Full Text PA-95-070

BRIEF INTERVENTIONS TO PREVENT THE SPREAD OF AIDS

NIH GUIDE, Volume 24, Number 2, June 16, 1995

PA NUMBER:  PA-95-070

P.T. 34

Keywords: 
  AIDS 
  Disease Prevention+ 
  Behavioral/Social Studies/Service 


National Institute of Mental Health

PURPOSE

The National Institute of Mental Health (NIMH) is encouraging
applications for the suppor tof research on brief preventive
interventions that can be implemented in public health clinics and
community-based organizations to prevent the further spread of HIV.
This program announcement (PA) is critical because prevention efforts
must be developed to reach individuals who may not proactively seek
HIV prevention programs to change high-risk behavior.

The urgency of the AIDS crisis demands that top priority be given to
research with implications for preventive interventions that access
hard-to-reach populations who are at high risk for HIV infection.
Even if an AIDS vaccine were to be identified in the next few years,
prevention efforts would continue to be the primary way to stop
further spread of HIV infection.  Research is needed to develop
methods and techniques to motivate people to assess their risk for
HIV and to seek help in changing high-risk, HIV-related behaviors,
and to seek additional behavior-change help.  Some people may not
actively seek long-term HIV prevention programs, but might be reached
at clinics where they are being treated for other medical problems.
Therefore, brief interventions that could be used in Sexually
Transmitted Disease (STD) clinics, health care facilities, and
alternative (non-health care) sites are urgently needed.

This program announcement solicits theoretically grounded research
applications focusing on developing models of brief HIV prevention
programs.  No definition is provided for "brief intervention" so that
investigators can develop and test a range of single and short-term
interventions.

HEALTHY PEOPLE 2000

The Public Health Service (PHS) is committed to achieving the health
promotion and disease prevention objectives of "Healthy People 2000,"
a PHS-led national activity for setting priority areas.  This PA,
Brief Interventions to Prevent the Spread of AIDS, is related to the
priority areas of mental health and mental disorders and HIV
infection.  Potential applicants may obtain a copy of "Healthy People
2000" (Full Report:  Stock No. 017-001-00474-0 or Summary Report:
Stock No. 017-001-00473-1) through the Superintendent of Documents,
Government Printing Office, Washington, DC 20402-9325 (telephone
202-783-3238).

ELIGIBILITY REQUIREMENTS

Applications may be submitted by foreign and domestic, for-profit and
non-profit organizations, public and private, such as universities,
colleges, hospitals, laboratories, units of State and local
governments, and eligible agencies of the Federal government.
Foreign institutions are not eligible for First Independent Research
Support and Transition (FIRST) (R29s) awards or program project
grants (PO1s).  Racial/ethnic minority individuals, women, and
persons with disabilities are encouraged to apply as principal
investigators.

MECHANISM OF SUPPORT

Support for applications submitted in response to this program
announcement will be through individual research projects (R01s),
FIRST awards (R29s), and program project grants (P01s).

RESEARCH OBJECTIVES

Background

The major objective of research supported under this PA is to
identify effective brief interventions that can be implemented in
clinics and other primary health care facilities.  Current research
indicates that HIV education campaigns that primarily provide
information about the HIV virus, modes of infection, and methods of
prevention do not produce sustained behavior change.  In addition,
models of brief interventions that access hard-to-reach populations
who may not otherwise be exposed to HIV prevention programs are
urgently needed.

