Implementation Research for Multi-morbidity Management in the Context of Non-communicable Diseases in Low- and Middle-Income Countries and US Tribal Populations (R01 Clinical Trial Optional)

Implementation Research for Multi-morbidity Management in the Context of Non-communicable Diseases in Low- and Middle-Income Countries and US Tribal Populations (R01 Clinical Trial Optional) is sponsored by National Institutes of Health (NIH). Funding for research on managing multiple chronic conditions in low- and middle-income countries and US tribal populations.

Expired PAR-25-213: Implementation Research for Multi-morbidity Management in the Context of Non-communicable Diseases in Low- and Middle-Income Countries and US Tribal Populations (R01 Clinical Trial Optional) This notice has expired. For NIH, in limited situations, applications may be accepted on a case-by-case basis for a short period after expiration to accommodate NIH late or continuous submission policies .

Contact the eRA Service Desk for any submission issues. Check the NIH Guide for active opportunities and notices. Department of Health and Human Services Part 1.

Overview Information Participating Organization(s) National Institutes of Health ( NIH ) Components of Participating Organizations Fogarty International Center ( FIC ) National Eye Institute ( NEI ) National Heart, Lung, and Blood Institute ( NHLBI ) Eunice Kennedy Shriver National Institute of Child Health and Human Development ( NICHD ) National Institute of Mental Health ( NIMH ) National Institute of Neurological Disorders and National Cancer Institute ( NCI ) All applications to this funding opportunity announcement should fall within the mission of the Institutes/Centers.

The following NIH Offices may co-fund applications assigned to those Institutes/Centers.

Office of Research on Women's Health ( ORWH ) Funding Opportunity Title Implementation Research for Multi-morbidity Management in the Context of Non-communicable Diseases in Low- and Middle-Income Countries and US Tribal Populations (R01 Clinical Trial Optional) R01 Research Project Grant March 31, 2025 - This funding opportunity was updated to align with agency priorities.

Carefully reread the full funding opportunity and make any needed adjustments to your application prior to submission. October 28, 2024 - Notice of Informational Webinar: Implementation Research for Multi-morbidity Management in the Context of Non-communicable Diseases in Low and Middle-Income Countries and US Tribal Populations (R01 Clinical Trial Optional; R61/R33 Clinical Trial Required). See Notice NOT-TW-24-011 .

April 4, 2024 - Overview of Grant Application and Review Changes for Due Dates on or after January 25, 2025. See Notice NOT-OD-24-084 . August 31, 2022 - Implementation Changes for Genomic Data Sharing Plans Included with Applications Due on or after January 25, 2023.

See Notice NOT-OD-22-198 . August 5, 2022 - Implementation Details for the NIH Data Management and Sharing Policy. See Notice NOT-OD-22-189 .

Funding Opportunity Number (FON) Companion Funding Opportunity Phase 1 Exploratory/Developmental Grant/ Exploratory/Developmental Grants Phase II See Section III. 3. Additional Information on Eligibility .

Assistance Listing Number(s) 93. 989, 93. 242, 93.

313, 93. 837, 93. 233, 93.

838, 93. 839, 93. 840, 93.

853, 93. 867, 93. 865, 93.

393, 93. 399, 93.

866 Funding Opportunity Purpose The National Institutes of Health (NIH) participating Institutes, Centers, and Offices (ICOs), in collaboration with the Global Alliance for Chronic Diseases (GACD), invite applications for implementation research that aims to improve the availability of effective, efficient, integrated, patient-centered, safe, and timely care for people living with multiple long-term conditions (non-communicable disease (NCD) multimorbidity) in low- and middle-income countries (LMICs) and/or within American Indian/Alaska Native (AI/AN) populations in the United States.

This Notice of Funding Opportunity (NOFO) supports innovative approaches to identifying, understanding, developing, and implementing strategies for overcoming barriers to the adoption, adaptation, integration, scale-up, and sustainability of evidence-based interventions, tools, policies, and guidelines. In addition, studies to advance dissemination and implementation research methods and measures into application are encouraged.

All applications must be within the scope of the mission of one of the Institutes/Centers listed above (see "Components of Participating Organizations," excluding the Fogarty International Center which manages this program but does not support awards). Applications will be accepted from US and World Bank-defined LMIC institutions only.

Open Date (Earliest Submission Date) The following table includes NIH standard due dates marked with an asterisk. Renewal / Resubmission / Revision (as allowed) AIDS - New/Renewal/Resubmission/Revision, as allowed All applications are due by 5:00 PM local time of applicant organization.

Applicants are encouraged to apply early to allow adequate time to make any corrections to errors found in the application during the submission process by the due date.

Required Application Instructions It is critical that applicants follow the instructions in the Research (R) Instructions in the How to Apply - Application Guide , except where instructed to do otherwise (in this NOFO or in a Notice from NIH Guide for Grants and Contracts ). Conformance to all requirements (both in the Application Guide and the NOFO) is required and strictly enforced.

Applicants must read and follow all application instructions in the Application Guide as well as any program-specific instructions noted in Section IV. When the program-specific instructions deviate from those in the Application Guide, follow the program-specific instructions. Applications that do not comply with these instructions may be delayed or not accepted for review.

Part 1. Overview Information Part 2. Full Text of Announcement Section I.

