The National Institute of Mental Health is issuing this Notice to highlight interest in receiving grant applications developmentally on tailored research focused on adolescents and emerging adults as it relates to HIV prevention and treatment.

There are approximately 1.8 billion adolescents and emerging adults (youth; 10 to 24 years old) in the world, a number that is greater than at any other time in history. The developmental periods of adolescence and emerging adulthood are characterized by the acquisition of essential life skills, increased experimentation and risk taking. Globally, youth are some of the most vulnerable to acquiring HIV. They also are the most likely to have poor health outcomes along the HIV care continuum.

While the NIH has a strong history of supporting research on youth and HIV, greater effort is needed to focus on the unique developmental processes during these time periods. It is well known that adolescence and emerging adulthood are characterized by enormous changes in biological, social, psychological, neurodevelopmental, hormonal, and immune functioning. Our understanding of these time periods is continuing to grow. Therefore, this Notice encourages applications that incorporate recent research advances in adolescent and emerging adulthood development to optimize outcomes in HIV prevention and care research.

Our understanding of adolescence and emerging adulthood has increased dramatically over the past 15 years. While it was previously believed that brain development was relatively complete prior to adolescence, recent research has demonstrated that adolescence is a time of increased neuroplasticity, which has important implications for development. Research has also shown that this is a time of heightened responsiveness to rewards or incentives and to socioemotional contexts, which has implications for decision making around sexual behavior and health care. In addition, adolescence is a time when impulse control and emotional regulation are still relatively immature. Because of the rapid neurodevelopment that occurs during adolescence, the neural impact of inflammation from the persistent exposure to HIV in the CNS could have a more substantial impact on brain development during this time. Neuroendocrine and immune changes are also rapidly occurring during adolescence and emerging adulthood. These biological changes are occurring at the same time as changes to youths’ social context, defined by increasing time spent with peers, increasing salience of peer relationships, increasing amounts of time spent using technology and being on social media, and initiation of romantic/sexual relationships. Gender and sexual orientation identity development are also key developmental processes that occur during adolescence and emerging adulthood. Internalized stigma and gender dysphoria may play a role in how youth navigate these tasks. However, given changing norms and laws regarding sexual orientation and gender identity, today’s youth are dealing with these tasks in a very different context than that which existed previously. For example, youth may receive more support from their communities or from online communities, while at the same time, these youth are sometimes facing very intense social scrutiny, social pressure, stigma, and violence. Lastly, adolescence and emerging adulthood are also characterized by increasing rates of mental health disorders and exposure to violence, both intimate partner violence and violence in their communities, and increasing mobility. Approximately 20% of adolescents have a diagnosable mental health disorder and many mental health disorders first present during adolescence. Recent evidence suggests that the number of adolescents and emerging adults who report having a major depressive episode is increasing. Other prevalent mental health disorders such as attention deficit hyperactivity disorder or externalizing disorders, which are associated with impairments in impulsivity and self-regulation, may also have implications for risk during this time. Additionally, youth can experience housing instability due to household changes, migrations, livelihood mobility, and displacement, among others, all of which can disrupt access to health care and impact prevention and treatment efforts during this period of development.

While advances in youth HIV research have been made, significant HIV health disparities continue to exist for youth. For these reasons, NIMH is calling for research on HIV treatment and prevention that focuses more on developmental factors. Specifically, additional research is needed on how developmental factors across adolescence and emerging adulthood 1) influence risk and resilience to HIV, 2) influence how youth cope with living with HIV, 3) affect the impact of HIV prevention and treatment interventions, and 4) can be more adequately incorporated into HIV prevention and treatment interventions to improve their impact.