Areas of Interest

The following section suggests areas of research to meet the health
promotion and disease prevention objectives of this PA.  However,
researchers responding to this PA need not limit themselves to these
topics.

o  Which modality of intervention (e.g., counseling, psychotherapy,
health information, health education, community-level intervention)
and modality of delivery (e.g., individual, group, written,
interactive video, etc.), provide the most effective, parsimonious
intervention in different settings?

o  What are the best settings for implementing brief HIV prevention
interventions, and who is the best intervenor (e.g., physician,
nurse, counselor, peer)?

o  What are the critical components in a brief intervention that will
motivate individuals to assess HIV risk and seek help?

o  Are there brief counseling models that are generalizable and
effective with different populations?

o  Which brief interventions are most effective in producing
sustained behavior change?

o  What are possible barriers to conducting brief interventions in
various settings (e.g., barriers to having health-care providers
discuss specific sexual behaviors, lack of referrals for
seropositives and for seronegatives, barriers to adopting preventive
health behaviors for individuals who have been serotested and learn
that they are seronegative) and how can they be overcome?

o  What is the appropriate means of defining, operationalizing, and
measuring the effectiveness of a given brief intervention?

o  What types of outcomes might be expected from brief interventions
(e.g., changes in sexual behavior, help-seeking behavior, increased
readiness to change, changed attitudes and beliefs, etc.)?

o  What are realistic behavioral outcome goals for different
individuals and groups as a result of brief interventions?

o  What factors mediate test-seeking behavior (e.g., demographic and
motivating factors)?  What is the emotional/ behavioral impact of
deciding to be tested or planning to be tested?  What factors predict
which individuals will return for test results?  What factors predict
an individual's ability to cope with test results?

o  Is it possible to set standards for the content and process  of
prevention interventions delivered in various settings?  How can the
content of counseling sessions be evaluated?  How can quality
assurance be conducted?

INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN
SUBJECTS

It is the policy of the NIH that women and members of minority groups
and their subpopulations must be included in all NIH supported
biomedical and behavioral research projects involving human subjects,
unless a clear and compelling rationale and justification is provided
that inclusion is inappropriate with respect to the health of the
subjects or the purpose of the research.  This new policy results
from the NIH Revitalization Act of 1993 (Section 492B of Public Law
103-43) and supersedes and strengthens the previous policies
(Concerning the Inclusion of Women in Study Populations, and
Concerning the Inclusion of Minorities in Study Populations), which
have been in effect since 1990.  The new policy contains some
provisions that are substantially different from the 1990 policies.

All investigators proposing research involving human subjects should
read the "NIH Guidelines For Inclusion of Women and Minorities as
Subjects in Clinical Research," which have been published in the
Federal Register of March 20, 1994 (FR 59 14508-14513) and reprinted
in the NIH Guide for Grants and Contracts, Volume 23, Number 11,
March 18, 1994.

Investigators also may obtain copies of the policy from the program
staff listed under INQUIRIES.  Program staff may also provide
additional relevant information concerning the policy.

APPLICATION PROCEDURES

Aplications are to be submitted on the grant application form PHS 398
(rev. 9/91) and will be accepted under the receipt deadlines for AIDS
applications.  Application kits are available at most institutional
offices of sponsored research and may be obtained from the Office of
Grants Information, Division of Research Grants, National Institutes
of Health, 6701 Rockledge Drive, Room 1040, Bethesda, MD 20892;
telephone 301/435-0714.  The title, "Brief Interventions to Prevent
the Spread of HIV," and number of the program announcement must be
typed in Section 2a on the face page of the application.

Applications for the FIRST award (R29) must include at least three
sealed letters of reference attached to the face page of the original
application.  FIRST award (R29) applications submitted without the
required number of reference letters will be considered incomplete
and will be returned without review.

The completed original application and five legible copies must be
sent or delivered to:

DIVISION OF RESEARCH GRANTS
NATIONAL INSTITUTES OF HEALTH
6701 ROCKLEDGE DRIVE, ROOM 1040, MSC 7710
BETHESDA, MD 20892-7710
BETHESDA, MD 20817 (for courier/overnight mail service)

REVIEW CONSIDERATIONS

Applications that are complete and responsive to the program
announcement will be evaluated for scientific and technical merit by
an appropriate peer review group convened in accordance with the
standard NIH peer review procedures.  As part of the initial merit
review, all applications will receive a written critique and undergo
a process in which only those applications deemed to have the highest
scientific merit, generally the top half of applications under
review, will be discussed, assigned a priority score, and receive a
second-level review by an appropriate National Advisory Council.

