NIH - Implementing the Most Successful Interventions to Improve HIV/AIDS Outcomes in U.S. Communities (R01, R21)

The following description was taken from the R01 version of this FOA.

The mobilization of resources for the global HIV and AIDS response over the past several decades, including the President’s Emergency Plan for AIDS Relief (PEPFAR), is unprecedented in the history of public health. Impressive biomedical technologies such as rapid testing, pre-exposure prophylaxis (PrEP) and antiretroviral therapies (ART) have been developed, and HIV-testing and treatment clinic locations throughout the U.S. are readily identifiable through a simple internet search. However, these technologies have not yet reached key populations throughout the U.S. where poor HIV- and AIDS-related health outcomes persist, even reaching epidemic levels.

Currently, more than 1.2 million people in the U.S. are living with HIV, and 1 in 8 don’t know it. UNAIDS estimates show that only 37 percent of known HIV-infected people in the U.S. have received antiretroviral therapy and even fewer, 30 percent, are virally suppressed. Gay, bisexual men and transgender women, including African Americans, Caucasians and Latinos, in that order are the largest groups impacted by HIV. Young minority men who have sex with men, ages 13-24, are at the highest risk for new HIV infection and some estimates project 1 in 2 will become HIV-infected in their lifetime. Heterosexual women are also significantly impacted by HIV, with African American women bearing a disproportionate HIV-burden and poorer health outcomes than other women. Individuals at risk for HIV-infection and the resulting poor health trajectories are embedded in the cultural, economic and social fabric of the places where they live and are subject to unique sets of circumstances that drive these health outcomes. Poverty, lack of stable housing, food insecurity, lack of transportation, poor intergenerational experience with health care systems, discrimination, stigma, lack of access to health care resources are some of the driving factors.

Successful strategies implemented in one country, region or community may be the key to unlocking HIV/AIDS morbidity and mortality in hard-to-reach communities in another. Highly successful evidenced-based practices and interventions (EBI) for HIV treatment and prevention have been developed over the past several decades around the world. These EBI are available on curated websites such as the CDC’s Compendium of Evidence-based Interventions and Best Practices for HIV Prevention, as well as in journals, books and grey literature housed in community organizations. In addition, ethnographic and socio-cultural analyses of the diverse U.S. communities, including descriptions of health practices, social and religious institutions and other aspects of daily life that may influence intervention uptake, are an often-untapped resource that can assist in intervention planning and analysis of study results. Several factors can help lay the foundation for selection and testing of evidence-based practices and strategies that are the most likely to be embraced by underserved communities and result in improved HIV-related health outcomes. These include understanding the circumstances and daily practices of individuals, families and communities, identifying gaps in provision of HIV treatment and prevention technologies, and documenting service capacity and resources.

This FOA encourages intellectual collaboration between team members that bring clinical, self-management and prevention expertise; in-depth understanding of socio-cultural dynamics of specific communities and iterative, in-depth qualitative methods and analysis; expertise in the distribution and spread of infectious disease, and; expertise in implementation science, e.g., iterative testing models. Researchers will ideally include local program experts from implementing organizations and community members on the team with an eye toward future sustainability and investment of community resources. Teams that pair relevant nurse scientists with researchers from the social sciences, epidemiology and implementation science are expected to blend the best knowledge across disciplines.

A primary goal of this initiative is to encourage implementation of interventions that demonstrate improved HIV-related health outcomes including HIV testing, PrEP and ART adherence and sustained viral suppression in communities at risk in the U.S. Research resulting from this initiative will also provide insights into the aspects of daily life among targeted, underserved groups at risk of morbidity and mortality from HIV and AIDS and other local circumstances that influence implementation success among these hard-to-reach, socially stigmatized, underserved groups. Studies may test and validate the use of innovative mixed methods strategies and refine existing implementation models.

Research Objectives

This FOA encourages adaptation and implementation of global evidence-based service provision strategies. Research projects of interest will include, but are not limited to, those that seek to:

Identify effective HIV prevention and treatment strategies or combination of strategies that can be adapted to high need U.S. settings and populations;
Determine the organizational and socio-cultural features and dynamics of the service environments and populations to be addressed that will facilitate (or hinder) adaptation or uptake of effective strategies;
Demonstrate improved patient outcomes such as timely HIV testing, PrEP and ART receipt and adherence and durable viral suppression among key populations and individuals;
Pinpoint which elements of effective strategies require adaptation to be implemented in a new setting as well as why and how this is best accomplished to ensure sustainability
Describe the implementation approaches, including measures and methodologies to best understand effective adaptation that improve health outcomes.

Applicants should develop their studies in keeping with the NIH OAR priorities for HIV research (https://grants.nih.gov/grants/guide/notice-files/NOT-OD-15-137.html).

This FOA focuses on clinical research only. Studies using animal models, pharmaceutical agents, herbal medicines, dietary supplements, probiotics, or other alternative medicines will be considered unsuitable. No unapproved technologies, including drugs or diagnostic tests are acceptable. Applicants are strongly encouraged to review the NINR Strategic Plan to ensure that their research addresses current strategic priorities. Other resources available to applicants include NINR’s Innovative Questions (IQ). Applicants are also encouraged to consult with NINR Scientific/Research staff to explore these priority areas and to help determine appropriateness to the FOA.

Deadlines: Standard dates and standard AIDS dates apply

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Filed Under: Funding Opportunities

NIH – Implementing the Most Successful Interventions to Improve HIV/AIDS Outcomes in U.S. Communities (R01, R21)