those data with other VISNs. In addition, programs such as the unique Emerging Pathogens Initiative allow VHA to conduct surveillance and monitor emerging pathogens anywhere in the VHA hospital system.

This appendix is intended to acquaint the reader with selected programs and aspects of the VHA which are unique, rather than provide a comprehensive review of all VHA programs that address infectious diseases. The following discussions address the five thematic areas discussed in the workshop summary (i.e., research, clinical practice, surveillance and monitoring, education, and drug formularies) and highlight some of the opportunities presented by the VHA system.

CLINICAL RESEARCH

In fiscal year 1997, the VHA research budget totaled more than $900 million. This funding included funds from a congressional appropriation, extramural grants awarded to individual researchers, and indirect support from the medical care budget. The Office of Research and Development (ORD) is the organizational structure responsible for allocating research dollars among the DVA facilities across the nation currently participating in research and development activities. Although the ORD consists of four research branches, the two most relevant to infectious disease are the Cooperative Studies Program (CSP) and the Medical Research Service (MRS).

CSP began in 1946 with landmark research in the treatment of tuberculosis (DVA, Office of Research and Development, 1997). CSP plays the important role of reviewing and providing administrative coordination to researchers nationwide who wish to conduct large, multisite clinical research studies. Indeed, more than 100 DVA hospitals are involved in cooperative studies. CSP provides an opportunity for researchers in infectious disease to coordinate and share resources and patient populations in the course of their investigations.

MRS is the main research branch responsible for biomedical research that enhances the quality of care received by veterans. One of the core research centers is the Center for AIDS and HIV Infection, with locations in Georgia, New York, California, and North Carolina.

Antimicrobial resistance is another research focus in VHA. Current projects include mechanisms of resistance in Mycobacterium tuberculosis , an investigation of the signal pathways in antibiotic resistance, and structure-function relationships of relevant enzymes such as the SHV-1 b-lactamase and amine oxidase.

VHA's Emerging Pathogens Initiative (EPI) has been in operation since 1998, serving as the data source for many research projects. One recent EPI finding showed a concordance between addiction disorders and hepatitis C virus infection, information that is important in designing intervention strategies and therapeutic trials. A second study with EPI data found that group A streptococcus afflicted a younger, disproportionately female population, thereby delineat-



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