	Background

To help fulfill its role as the nation’s health protection agency, HHS’s CDC  conducts and supports research, including prevention research. CDC makes its PRC awards through a competitive  process; there are currently 26 PRCs, located in 24 states, funded for  fiscal years 2014 through 2019. According to CDC, eligibility for SIPs is limited to PRCs  because the centers are “uniquely positioned to oversee, coordinate, and  perform applied public health research that promotes the field of health  promotion and disease prevention research due to their established  relationships with multidisciplinary faculty and community partners.”

		SIP Award Process and Public Disclosure

Subject matter experts (SME) within CDC sponsoring units propose  potential SIPs each year, depending on unit needs—e.g., particular  research gaps that have been identified—and available funding. CDC Chooses the SIP Mechanism to Fund Community- Based Prevention Research

		CDC Chooses the SIP Mechanism to Fund Research Focused on Public Health Prevention Involving Community Participation

In general, CDC officials we spoke with told us they will choose the SIP  mechanism when seeking to fund prevention research that is community- based and would benefit from having access to a multidisciplinary group  of researchers. In addition, CDC officials told us that they choose the SIP mechanism to  conduct research when seeking to access researchers who have  established partnerships with diverse population groups across the  country. In contrast, CDC officials explained that they would not choose the SIP  mechanism if the desired research would be better suited for an entity  other than an academic health center. Sponsoring unit officials also told us that they will not choose the  SIP mechanism when the research they want to fund is not focused on  public health prevention, such as when the research is clinical or  laboratory based, or when the timing of the research does not align with  the PRC funding cycle (e.g., a longitudinal study or a study that would  cross two PRC funding cycles). Collaboration with Federal and Nonfederal Experts Informs Development of SIP Funding Opportunities and Reduces Potential for Unnecessary Duplication

CDC officials told us that CDC SMEs’ relationships and collaboration with  experts in the field—including federal and nonfederal experts—help  inform the development of the research funding opportunities made  available through SIPs, as well as other mechanisms. (See table 1 for examples of the workgroups and  advisory committees in which CDC SMEs participate.) These interactions,  as well as the SME’s review of the scientific and nonscientific literature,  are used to determine gaps in knowledge and inform the research  proposed to be funded through SIPs or other mechanisms. Ability to Rapidly Initiate Research Cited as Key Advantage of Limited Eligibility for SIPs; Disadvantages Included Potentially Reduced Access to Outside Expertise

The main advantage of limiting eligibility for SIPs to the PRCs is the ability  to rapidly initiate high-quality research, due to the infrastructure and  relationships the PRCs have in place, according to officials from CDC,  outside organizations, and PRCs. Officials from CDC and outside organizations identified a few potential  disadvantages to limiting eligibility for SIPs, including the potential for  reduced access to expertise outside of the PRCs and the risk of being  unable to conduct desired research at the desired time. CDC officials and officials from PRCs said that PRCs have the  ability to bring in the expertise from outside the PRC institution through  subcontracts with other entities, which could help alleviate this concern. Agency Comments

We provided a draft of this report to HHS for review. HHS provided  technical comments, which we incorporated as appropriate. GAO staff who made key contributions to this  report are listed in appendix II. Appendix I: Information on Centers for Disease Control and Prevention (CDC) Special Interest Projects (SIPs)

Appendix I: Information on Centers for Disease  Control and Prevention (CDC) Special Interest  Projects (SIPs)
Tables 2, 3, and 4 below present data on SIPs awarded in fiscal years  2014 through 2016.
Why GAO Did This Study

CDC, an agency within HHS, created the SIP program in 1993 as a supplemental funding mechanism to support health promotion and disease-prevention research being done at its PRCs. Currently, there are 26 PRCs. In fiscal years 2014 through 2016, CDC awarded more than $40 million for SIPs. SIP topics vary from year to year but are to be aligned with public health priorities, such as the Healthy People 2020 Objectives—HHS's 10-year national objectives for improving Americans' health. SIPs are sponsored and primarily funded by CDC organizational units, referred to as sponsoring units.
House Report 114-195 included a provision for GAO to review the SIP program. This report describes (1) what research CDC chooses to fund through the SIP mechanism, and (2) what have been identified as advantages and disadvantages of SIP eligibility being limited to PRCs. GAO reviewed documents from CDC and analyzed CDC data on SIPs awarded in fiscal years 2014 through 2016. GAO also interviewed CDC officials, including officials from 5 of the 10 sponsoring units that together accounted for over 90 percent of SIP funding during this time period, officials from 4 PRCs with varying experience with SIPs, and 4 organizations with knowledge of prevention research.

What GAO Found

The Centers for Disease Control and Prevention (CDC) uses the Special Interest Project (SIP) mechanism to fund community-based prevention research that would benefit from a multidisciplinary group of researchers. SIPs are supplemental funding awards that focus on topics of interest or gaps in knowledge or research and can also support the development of state and local public health interventions and policies. SIPs are only available to CDC's Prevention Research Centers (PRC)—selected academic health centers at universities with schools of public health or medical schools with residency programs in preventive medicine.
CDC officials said that they would choose the SIP mechanism when the research they want to fund is intended to involve community-based organizations or members of the community. They also use SIPs when they seek access to researchers who have established partnerships with diverse population groups across the country. They would not choose the SIP mechanism when the research they want to fund is not focused on public health prevention, including research that is clinical or laboratory-based; would be better suited for an entity other than an academic health center; or would be better funded through a contract to allow CDC to direct the research protocol. CDC's collaborations with experts in the field—including those at other federal agencies—help to inform its development of the research funding opportunities offered through SIPs. For example, CDC officials use information they learn through participation in multiagency workgroups and advisory committees to identify gaps in knowledge that SIP funding could help to address. CDC officials also stated that this collaboration can also help to avoid potential duplication of research.
The key advantage of SIPs being limited to PRCs is the ability to rapidly initiate research, according to officials with whom GAO spoke—including officials from CDC, PRCs, and organizations with knowledge of prevention research. Factors cited as contributing to this ability included the research infrastructure and community relationships already established at the PRCs. Officials from CDC and outside organizations also identified a few potential disadvantages to limiting eligibility for SIPs, including the potential for reduced access to expertise from researchers or others who are not affiliated with the universities in which PRCs are located, although some noted that PRCs may bring in outside expertise through subcontracts with other entities.
The Department of Health and Human Services (HHS) provided technical comments on a draft of this report, which GAO incorporated as appropriate.