Several other Institutes have an interest in research in this
research area.  Most notably, the National Institute of Nursing
Research, the National Institute on Drug Abuse, the National
Institute on Alcohol Abuse and Alcoholism, the National Institute on
Aging, and the National Institute on Child Health and Human
Development.  Applications submitted in response to this Program
Announcement will be referred to initial review groups in accordance
with PHS referral guidelines.

Review Criteria

o  significance and originality from a scientific or technical
standpoint of the goals of the proposed research

o  qualifications and experience of the Principal Investigator and
demonstrated staff expertise in prevention research, AIDS,
multicultural assessment of diverse populations, statistics, AIDS,
and other areas specific to the questions under investigation

o  adequacy of the conceptual and theoretical framework for the
research and evidence of familiarity with relevant research
literature

o  scientific merit of the research design, approaches, intervention,
and methodology

o  access to target population(s)

o  sample selection and retention methods and efforts to determine
factors that influence refusal rate

o  adequacy of the data analysis plan

o  adequacy of the existing and proposed facilities and resources

o  appropriateness of the budget, staffing plan, and time frame to
complete the project

o  adequacy of plans to include both genders and minorities and their
subgroups as appropriate for the scientific goals of the research.
Plans for the recruitment and retention of subjects will also be
evaluated.

The initial review group will also examine the provisions for the
protection of human subjects and the safety of the research
environment.

AWARD CRITERIA

Applications will compete for available funds with all other approved
applications assigned to that Institute.  For those applications
assigned to the NIMH, the following will be considered in making
funding decision:

o  scientific merit as determined during the peer review process
o  availability of funds
o  balance among target populations, with priority given to
understudied populations
o  balance among theoretical and multicultural approaches
o  balance among geographic areas

INQUIRIES

Inquiries are encouraged.  The opportunity to clarify any issues or
questions from potential applicants is welcome.

Direct inquiries regarding programmatic issues to:

Willo Pequegnat, Ph.D.
Office on AIDS
National Institute of Mental Health
Parklawn Building, Room 10-75
5600 Fishers Lane
Rockville, MD  20857
Telephone:  (301) 443-6100
FAX:  (301) 443-9719
Email:  WPEQUEGN@A0AMH2.SSW.DHHS.GOV

Direct inquiries regarding fiscal matters to:

Diana S. Trunnell
Grants Management Branch
National Institute of Mental Health
Parklawn Building, Room 7C-08
5600 Fishers Lane
Rockville, MD  20857
Telephone:  (301) 443-3065
FAX:  (301) 443-6885
Email:  DT21a@NIH.GOV

AUTHORITY AND REGULATIONS

This program is described in the Catalog of Federal Domestic
Assistance 93.242, Mental Health Research Grants.  Awards are made
under authorization of the Public Health Service Act, Title IV, Part
A (Public Law 78-410, as amended by Public Law 99-158, 42 USC 241 and
285) and administered under PHS grants policies and Federal
Regulations 42 CFR 52 and 45 CFR Part 74.  This program is not
subject to the intergovernmental review requirements of Executive
Order 12372 or Health Systems Agency review.  Awards will be
administered under PHS grants policy as stated in the Public Health
Service Grants Policy Statement (April 1, 1994).

The PHS strongly encourages all grant and contract recipients to
provide a smoke-free workplace and promote the non-use of all tobacco
products.  In addition, Public Law 103-227, the Pro-Children Act of
1994, prohibits smoking in certain facilities (or in some cases, any
portion of a facility) in which regular or routing education,
library, day care, health care or early childhood development
services are provided to children.  This is consistent with the PHS
mission to protect and advance the physical and mental health of the
american people.

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