Related Announcements

PA-20-183 - Research Project Grant (Parent R01 Clinical Trial Required)

PAR-20-221 - NIDA Avant-Garde Award Program for HIV/AIDS and Substance Use Disorder Research (DP1, Clinical Trial Optional)

PAR-20-224 - Avenir Award Program for Research on Substance Use Disorders and HIV/AIDS (DP2 Clinical Trial Optional)

PA-21-205 - Development & Testing of Novel Interventions to improve HIV Prevention, Treatment, and Program Implementation for People Who Use Drugs (R34 Clinical Trial Required)

PA-21-110 - Pilot and Feasibility Studies in Preparation for Substance Use Prevention Trials (R34 Clinical Trial Optional)

PAR-19-213 - Behavioral & Integrative Treatment Development Program (R34 Clinical Trial Optional)

PAR-20-274 - New Models of Integrated HIV/AIDS, Addiction, and Primary Care Services (R34 - Clinical Trial Optional)

NOT-MH-20-020 - Notice of Special Interest: Stigma or Other Social Determinants of Health (SDOH) in HIV Prevention and Treatment

PA-20-144 - Innovations in HIV Prevention, Testing, Adherence and Retention to Optimize HIV Prevention and Care Continuum Outcomes (R01 Clinical Trial Optional)

PA-20-141 - Formative and Pilot Intervention Research for Prevention and Treatment of HIV/AIDS (R34 Clinical Trial Optional)

Issued by

National Institute on Drug Abuse (NIDA)

National Institute of Mental Health (NIMH)

Purpose

Background

Many gaps remain in the provision and uptake of HIV prevention and care services in the US despite the scaling-up of HIV testing, pre-exposure prophylaxis (PrEP), and modern antiretroviral (ARV) treatments. Consequently, many people living with HIV (PLWH) remain out of treatment or undiagnosed and many people at-risk for HIV acquisition are not benefiting from evidence-based prevention. One of the most important barriers to the uptake of HIV prevention and care services is stigma.

For the purpose of this FOA, stigma is defined as an identity marked by disgrace, disapproval or shame, which often leads to discriminatory treatment by others. Stigma typically is reflective of stereotypes or negative views attributed to a person or groups of people because of behavior or other attributes that are seen as different from broad societal norms.

Within human service settings, stigma can occur at the individual (internalized, anticipated or enacted experiences), interpersonal, organizational and/or structural levels. The design and atmosphere of settings such as clinics may create inhospitable environments, and stigma can arise from policies and practices of settings, as well as from the behaviors of professional providers and other staff (e.g., receptionists, technicians). At the individual level, health care providers or pharmacists may experience anticipatory or other stigmas because they worry that their settings or practices may be adversely affected if they are identified with populations such as opioid injectors. Ultimately, stigma enables discriminatory behaviors and practices; anticipated stigma in human service settings may prevent people from seeking out or using needed services even when steps have been taken in these settings to mitigate stigma. Reducing stigma should lead to measurable improvements in the availability and uptake of services across the continua of HIV prevention and care.

This NOSI requests projects conducted in the United States (US), although foreign components are allowed if they support domestic research in the US. This NOSI is not seeking projects that focus only on development of intervention protocols, manuals, or the standardization of protocols as interventions. Instead, this NOSI seeks R34 pilot or feasibility studies of new or adapted interventions, as well as R01 studies that conduct efficacy or effectiveness trials and trials that are conducted under the DP1 and DP2 mechanisms that promote paradigm shifting research the R01 or other traditional mechanisms. Regardless of grant mechanism, research aims should address efforts to reduce stigma that impedes the provision and utilization of HIV care and prevention services.

Purpose

The National Institute on Drug Abuse (NIDA) recognizes that stigma is pervasive in clinic, social service and other settings related to HIV prevention and care. Stigma contributes to a lack of attention to drug use screening, inadequate outreach to people who use drugs (PWUD) and insufficient uptake of services to prevent, treat, or mitigate HIV infection (and related consequences of drug use) among PWUD. Stigmas of interest include: internalized stigma among drug users, stigma associated with providing services to PWUD, and stigma toward PWUD by providers or service settings. Policies and practices that create or augment stigma also are of interest here, as well as stigma experienced by providers who might otherwise broaden their services to PWUD. Stigma reduction interventions for HIV service settings have been developed and, in some cases, implemented on a wide scale, but generally target sexual transmission as the primary behavioral risk; however, knowledge from this work can inform stigma among PWUD. Large literatures on stigma also exist in a variety of other conditions (e.g., cancer, mental illness) which also can provide conceptual and programmatic bases to speed the development of new interventions addressing PWUD.

Outcomes should include services related to the HIV prevention continuum (e.g., uptake of HIV testing; uptake and persistence of PrEP or post-exposure prophylaxis (PEP), needle exchange) or the HIV care continuum (e.g., ARV adherence, viral suppression and treatment as prevention applications). Consideration should be given to also including outcomes related to consequences of drug use which may co-occur or contribute to HIV risk and HIV treatment outcomes (e.g., HCV screening and linkage to care). Stigma related to drug use should be the primary intervention target, although consideration of other, intersectional stigmas should be addressed, as appropriate. Interventions that are multi-level in scope (e.g., targeting individuals, provider-patient/client, and organizational factors) are encouraged.

