Seek, Test, Treat and Retain For Youth and Young Adults Living with or at High Risk for Acquiring HIV (R01)

RFA-DA-16-010
Seek, Test, Treat and Retain For Youth and Young Adults Living with or at High Risk for Acquiring HIV (R01)
Department of Health and Human Services
National Institutes of Health

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Section I. Funding Opportunity Description
Background

The “Seek, Test, Treat, and Retain” (STTR) approach to HIV prevention involves reaching out to high-risk, hard-to-reach groups who have not been recently tested for HIV (Seek), engaging them in HIV testing (Test), initiating, monitoring, and maintaining antiretroviral therapy (ART) for those testing HIV+ positive (Treat) and retaining patients in HIV and other relevant care (Retain) to impact HIV transmission on a population basis. The STTR paradigm has demonstrated efficacy in reducing HIV transmission at a population level among various key populations. Limited and inconsistent focus has been placed on the STTR paradigm among adolescents and young adults (defined in this RFA as 13-25 years of age) in the United States and internationally, particularly among substance using youth.  Youth generally are less likely to know their HIV status as compared to older populations. Consistent antiretroviral use and virologic suppression among adolescents and young adults are troublingly low as compared to adults in the US, with estimates that under 10% of all HIV+ youth are suppressed.  Similar findings have been observed in foreign settings.

Numerous individual and structural factors contribute to the challenges facing adolescent and young adult populations at risk for or living with HIV. If these factors are not addressed, the likelihood of STTR approaches making a difference in HIV incidence will be limited, at best. Younger populations at-risk for HIV may be members of groups that experience health care disparities, such as sexual minorities and, in the US, ethnic/racial minorities. High rates of substance use/abuse, particularly marijuana, alcohol, and stimulants, as well as are seen among youth in many locales and these are associated with risky sexual behavior (e.g., condomless sex) among both HIV- and HIV+ youth and young adults. Substance use prevention has demonstrated a  role in reducing HIV sexual risk and consequences such as sexual transmitted infections (STIs) is likely to serve as a facilitator of HIV treatment adherence. Youth may be more difficult to reach because adolescence and young adulthood are periods of transition, which may include repeated geographic moves, changes in educational or work status, and changing eligibility for entitlements and health insurance. HIV+ youth may transition from pediatric and adolescent health settings to adult health care settings with little systematic transfer of health records and clinical follow-up. Laws that govern the role of parents in the health care of youth and the autonomy of minors vary greatly within the US and across countries. These laws affect the ability of youth to seek HIV testing services, as well as services for substance use problems. Laws also may affect autonomy to participate in parts of STTR (e.g., initial screening and perhaps treatment of collateral, contributory problems such as STIs or substance abuse). Cultural norms may lead to parent or guardian involvement in health care decisions after youth reach majority in many places.  Therefore, involvement of parents and guardians needs to be a continuing consideration.

Because adolescents and young adults have not achieved full physical or cognitive maturity, linking and retaining HIV+ youth in care can be challenging. There is a dearth of HIV-specialty care geared toward adolescents and a lack of attention to their developmental needs. Where adolescent services exist there often is an absence of seamless transition to adult-based health care when they become adults. Beyond reproductive health care for young women, there is no systematic focus for routine and preventive health care among youth (regardless of HIV status) and young people realistically may perceive that they are at low risk for many of the most common chronic conditions like HIV, and may only engage health care for accidents or obvious clinical symptoms.

There are a small number of HIV or substance use providers who target youth, whereas most services are designed for adults. Simply promoting utilization of these adult-focused services by youth may fail to surmount the structural and other factors that govern the health behavior of younger people. Because youth may access HIV testing at community sites outside of the health care system, linkage between organizations that target and service youth (e.g., non-governmental organizations, social service, juvenile justice) and health care systems is important, as well as coordination of collateral services, as needed, for comorbid conditions that interfere with treatment adherence or virologic response (e.g., substance use disorders, STIs).

Research Objectives

The purpose of this FOA is to examine delivery models of HIV-focused services (testing, linkage, engagement and retention in care) for high risk or already HIV+ infected youth and young adults, with the ultimate goal of preventing HIV acquisition or onward transmission. Applications should incorporate substance use into study aims; objectives should address access to substance use prevention, screening, and/or treatment, as appropriate. Applications examining interventions that focus only on individual-level behavior and outcomes will be considered non-responsive, given the systemic and structural determinants of serostatus screening, treatment retention and viral suppression, which are the most striking areas of deficit among youth in the HIV continuum of care. The developmental, structural, and systemic factors related to serving youth need to be clearly incorporated into study aims, rather than simply refocusing existing interventions to younger people. Projects do not need to address the complete STTR continuum but should clearly address areas of particularly significant deficits for serving youth. Merely providing referrals to specialty care settings – without structural supports to ensure receipt of the referred service and ongoing coordination of care among service providers – is insufficient to be responsive to this FOA. Applications should demonstrate empirically that the target population is at high risk for HIV acquisition or has elevated rates of current HIV infection, and is therefore of high priority for testing, screening, or linkage. Integration of collateral services (e.g., substance use or STI treatment; prevention or early intervention for substance use) needs to be clearly integrated into the STTR framework, but should not be the primary focus of the study outcomes.

