIDS Research Training Program. Dr. Walters noted several goals of the program: significantly increase the number of Native American Alaska Native(AIAN) scholars in the research pipeline; grow and mentor new investigators; and provide new indigenous investigators with resources that would support their success. TheIHART program curriculum development objectives are: 1) to match fellows with mentors and 2) to develop indigenous based protocols and ethics for research. The IHART co-directors asked the community of meeting attendees to “let us know of others who need to be here at the table. We need more community-based scholars.”

The IHART program provides grant opportunities (approximately $300,000) to selected native investigators through the National Institutes of Health (NIH) Research Project Grant grant process.

The Indigenous Wellness Research Institute is undertaking this training program for the following aims: to discuss problems of insufficient data on HIV/AIDS; address the invisibility of the issue in the Native communities; and generate this information for developing programs.

Co-Directors Bonnie Duran and Karina Walters described the diffusion of effective environmental interventions (DEBI) brieflyand noted that DEBI model has not crossed over into HIV-AIDS issues.

This initial meeting provided the opportunity for the mentors and advisors from the Scientific and Community Leadership Council, the Scientific Mentors Network and the Native Community Advisory Expert Panel to come together,begin the process of identifying priority areas and start developing a curriculum for the scholars’pilot research training program. The training program currently has funding for 13 scholars. The program has sparked high interest and could benefit from increasing funding to accommodate more scholars. The co-directors propose targeting senior researchers for the first cohort. These senior scholars can serve as mentors to subsequent cohorts of more junior researchers in two to three years down the line.

Candidate Selection. Candidates will be selected on two criteria: either AIAN researchers who do HIV/AIDS research or researchers who do HIV research but have not worked with native populations. Allied scholars are also eligible. There are two spots in the program set aside for AIAN researchers living within the Pacific Northwest region.

The program is national in scope and anyone from around the country can apply. Applications will be made available online by July 2010. The co-directors would like input on the application process from the community of mentors and advisors. The website is being retooled to make it more interactive. Website resources will include help on editorial skills development and statistical sources.

Summer Research Institute. In collaboration with the University of Washington Center for AIDS and STD, the IWRI will provide a summer research program for IHART fellows. The two-week summer program involves a one week curriculum focus on indigenous issues and a one week curriculum focus on HIV/AIDS issues. Each IHART fellow receives $22,000 to develop a pilot project. Nabila El-Bassel, an IHART mentorfrom Columbia University, will serve as a resource for the summer research institute.

Mentoring Match.The mentoring component of the program will match each fellow with two mentors: a primary mentor who will be a person from a substantive area of expertise and a secondary mentor who will be part of the IHART administrative core. Members of the Mentor Advisory Network will have an opportunity to participate on the selection review committee. IHART also will conduct evaluations in order for mentors to provide feedback.

IHART values partnership publications as integral to the mentoring process and offers approximately $10,000 for editorial support. The IHART program will host a winter roundtable and provide other training support. There are also plans to create a native listserv for posting research so that Native American communities can have easier access to past research. David Stoff noted that NIH also has an interactive websitedesigned for R25 program grantees to communicate with each other and with NIH staff.

Presentation Two: NIMH Funding to Diversity the AIDS Mental Health Workforce by David Stoff PhD

In the second half of the meeting, Dr. David Stoff of the National Institute of Mental Health (NIMH) presented a detailed overview of the focus and funding initiatives of diversity research education programs (R25).

NIH and NIMH funded research projects related to health disparities using the R25 mechanism started with one grant and now includes 13-14 grants. The American Journal of Public Health of March 2009 published a supplement on the program.

What the R25 mechanism funds. The R25 mechanism funds projects on health disparities between people infected on lines of race and ethnicity. NIH has a history of funding diversity focused projectsand Congress mandates that NIH fund health disparities related research. A very small percentage of minority researchers were awarded grants under R25.

Changes in the R25 approach to project funding. The prior R25 granting process regarding disparities-related research was less systematic and allowed research projects that focused on a single population. Now research projects have to be broader and address at least two of the three populations: 1) racial, 2) disadvantaged and 3) disabled.