Examples of projects described by this NOSI include but are not restricted to:

• Adaptations of stigma reduction interventions from other areas of public health that have demonstrated efficacy among health care or social service providers for use in the context of providing HIV prevention and care services to PWUD.
• Develop and test interventions that address PWUD's self-stigmas that impede their use of HIV prevention or care services.
• Stigma reduction interventions that target providers during key points in their professional development, including their initial professional or specialty training; certification for Buprenorphine or other specialized modalities; or as part of telehealth consultation programs.
• Develop and test interventions that enable harm reduction, drug treatment, or AIDS service organizations to address potential sources of stigma and increase the reach of HIV prevention and care to PWUD.
• Pilot feasibility and acceptability studies to develop organizational or structural intervention approaches to reducing PWUD-related stigmas in HIV service settings.
• Develop and test interventions that address multi-level factors (self, provider, and /or setting) that that foster stigma toward and among PWUD and impede the use of HIV prevention and care services.
• Extensions of efficiacious intersectional stigma interventions that incorporate drug use identities.

National Institute of Mental Health

NIMH is interested in intervention research that reduces the impact of intersectional stigma and strengthens the provision and utilization of HIV prevention or care services in select human service settings. NIMH is not interested in settings that primarily focus on the delivery of alcohol or drug treatment services, or syringe exchange programs. For consideration at NIMH, the target population should not be primarily individuals with substance use disorders including alcohol or other injection- or non-injection drug use. The concept of intersectionality must be applied. Outcomes should include services related to the HIV prevention or treatment continua. Multi-level interventions targeting individuals, providers, and organizational factors are encouraged as well. Studies that include mental illness stigma as a component of intersectional stigma are encouraged.

Examples of projects of interest to NIMH supported by this Notice include, but are not restricted to:

• Studies to develop- and test interventions that will address the role of intersectional stigma in the provision and uptake of HIV prevention or care services;
• Studies to address the multi-level factors facilitating intersectional stigma to improve HIV prevention or care outcomes;
• Studies to determine the optimal combination of intersectional stigma reduction interventions to improve HIV prevention or care outcomes;
• Studies using implementation sciences approaches to integrate interventions focused on intersectional stigma into existing services to improve the HIV prevention continuum or the HIV care continuum.

Application and Submission Information

This notice applies to due dates on or after February 5, 2022 and subsequent receipt dates through January 8, 2025. 

Submit applications for this initiative using one of the following funding opportunity announcements (FOAs) or any reissues of these announcement through the expiration date of this notice.

• PA-20-183 - Research Project Grant (Parent R01 Clinical Trial Required)
• PAR-20-221 - NIDA Avant-Garde Award Program for HIV/AIDS and Substance Use Disorder Research (DP1, Clinical Trial Optional)
• PAR-20-224 - Avenir Award Program for Research on Substance Use Disorders and HIV/AIDS (DP2 Clinical Trial Optional)
• PA-21-205 - Development & Testing of Novel Interventions to improve HIV Prevention, Treatment, and Program Implementation for People Who Use Drugs (R34 Clinical Trial Required)
• PA-21-110 - Pilot and Feasibility Studies in Preparation for Substance Use Prevention Trials (R34 Clinical Trial Optional)
• PAR-19-213 - Behavioral & Integrative Treatment Development Program (R34 Clinical Trial Optional)
• PAR-20-274 - New Models of Integrated HIV/AIDS, Addiction, and Primary Care Services (R34 - Clinical Trial Optional)
• NOT-MH-20-020 - Notice of Special Interest: Stigma or Other Social Determinants of Health (SDOH) in HIV Prevention and Treatment
• PA-20-144 - Innovations in HIV Prevention, Testing, Adherence and Retention to Optimize HIV Prevention and Care Continuum Outcomes (R01 Clinical Trial Optional)
• PA-20-141 - Formative and Pilot Intervention Research for Prevention and Treatment of HIV/AIDS (R34 Clinical Trial Optional)

All instructions in the SF424 (R&R) Application Guide and the funding opportunity announcement used for submission must be followed, with the following additions:

• For funding consideration, applicants must include “NOT-DA-21-060” (without quotation marks) in the Agency Routing Identifier field (box 4B) of the SF424 R&R form. Applications without this information in box 4B will not be considered for this initiative.

Applications nonresponsive to terms of this NOSI will be withdrawn from consideration for this initiative.

Inquiries

Richard A. Jenkins PhD
National Institute on Drug Abuse (NIDA)
Telephone:301-443-1923
Email: jenkinsri@mail.nih.gov

Gregory Greenwood, Ph.D., MPH
National Institute of Mental Health (NIMH)
Phone: 240-669-5532
Email: gregory.greenwood@nih.gov