Because youth are likely to be early in their sexual development and can be exposed to the HIV virus over the course of years of subsequent sexual activity, it is imperative that projects that include screening also provide effective prevention modalities to HIV-negative youth. The purpose of this FOA is not to develop new prevention modalities, but projects are expected to incorporate, implement, and evaluate efficacious interventions with consideration to biologic as well as behavioral approaches. Projects should provide an evidence-based rationale for how their approach will lead to the expected outcomes, utilizing behavioral, social, organizational systems or other applicable theory.

Projects need not encompass the full age range covered by this FOA (ages 13-25) but a rationale should be provided for the age range that is chosen, and the components of the proposed project should be developmentally appropriate to that age group and their HIV and substance use epidemiology. Applicable laws regarding the participation of minors in research and clinical care vary widely, however, this should not preclude consideration of younger age groups, nor should it exclude consideration of parent or guardian roles among youth of any age.

Projects should take into account NIH HIV/AIDS research priorities http://grants.nih.gov/grants/guide/notice-files/NOT-OD-15-137.html

General Information

Document Type: Grants Notice
Funding Opportunity Number: RFA-DA-16-010
Funding Opportunity Title: Seek, Test, Treat and Retain For Youth and Young Adults Living with or at High Risk for Acquiring HIV (R01)
Opportunity Category: Discretionary
Funding Instrument Type: Grant
Category of Funding Activity: Education
Health
Category Explanation:
Expected Number of Awards:
CFDA Number(s): 93.279 — Drug Abuse and Addiction Research Programs
Cost Sharing or Matching Requirement: No
Posted Date: Dec 8, 2015
Creation Date: Dec 8, 2015
Original Closing Date for Applications: Mar 2, 2016  
Current Closing Date for Applications: Mar 2, 2016  
Archive Date: Apr 2, 2016
Estimated Total Program Funding: $3,000,000
Award Ceiling:
Award Floor:

Eligibility

Eligible Applicants:
Others (see text field entitled “Additional Information on Eligibility” for clarification)
Independent school districts
Native American tribal governments (Federally recognized)
Public housing authorities/Indian housing authorities
State governments
Native American tribal organizations (other than Federally recognized tribal governments)
For profit organizations other than small businesses
Private institutions of higher education
Special district governments
Nonprofits that do not have a 501(c)(3) status with the IRS, other than institutions of higher education
Public and State controlled institutions of higher education
Small businesses
County governments
City or township governments
Nonprofits having a 501(c)(3) status with the IRS, other than institutions of higher education
Additional Information on Eligibility: Other Eligible Applicants include the following: Alaska Native and Native Hawaiian Serving Institutions; Asian American Native American Pacific Islander Serving Institutions (AANAPISISs); Eligible Agencies of the Federal Government; Faith-based or Community-based Organizations; Hispanic-serving Institutions; Historically Black Colleges and Universities (HBCUs); Indian/Native American Tribal Governments (Other than Federally Recognized); Non-domestic (non-U.S.) Entities (Foreign Organizations); Regional Organizations; Tribally Controlled Colleges and Universities (TCCUs) ; U.S. Territory or Possession.

Additional Information

Agency Name: National Institutes of Health
Description: The purpose of this Funding Opportunity Announcement (FOA) is to examine seek, test, treat and retain approaches among youth and young adults (ages 13-25) who are at high risk for HIV acquisition or have already acquired HIV. Applications should incorporate substance use into study aims; objectives should address substance use prevention, screening, and/or treatment in ways that facilitate use of HIV prevention and treatment services. Youth are the target of this RFA because they demonstrate lower levels of screening and engagement across the HIV continuum of care and HIV+ youth are less likely to achieve viral suppression than those at older ages. These disparities are evident in US and foreign populations. The developmental, structural, and systemic factors related to serving youth need to be clearly incorporated into study aims, rather than simple incremental refocusing of existing interventions to younger people. Both domestic and international projects will be supported
Link to Additional Information: http://grants.nih.gov/grants/guide/rfa-files/RFA-DA-16-010.html
Contact Information: If you have difficulty accessing the full announcement electronically, please contact:

NIH OER Webmaster FBOWebmaster@OD.NIH.GOV
If you have any problems linking to this funding announcement, please contact the NIH OER Webmaster

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