Learning from the Transfer of HIV Interventions from Low- and Middle-Income Countries (LMICs) to the United States: Informing the Plan for America to End the HIV Epidemic

Notice Number: NOT-TW-19-008

Key Dates
Release Date: December 18, 2019
Response Date: February 15, 2020

Related Announcements
None

Issued by
National Institutes of Health (NIH)
Fogarty International Center (FIC)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
National Institute of Allergy and Infectious Diseases (NIAID)
National Institute of Mental Health (NIMH)
National Institute of Nursing Research (NINR)
National Institute on Minority Health and Health Disparities (NIMHD)
Office of Behavioral and Social Sciences Research (OBSSR)

Purpose

Background

In February 2019, the U.S. Department of Health and Human Services (HHS) announced an initiative to end the HIV epidemic in the United States (U.S.) within 10 years. To achieve this goal and address the ongoing HIV public health crisis, the proposed Ending the HIV Epidemic: A Plan for America intends to leverage existing data and tools to reduce new HIV infections in the U.S. by 75% in five years and by 90% by 2030 (REF). As part of this plan, HHS has identified high burden areas - many in low-resource settings - that have a disproportionate share of new HIV infections (REF). Leading the initiative at the NIH, Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID) stated that “with existing, powerful HIV treatment and prevention tools, we can end the epidemic in the United States. The new initiative is a practical, achievable implementation plan. By working directly with health departments and other community organizations, researchers can find the best ways to use the highly effective methods at our disposal to diagnose, prevent and treat HIV in the United States” (REF). In support of this effort, the NIH awarded approximately $11.3 million to 23 institutions across the U.S. participating in the Center for AIDS Research (CFAR) and AIDS Research Centers (ARCs) programs, leveraging existing research infrastructure and resources.

Purpose

Given potential similarities between low- and middle-income countries (LMICs) and some of the targeted low-resourced settings in this domestic initiative, it is suggested that HIV and related interventions that were originally developed and designed for use in LMICs may be relevant to these high burden areas. Thus, the purpose of this RFI is to identify HIV and other disease interventions developed in LMICs that have been or could be implemented in the U.S. in order to understand the scientific processes by which these interventions have adapted. We are seeking additional information about HIV interventions developed in LMICs that could or should be transferred to the U.S. specifically to address the HIV high burden areas. We would like to understand the role that research, particularly implementation research, can play in the transfer of successful intervention strategies from LMICs to the U.S and how they can be harnessed. We plan to host an NIH workshop to highlight successful and unsuccessful intervention transfers that have been identified through this RFI and other means. Our goal is to harness these lessons learned to develop a scientific research agenda to inform the initiative to end the U.S. HIV epidemic.

There are many cases of health discoveries made abroad that have been transferred for use in the U.S. For example, in sub-Saharan Africa, emergency management was utilized to establish health service systems to more easily address the HIV epidemic. Once established, the services shifted from emergency to sustainable holistic care programs responsive to community needs, a process that has been replicated in Harlem, New York (REF). Additionally, in the Rio Grande Valley of Texas, scientists are seeking to eliminate the need for multiple follow-up appointments by implementing the use of a high-resolution microendoscope, a low-cost, point-of-care cervical cancer diagnostic tool originally developed for use in Brazil and El Salvador (REF). More examples are listed on page 26 of the FIC Strategic Plan.

Information Requested

We are soliciting examples of interventions in HIV prevention, care or treatment that were developed in LMICs and have been transferred and attempted to be implemented in the U.S. This could include both successful and unsuccessful cases. We are also interested in interventions that have not yet been transferred from LMICs to the U.S. but could potentially be transferred to help curb the HIV epidemic, with a particular focus on the geographic hotspots identified by HHS (REF). Though we are most interested in examples from the HIV field, we are also seeking information about LMIC to U.S. intervention transfers from other disease areas, as we believe much can be learned from a wide range of examples. We request information about how healthcare interventions have been transferred and implemented in the past, and what the role (if any) research has played in the adaptation and implementation process. We would like to know about the barriers and facilitators to this process and whether there are lessons learned that we can translate into a more systematic methodology, for example by utilizing implementation science.

Specifically, this RFI is seeking:

  • Examples of healthcare interventions in HIV prevention, care or treatment that have been, attempted to be, or were unsuccessfully transferred from LMICs to the U.S.
  • Examples of HIV interventions that could be transferred from LMICs to the U.S., specifically to inform the U.S. HIV initiative to end the epidemic by 2030.
  • Examples of LMIC-to-U.S. intervention transfers from all disease areas that may provide helpful information about the research, adaptation or implementation processes.

To the extent possible and with as much specificity as possible, please provide information about:

  1. the intervention transferred and implemented, or an intervention that you believe could or should be considered for transfer/implementation and why
  2. the context or setting of the original intervention and that of the adapted/adopted intervention (e.g. country, state, city, neighborhood, hospital, clinic, etc.)
  3. facilitators to the intervention transfer and implementation process (e.g. specific program support or policies that enabled the transfer, local stakeholders or champions, ministry of health involvement/support, etc.)
  4. barriers to the intervention transfer or implementation process
  5. the specific part of the continuum of care that the intervention targets
  6. the population(s) the intervention targets, the demographics of that population (e.g. age, sex, gender, race/ethnicity, cultural background, socioeconomic characteristics, population’s health risk profile, healthcare disparities, etc.), and the extent to which the LMIC and U.S. populations resemble each other
  7. the process by which the intervention was transferred and implemented
  8. the stakeholders involved in the transfer process
  9. the sustainability of the transferred intervention (e.g. does it currently exist?)
  10. whether it was scaled or transferred to other U.S. settings
  11. the type of research involved in the transfer and implementation process (e.g. basic science, implementation science, clinical research, translation research, cost effectiveness research, natural experiment/impact of policy, etc.), and, if implementation science was utilized, the relevant frameworks, strategies and/or implementation science outcomes
  12. published materials documenting the intervention’s transfer and implementation process (e.g. peer-reviewed, grey or white literature, newspaper articles, etc.)
  13. evaluations related to the transfer and implementation process and its success or failure
  14. the funder(s) involved (e.g. NIH or USAID grants, etc.)

The Fogarty International Center and its NIH partners seek input from all interested stakeholders, including members of the scientific community, trainees, academic institutions, the private sector, health professionals, professional societies, advocacy groups, and patient communities, as well as other interested members of the public.

Please use the form linked here for your response: https://grants.nih.gov/grants/rfi/rfi.cfm?ID=99

Inquiries

Please direct all inquiries to:

Arianne Malekzadeh
Fogarty International Center
Telephone: 301-827-7855
Email: arianne.malekzadeh@nih.gov