Other considerations for this notice:

• Given the significant amount of heterogeneity that exists among adolescents and emerging adults, researchers are encouraged to consider the use of different metrics for measuring development beyond chronological age
• Given the importance of incorporating youth input throughout the research process, youth advisory boards are required for all submissions to this Notice
• Research needs to take into consideration the heterogeneity of youth as well as sex and gender differences

Areas of Research Interest

Research topics encouraged by this Notice include, but are not limited to, the following:

Research to better understand mechanisms, relationships, and intervention targets:

• Applications of new longitudinal social network analyses/approaches to better understand the influence of peers/friends/partners/family on HIV risk behavior and health behaviors among youth living with HIV and among youth who are vulnerable to HIV infection
• Studies to better understand how changing gender identity development and sexual orientation development impact HIV risk and resilience
• Research to better understand the effects of persistent exposure to HIV and/or exposure at critical time points to HIV on the developing adolescent brain
• Research to better understand how developmental factors influence uptake and adherence to biomedical prevention strategies
• Research to better understand violence as an obstacle to engagement in and adherence to HIV prevention and treatment among youth
• Development of methods to assess developmental readiness for autonomous adherence to prevention or treatment or readiness to transition to adult HIV care
• Research to assess how structural factors relevant to youth, such as age of consent for HIV testing, HIV treatment, or PrEP, affects HIV prevention and treatment outcomes for adolescents
• Studies to better understand stigma among youth and the influence of stigma on youth HIV prevention and treatment behaviors
• Potential impact of laws and state policies on enrollment into adolescent HIV research
• Implementation science research on the impact of laws and state policies on access and uptake of adolescent HIV services
• Development and/or testing of measures to better understand youth’s ability to engage in self-care behaviors or to predict developmental capacity to adhere to biomedical prevention or treatment
• Analysis of existing data to determine the critical components in the delivery of adolescent-friendly HIV prevention and treatment services and how to increase demand for these services
• Research to better understand how mobility in adolescents and young adults impacts HIV prevention and/or care
• Intervention research to improve HIV prevention and HIV continuum of care:Approaches that take in to consideration both economic principles (e.g., scarcity mindset, behavioral biases, delay discounting) and adolescent neurodevelopment (e.g., sensitivity to rewards, relative cost/benefit of risky behaviors) in developing interventions for adolescents and emerging adults. Development and testing of interventions that capitalize on new findings on adolescent and emerging adulthood neurodevelopment. Interventions that capitalize on the protective and risk-enhancing effects of peers and/or parents. Interventions to enhance adolescents’ self-control, particularly in the context of heightened emotional states, mental health disorders and/or substance use. Structural interventions that reduce adolescents’ exposure to risk, given important developmental factors such as adolescents’ enhanced response to anticipated reward, their developing self-regulatory skills, and the enhancement of risky behavior when peers are present. Implementation science research to determine the critical components in the delivery of adolescent-friendly HIV prevention and treatment services and how to increase demand for these services. Development of interventions to assist with the transition from pediatric or adolescent HIV care to adult HIV care. Development of interventions that capitalize on youths’ social networks (in person or on-line) to speed up the diffusion of new biomedical prevention options or enhance engagement in HIV care for youth living with HIV. Development of differentiated care models for youth to improve outcomes along the HIV care continuum.

Application and Submission Information

This notice applies to due dates on or after May 7, 2020 and subsequent receipt dates through May 8, 2023.

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

PA-20-145, Innovations in HIV Prevention, Testing, Adherence and Retention to Optimize HIV Prevention and Care Continuum Outcomes (R21 Clinical Trial Optional)

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

PA-19-126

, Mentored Research Scientist Development Award (Parent K01 - Independent Clinical Trial Not Allowed)

PA-19-127, Mentored Research Scientist Development Award (Parent K01 - Independent Clinical Trial Required)

PA-19-116, Mentored Clinical Scientist Research Career Development Award (Parent K08 Independent Clinical Trial Required)

PA-19-117, Mentored Clinical Scientist Research Career Development Award (Parent K08 Independent Clinical Trial Not Allowed)

PA-19-118, Mentored Patient-Oriented Research Career Development Award (Parent K23 Independent Clinical Trial Required)