Why such low percentage of funding of minority researchers? Despite the gains in the program of funding health disparities research, NIH recognized the persistently low percentage of minority researchers receiving funding from NIH. A study identified the research pipeline problem as a problem of retention of minority scholars in the research community. As David Stoff stated “we lose people as they get older and more advanced.”

Mentoring as a solution. Research conducted by Vicki Shaver at the National Cancer Institute found thatmentoring is one of the three most important factors in retaining minority researchers. Mentoring is a tractable solution that can be deployed to address the problem of attrition of minority scholars.

Changes in Mentoring Models. Instead of the old “top-down” model, mentoring models are more synergistic and collaborative in nature. The R25 mechanism is designed to support these collaborative models.

What R25 cannot address: institutionalized racism, salary differentials, undervalued work. What R25 can address: grant skills, time and project management skills, critical mass of researchers, co-mentoring, conceptually based research, empirically based research.

There are several institutional challenges to new mentoring models and the R25 funding process. First, there needs to be “top-level institutional buy-in.” Second, institutions need to generate a culture conducive to mentoring. Third, a mentoring network needs to be in place for sustainability and success.

Dr. Stoff provided some guidelines for minority scholars engaging in HIV/AIDS health disparities. It is important for minority researchers to know what is going on in the Office of AIDS Research (OAR) at NIH and to be familiar with OAR’s strategic plan. It is also important to know current DAR primary and secondary prevention priorities for research. Finally, successful research projects submitted by minority scholars need to have a model of disparities within the research design. IHART program scholars need to be acquainted with research and work outside of their own realm.

Funding Strategies for Success.David Stoff provided information on funding strategies for success that can be used by I-HART scholars and their mentors. It is important to diversify funding sources and outreach of other institutes outside of NIMH. The funding environment is competitive. Funding is flat. The number of applications increases while funding success rate decreases. In a response to a question about the health care bill as a possible funding source, David Stoff noted that it is too early to tell whether and how NIH funding will be effected by the bill. NIH and its leadership (e.g.,former NIH Director Dr. Elias Zerhouni) have a history of commitment to disparities research related research. Recently NIMH and other institutions are phasing out program initiatives and consolidating on intervention, dissemination and training programs on HIV/AIDS.

What has been done? What is needed?

• Transformational approach “can’t continue to just describe things.”
• A vision about the work.
• More trans-disciplinary work that may result in creating new disciplines.
• Balance of high risk innovative research projects with low risk research projects.

David Stoff concluded his presentation with examples of NIH and NIMH support of these research directions with recognitions and awards that focus on diversity, health disparities and minority researcher scholarship. These awards include: Pathfinder Award to Promote Diversity (AARA funded), Directors Pioneer, the BRAINS Award and the Eureka Award.

SECTION TWO: VALUE THEMES

Value Theme: Identifying Success and Outcomes for Different Stakeholders

A key issue that emerged from the group’s discussion is that of determining outcomes of success for the different and diverse stakeholders. Several members pointed out that success is seen and valued very differently by NIH, by different tribal communities, by different constituents within a single AIAN community, and by (and for) the program scholars. Meeting participants identified the importance of focusing on the success of the fellows in terms of metrics such as publication output and funding awards. It was also noted that it is important to track scholars’ career paths.

Other meeting participants spoke about the need to take into account AIAN community defined evidence of success. For example, Jami Bartgis stated that what institutional systems (e.g., National Institutes of Health, the Center for Disease Control) considerto be valuable outcomes are not necessarily what our communities consider to be valuable outcomes.”It was also noted that it is challenging to discuss values and outcomes across Native communities. Moreover, it was noted that not every one considers outcomes important/relevant.

