Innovations in Mechanisms and Interventions to Address Mental Health in HIV Prevention and Care Continuum (R21 Clinical Trial Optional) | PA 18 275

Opportunity Information: Apply for PA 18 275

The National Institutes of Health (NIH) funding opportunity PA-18-275, titled "Innovations in Mechanisms and Interventions to Address Mental Health in HIV Prevention and Care Continuum (R21 Clinical Trial Optional)," supports research that connects mental health and HIV outcomes in practical, measurable ways. The overall aim is to strengthen HIV prevention and treatment by tackling mental health factors that can interfere with engagement in care, medication adherence, and long-term viral suppression. This announcement is designed for investigators who want to either clarify how mental health influences HIV-related behaviors and treatment outcomes, or to build and test new or expanded interventions that improve both mental health and HIV results across the entire HIV care continuum, from initial HIV testing through consistent care and ultimately viral suppression.

A major emphasis of this opportunity is on mechanisms, meaning the underlying pathways that explain why and how mental health conditions (or mental health-related experiences) affect HIV prevention and care outcomes. The FOA encourages studies that move beyond simply documenting that depression, anxiety, trauma, substance use, or other psychological and behavioral health challenges are associated with poorer HIV outcomes. Instead, applicants are expected to dig into what is driving those links and to identify intervention targets that are modifiable, such as specific cognitive, emotional, social, or structural processes that can realistically be changed through prevention or treatment approaches. The goal of this mechanistic focus is to generate actionable knowledge that can directly inform better intervention design, better clinical decision-making, and better implementation strategies in real-world settings.

Alongside mechanism-focused research, the FOA also prioritizes intervention development and early testing. This includes developing and pilot testing "expanded interventions" that address mental health and HIV outcomes together, rather than treating them as separate problems handled in separate systems. The intent is to encourage integrated or coordinated approaches that could improve outcomes at multiple points along the continuum, such as increasing HIV testing uptake, improving linkage to care after diagnosis, supporting retention in care, improving adherence to antiretroviral therapy, and achieving and maintaining viral suppression. Because mental health challenges can affect motivation, decision-making, risk perception, self-efficacy, and the ability to navigate healthcare systems, the NIH is looking for innovative strategies that improve both mental health and HIV prevention/treatment outcomes in tandem.

This specific announcement uses the R21 grant mechanism and is described as "Clinical Trial Optional," which signals that applicants may propose a study that includes a clinical trial component, but they are not required to do so. The R21 is framed as a good fit for high-risk, high-reward projects, especially those that may not yet have extensive preliminary data. It can also be appropriate for projects that use existing datasets or pursue novel ideas that are still at an early stage but could have strong payoff if successful. The FOA contrasts the R21 with a related R01 version (referenced as using the R01 mechanism), where applicants who already have stronger preliminary evidence and/or plan to conduct more extensive work, including longitudinal analysis, might be better positioned to apply under the R01 pathway instead.

In terms of practical funding details included in the source information, this is a discretionary grant opportunity with an award ceiling of $200,000. The funding activity categories are education and health, and the CFDA numbers listed are 93.242 and 93.279. The original closing date shown is 2020-01-07, and the opportunity was created on 2017-11-29. While the listing shows "ExpectedAwards:" without a number provided, the key takeaway is that this was structured as a pilot or early-stage research support mechanism consistent with typical R21 goals: generating proof-of-concept evidence, establishing feasibility, refining intervention components, and producing results that can justify larger-scale research later.

Eligibility is broad and includes a wide range of government, academic, nonprofit, and private-sector organizations. Eligible applicants include state, county, city or township, and special district governments; independent school districts; public and state-controlled institutions of higher education; private institutions of higher education; federally recognized Native American tribal governments; public housing authorities and Indian housing authorities; and Native American tribal organizations other than federally recognized tribal governments. The FOA also allows nonprofits with and without 501(c)(3) status, for-profit organizations (other than small businesses), and small businesses, along with other categories. It explicitly highlights additional eligible applicants such as Alaska Native and Native Hawaiian Serving Institutions, Asian American Native American Pacific Islander Serving Institutions (AANAPISISs), Hispanic-serving Institutions, Historically Black Colleges and Universities (HBCUs), Tribally Controlled Colleges and Universities (TCCUs), faith-based or community-based organizations, eligible federal agencies, non-U.S. entities (foreign organizations), regional organizations, Indian/Native American tribal governments that are not federally recognized, and U.S. territories or possessions. This wide eligibility scope reflects the reality that HIV prevention and care, as well as mental health services research, often depend on partnerships that span universities, health systems, community organizations, and public agencies, including those serving communities disproportionately affected by HIV and mental health burdens.

Taken together, PA-18-275 is aimed at accelerating innovation at the intersection of mental health and HIV outcomes by funding research that either clarifies the modifiable drivers of mental health-related disparities and drop-offs in the HIV continuum, or tests new integrated strategies that can realistically improve both psychological well-being and HIV prevention/treatment results. The R21 format is positioned as a way to support bold, early-stage ideas and pilot work, with the long-term expectation that successful projects will lay the groundwork for larger trials, broader implementation research, or more definitive longitudinal studies in the future.

• The National Institutes of Health in the education, health sector is offering a public funding opportunity titled "Innovations in Mechanisms and Interventions to Address Mental Health in HIV Prevention and Care Continuum (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.
• This funding opportunity was created on 2017-11-29.
• Applicants must submit their applications by 2020-01-07. (Agency may still review applications by suitable applicants for the remaining/unused allocated funding in 2026.)
• Each selected applicant is eligible to receive up to $200,000.00 in funding.
• 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.

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