research that includes obstetric and newborn patients in addition to pediatric patients. Research funds support individual clinic budgets for staff and patients and care-related services, including enhancement of recruitment and retention of patients. Pregnant women access clinical trials research through the PACTG arm; there are limited opportunities to access treatment unrelated to pregnancy (e.g., cervical dysplasia). Grantees are almost all university, hospital-based clinics and some community-based providers. There is currently a new collaboration with the Ryan White Title IV grantees to establish linkages to research sites related to nutrition research.
National Institute of Allergy and Infectious Diseases (NIAID) is the institute that expends the majority of NIH funding for extramural PACTG research. In FY 1997, NIAID dedicated $32 million to PACTG research (32% of which was targeted specifically to women), and $69.6 million to adult ACTG research (approximately 22.5% of which was specifically targeted to women). NIAID has 21 clinical sites (or main units) with multiple subunits, located in 14 states, the District of Columbia, and Puerto Rico. Research dollars are provided in the form of long term cooperative agreements, and grants and are expended for a core of fixed costs related to staffing based on the number of patients in a given period. NIAID conducts the CPCRA described above.
A description of the agencies and bodies that may exercise general or specific authority over some or all of the services provided by providers profiled on the community level accurately reflects the complexity of our health care system. An individual provider may have one or many agencies and/or government and community bodies that have oversight responsibilities and guide policies for service delivery. Providers in the private practice setting are responsible to their licensing boards and the policies and oversight of the organizations with whom they contract to deliver services. Public providers tend to use multiple funding streams and so must respond to the authority of each of the funders, as well as state and local governing bodies.
By law and custom, responsibility in health affairs is shared by federal, state, and local authorities. As a result, there is often an effort on the part of federal and state entities to avoid from issuing too many regulations or offering what might be perceived by their respective constituents as "excessive" guidance. Many of these authorities "recommend" rather than "require." The degree to which responsibility or authority is shared among these authorities has fluctuated. The locus of responsibility for decisions about public benefits has clearly shifted over this decade. Recent welfare legislation embodies this fundamental change in how