Movement on provision of services for Native peoples with HIV/AIDS. The group discussed the need for discernible movement as a result of research on HIV/AIDS policies and services that could directly benefit Native peoples with HIV/AIDS. Participant Kory Montoya observed the difficulty of going through recurring cycles of participating, providing feedback and then be left waiting. It is hard to get NA and people living with AIDS to the table. Co-director Karina Walters stated that IHART will be the starting place “to get money behind some accurate numbers/metrics and that a successful outcome would be to see some movement.”

Success measured in terms of research productivity metrics. The meeting participants discussed the need to take into account that funding institutions measure outcome in terms of productivity metrics. The IHART program will increase its chances for funding renewal by putting the following metrics in place: grant awards, presentations and publications.

The diversity of research projects and programs poses the challenge ofdeveloping common core metrics or uniform outcome data for the purpose of comparing across programs. This is an issue that needs mentor network input. Barbara Marin founding director of Visiting Professor Program at University of California San Francisco was identified as a possible resource.

Value Theme: Balancing Needs and Accountability of Program Scholars, Tribal Communities and Research Funding Institutions/Communities

A theme closely related to identifying success/outcomes is the theme of balancing needs and accountability of program scholarsin tribal communities where research is taking place and with institutions providing research funding opportunities (e.g. NIMH, NIH, CDC). This balancing act includes building HIV/AIDS programs in and for indigenous communities, developing mechanisms for outcome data that meet the needs of research funding institutions, and generate indigenous and research support for the program scholars. Spero Manson observed that the different constituent needs and accountability pieces are not unlike “a ven diagram with shrinking amounts of overlaps.”

The following are some of the main considerations within this theme.

Sustainability of programs. Several participants stressed the need for focusing on sustainable program development. It was also noted that developing sustainabilitywill be challenging. Participant Sharon Day noted this is coupled with the challenge of the governmental institutions and agencies which do not include tribal communities in their RFPs. We need to educate tribes about the relevance of HIV/AIDS research. Tribal communities may not be interested in this area and we need to do outreach education.” Program sustainability may involve getting creative about how to get people interested in participating in research done by indigenous scholars.

Budgets and Timelines. Several participants brought to the discussion the need for addressing the boundaries of budgets and timelines. For example, Dedra Buchwald noted that it will be difficult for IHART fellows to set up a program in the native communities in which they are conducting their research. Instead, it is more likely that researchers would be developing a feasibility study. In addition, they may be planting a seed for obtaining major grant funding in three years time from the feasibility study period. Finally, it may take eight years or more before a program is funded and developed.

Responsiveness to AIAN community priorities. It is important that IHART take into account what communities want. Members concurred that program development cannot be primarily grant driven. The program must be responsive to what communities have identified as their priorities. When asked the question: what are some of the issues you are seeing in the community?” the group provided the following responses.

• Research that best serves the needs of the community.
• Need for continued education about HIV/AIDS. Lisa Tiger noted that there is still much work to be done in educatingNative communities about HIV/AIDS. She said she encounters indigenous people, especially youth who do not know about AIDS.
• Devising creative and effective ways of getting people to get tested. Participant Kory Montoya gave examples ofhis community outreach efforts in New Mexicogeared toward persuading Native peoples to get tested.
• Need for protection for indigenous communities in urban areas. Sharon Day noted the need to ensure protections when doing research work with native people who live in urban area as they do not have the same protections as native people who live on the reservation.
• Need for strong community and cultural focus on the design and process of programs.

Group members concurred with the perspective that the IHART program will lay new groundwork for responsiveness of what works and does not work for indigenous communities and scholars.

Value Theme: Strategies for DiversifyingFunding Sourcesand Strengthening Native Voices in the RFP Process and Design

A theme that emerged both during the early morning group discussion and after the funding strategies presentation was that of diversifying funding sources and developing the inclusion of Native American voices and experts in the grant funding policy process. Several participants voiced concern about the issue of diversifying funding sources and strengthening Native American participation in the RFP process from the ground up. Participants identified issues and made suggestions about increasing tribal community input in the policy process. For example, one participant suggested that the IHART mentoring network group talk to sister organizations that fund AIAN community related research. Several participants expressed the need for getting Native communities to give a higher priority to policy work.