PA-19-119, Mentored Patient-Oriented Research Career Development Award (Parent K23 Independent Clinical Trial Not Allowed)

PA-19-052, NIH Small Research Grant Program (Parent R03 Clinical Trial Not Allowed)

PA-19-129, NIH Pathway to Independence Award (Parent K99/R00 Independent Clinical Trial Required)

PA-19-130, NIH Pathway to Independence Award (Parent K99/R00 - Independent Clinical Trial Not Allowed)

PA-19-121, Midcareer Investigator Award in Patient-Oriented Research (Parent K24 Independent Clinical Trial Required)

PA-19-122, Midcareer Investigator Award in Patient-Oriented Research (Parent K24 Independent Clinical Trial Not Allowed)

PA-19-272, PHS 2019-02 Omnibus Solicitation of the NIH, CDC, and FDA for Small Business Innovation Research Grant Applications (Parent SBIR [R43/R44] Clinical Trial Not Allowed)

PA-19-273, PHS 2019-02 Omnibus Solicitation of the NIH, CDC, and FDA for Small Business Innovation Research Grant Applications (Parent SBIR [R43/R44] Clinical Trial Required)

PA-19-270, PHS 2019-02 Omnibus Solicitation of the NIH for Small Business Technology Transfer Grant Applications (Parent STTR [R41/R42] Clinical Trial Not Allowed

PA-19-271, PHS 2019-02 Omnibus Solicitation of the NIH for Small Business Technology Transfer Grant Applications (Parent STTR [R41/R42] Clinical Trial Required

PAR-19-051, Emerging Global Leader Award (K43 Independent Clinical Trial Required)

PAR-19-098, Emerging Global Leader Award (K43 Independent Clinical Trial Not Allowed)

PAR-17-485, NIMH Research Education Mentoring Program for HIV/AIDS Researchers (R25)

PAR-18-714, Academic Research Enhancement Award for Undergraduate-Focused Institutions (R15 - Clinical Trial Not Allowed)

PAR-19-133, Academic Research Enhancement Award for Undergraduate-Focused Institutions (R15 Clinical Trial Required)

PAR-19-134, Research Enhancement Award Program (REAP) for Health Professional Schools and Graduate Schools (R15 Clinical Trial Not Allowed)

PAR-19-135, Research Enhancement Award Program (REAP) for Health Professional Schools and Graduate Schools (R15 Clinical Trial Required)

PAR-19-283, Fogarty HIV Research Training Program for Low-and Middle-Income Country Institutions (D43 Clinical Trial Optional)

PA-19-192, Ruth L. Kirschstein National Research Service Award (NRSA) Individual Fellowship for Students at Institutions Without NIH-Funded Institutional Predoctoral Dual-Degree Training Programs (Parent F30)

PA-19-195, Ruth L. Kirschstein National Research Service Award (NRSA) Individual Predoctoral Fellowship (Parent F31)

PA-19-196, Ruth L. Kirschstein National Research Service Award (NRSA) Individual Predoctoral Fellowship to Promote Diversity in Health-Related Research (Parent F31 -Diversity)

PA-19-188, Ruth L. Kirschstein National Research Service Award (NRSA) Individual Postdoctoral Fellowship (Parent F32)

PA-18-403, Ruth L. Kirschstein National Research Service Award (NRSA) Institutional Research Training Grant (Parent T32)

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-MH-20-035” (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 not be considered for the NOSI initiative.

Please direct all inquiries to the contacts in Section VII of the listed funding opportunity announcements with the following additions/substitutions:

Scientific/Research Contact(s)

Susannah Allison
National Institute of Mental Health (NIMH)
Telephone: 240 627-3861
Email: [email protected]

Peer Review Contact(s)

Examine your eRA Commons account for review assignment and contact information (information appears two weeks after the submission due date).

Financial/Grants Management Contact(s)

Rita Sisco
National Institute of Mental Health (NIMH)
Telephone: 301-443-2805
Email: [email protected]