HIV-associated Non-Communicable Diseases Research at Low- and Middle-Income Country Institutions (R21 Clinical Trial Optional) | PAR 21 246

Opportunity Information: Apply for PAR 21 246

This NIH grant opportunity (PAR-21-246) supports exploratory, locally relevant research on HIV-associated non-communicable diseases (NCDs) led by institutions in low- and middle-income countries (LMICs). It uses the R21 mechanism, meaning it is geared toward early-stage, proof-of-concept, and feasibility-style projects that can generate preliminary data, test novel ideas, and lay the groundwork for larger future studies. Clinical trials are allowed but not required ("Clinical Trial Optional"), so applicants can propose anything from observational and mechanistic studies to early intervention or implementation-focused work, as long as the approach fits the R21 exploratory scope and the application clearly justifies feasibility.

The central scientific focus is the growing burden of chronic, non-infectious conditions among people living with HIV (PLWH), especially in LMIC settings where health systems often face dual pressures of infectious diseases and long-term chronic care. The program aims to stimulate new research on how HIV infection, HIV-related immune activation/inflammation, and antiretroviral therapy may contribute to the development, progression, or severity of NCDs. A key theme is understanding "interplay": not just documenting that HIV and NCDs co-occur, but investigating the pathways and context that shape risk and outcomes, including etiopathogenesis where appropriate. The initiative also emphasizes practical outputs: improving diagnosis, prevention strategies, therapeutic interventions, and integrated models of clinical care for PLWH who also have NCD comorbidities.

Projects are expected to align with NIH HIV/AIDS research priorities, and applicants are directed to use the NIH Office of AIDS Research (OAR) priorities as a guide when shaping research questions, populations, and outcomes. In practice, that means proposals should make a clear case for why the question matters to the HIV response, why the NCD issue is urgent in the intended LMIC context, and how the work will meaningfully advance knowledge or care beyond what is already known. Strong applications will typically connect the local disease burden to a specific research gap, propose a method that can realistically be completed within an R21 timeframe, and describe how results could translate into improved clinical practice, prevention programs, or larger-scale investigations.

A notable feature of the announcement is its emphasis on team science and partnership across disciplines. Applicants are encouraged to build research teams that include both HIV and NCD expertise, reflecting the reality that effective work in this area often requires combining infectious disease/HIV clinical knowledge with chronic disease epidemiology, cardiometabolic or neurologic expertise, oncology, mental health, implementation science, or health systems research. The program explicitly supports collaborations that bring together investigators who may not traditionally work together, with the goal of generating new ideas and testing novel approaches to reduce long-term illness and disability tied to HIV-NCD comorbidity.

Beyond the research itself, the opportunity has a clear capacity-building and network-building mission. Applicants are expected to address the needs of the collaborating LMIC institution(s) and describe how the project will strengthen the ability to conduct high-quality HIV-NCD research locally. Depending on the setting, this can include developing research infrastructure, strengthening data systems, enhancing laboratory or clinical measurement capacity, improving regulatory and ethics processes, building skills in study design and analysis, or supporting training and mentorship pathways for early-career LMIC investigators. The broader intent is not only to fund individual projects, but also to help establish a connected community of researchers within and across LMICs who can continue tackling HIV-associated NCDs over time.

Eligibility and partnership rules are designed to keep the work anchored in LMIC sites while still enabling international collaboration. Both U.S. and LMIC investigators can participate, but collaborative applications for projects conducted at LMIC sites must include both a U.S. investigator and an LMIC investigator applying together, reflecting a joint effort rather than a purely external project. LMIC status is determined using the World Bank country income classifications (low-income, lower-middle-income, and upper-middle-income based on GNI per capita), and applicants are expected to ensure their proposed sites meet those criteria at the time of application.

The eligible applicant pool is broad and includes many types of organizations and institutions: government entities (state, county, city/township, special districts), independent school districts, public and private institutions of higher education, tribal governments and tribal organizations, public housing authorities/Indian housing authorities, a range of nonprofit organizations (with or without 501(c)(3) status), for-profit organizations other than small businesses, and small businesses. The announcement also highlights additional eligible groups such as faith-based or community-based organizations, U.S. territory or possession entities, foreign (non-U.S.) organizations, regional organizations, and several categories of minority-serving institutions (including HBCUs, Hispanic-serving institutions, AANAPISI institutions, Alaska Native and Native Hawaiian serving institutions, and tribally controlled colleges and universities). The sponsoring agency is the National Institutes of Health, and the opportunity is categorized as a discretionary grant program.

From a practical standpoint, a competitive application will usually do three things clearly. First, it will define a specific HIV-NCD problem in an LMIC population and show why it is locally important and scientifically unresolved. Second, it will propose an R21-appropriate plan that is realistic, innovative, and capable of producing actionable findings (for example, feasibility metrics, validated measurement approaches, and a credible analytic plan). Third, it will treat capacity strengthening as a real deliverable rather than an afterthought, explaining what will be built, who will be trained or supported, and how the LMIC institution will be better positioned to sustain and expand HIV-NCD research after the project ends.

Key administrative details from the listing include the funding opportunity number PAR-21-246, an original closing date of 2022-12-08, and multiple CFDA program numbers associated with NIH health research funding (including 93.242, 93.279, 93.393 through 93.399, 93.846, 93.847, 93.866, and 93.989). The announcement does not specify an award ceiling or expected number of awards in the provided text, so applicants would typically confirm budget and award guidance in the full NIH funding opportunity announcement and related NIH policy pages.

• The National Institutes of Health in the education, food and nutrition, health sector is offering a public funding opportunity titled "HIV-associated Non-Communicable Diseases Research at Low- and Middle-Income Country Institutions (R21 Clinical Trial Optional)" and is now available to receive applicants.
• Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.242, 93.279, 93.393, 93.394, 93.395, 93.396, 93.399, 93.846, 93.847, 93.866, 93.989.
• This funding opportunity was created on 2021-07-06.
• Applicants must submit their applications by 2022-12-08. (Agency may still review applications by suitable applicants for the remaining/unused allocated funding in 2026.)
• Eligible applicants include: State governments, County governments, City or township governments, Special district governments, Independent school districts, Public and State controlled institutions of higher education, Native American tribal governments (Federally recognized), Public housing authorities/Indian housing authorities, Native American tribal organizations (other than Federally recognized tribal governments), Nonprofits having a 501 (c) (3) status with the IRS, other than institutions of higher education, Nonprofits that do not have a 501 (c) (3) status with the IRS, other than institutions of higher education, Private institutions of higher education, For-profit organizations other than small businesses, Small businesses, Others.

Apply for PAR 21 246

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