Notice of Funding Opportunity Description Section II. Award Information Section III. Eligibility Information Section IV.

Application and Submission Information Section V. Application Review Information Section VI. Award Administration Information Section VII.

Agency Contacts Section VIII. Other Information Part 2. Full Text of Announcement Section I.

Notice of Funding Opportunity Description The National Institutes of Health (NIH) participating Institutes, Centers, and Offices (ICOs), in collaboration with the Global Alliance for Chronic Diseases (GACD), invite applications for implementation research that aims to improve the availability of effective, efficient, integrated, patient-centered, safe, and timely care for people living with multiple long-term conditions (non-communicable disease (NCD) multimorbidity) in low- and middle-income countries (LMICs) and/or within American Indian/Alaska Native (AI/AN) populations in the United States.

This Notice of Funding Opportunity (NOFO) supports innovative approaches to identifying, understanding, developing, and implementing strategies for overcoming barriers to the adoption, adaptation, integration, scale-up, and sustainability of evidence-based interventions, tools, policies, and guidelines. In addition, studies to advance dissemination and implementation research methods and measures into application are encouraged.

Applications will be accepted from US and LMIC institutions only. Eligible LMIC institutions are defined by the World Bank at the following link: datahelpdesk. worldbank.

org/knowledgebase/articles/906519-world-bank-country-and-lending-groups . While it is not required (although encouraged) for applications submitted to this NOFO by LMIC institutions to have US partners, all applications submitted to this NOFO by US institutions are required to involve LMIC researchers as key personnel. NCDs account for 60% of deaths globally.

Importantly, this global burden is felt even more deeply in low- and middle-income countries (LMICs), and low-resource settings of high-income countries (HICs), such as within tribal nations—even though NCD risk factor burden is often lower in LMICs, due to the ongoing epidemiological transition from communicable to non-communicable disease risk factors as the primary drivers of health burden, mortality rate is much higher due in part to the lack of access to quality, integrated health services and the poor availability of early interventions and effective NCD prevention programs.

While NCDs account for the greatest loss of disability-adjusted life years (DALYs) around the world, they are relatively ignored and under-resourced, especially in LMICs where the burden is rising at the fastest rates throughout the world. In response to this major concern, the Global Alliance for Chronic Diseases (GACD) ( www. gacd.

org ) was formed in 2010 as a partnership of 15 Associate Member health research funding agencies around the world to coordinate funding for research and research training on NCDs in LMICs and among tribal nation communities of HICs. GACD supports research and intervention scaling to address the burden of NCDs practically, effectively, contextually, and sustainably.

Specifically, GACD supports implementation research that examines what works, for whom and under what circumstances, and how interventions can be adapted and scaled up in ways that are accessible and effective for the population. Projects funded through the GACD program are encouraged to work toward both location-specific and globally transferable lessons across low- and high- income countries.

Since 2011, the GACD has awarded over $375 million in implementation science research grants focused on preventing and managing NCDs in low-resource contexts. GACD has now supported over 1,300 researchers at over 250 institutions in 80+ countries through investment in 182 funded research projects to-date.

GACD Associate Members issue aligned funding announcements each year to address global health issues associated with chronic, non-communicable diseases; as such, funding announcement focus areas have included both targeted opportunities for specific NCDs and cross-cutting opportunities (please see https://www. gacd. org/funding for more information).

Together, the GACD Associate Members aim to foster collaboration and coordination of research programs by agreeing on joint research priorities and funding world-class research.

This NOFO is aligned with the overall GACD initiative to support implementation research, defined as the scientific study of the use of strategies to adopt and integrate evidence-based health interventions into clinical and community settings to improve individual outcomes and benefit population health.

Implementation research examines which strategies work, for whom, and under what circumstances to promote the uptake, scale-up, and spread of effective interventions. Projects may also address how interventions can be adapted and scaled up in ways that are feasible, acceptable, accessible, sustainable, and effective in a given national context.

Implementation research is especially relevant in LMICs, where it can help ensure that limited resources are invested in cost-effective interventions. Implementation research is needed to account for the complexities of the systems in which interventions are implemented since other approaches often fail to address these.

Results of implementation research support evidence-based policymaking that can build robust programs to improve public health. Additional information and resources on implementation research can be found on the GACD website . NCD multimorbidity refers to the co-occurrence of multiple long-term (chronic) conditions, at least one of which is an NCD.

Chronic NCDs include cardiovascular disease, respiratory diseases, certain cancers, musculoskeletal disorders, diabetes, hypertension, hematological disorders, sleep disorders, and mental illness. The high prevalence of NCD multimorbidity is projected to rise with the aging world population and the increasing burden of NCDs.

NCD multimorbidity has a profound impact on patients, and is associated with premature death, physical disability, substance abuse, poor quality of life, depression, and financial difficulties from high costs of care. It is also associated with difficulties in adherence to and high rates of adverse effects from treatment with multiple medications.

In addition, due to poor health and the complexity of managing their conditions, patients with multimorbidity are high utilizers of health care, straining already over-burdened health care systems, especially in low-resourced contexts.

Addressing multimorbidity demands a shift from fragmented models of care, that treat individual health issues separately as they occur, to a more holistic integrated care model that provides a whole person focus on health management.

The World Health Organization advocates that health systems move towards offering a continuum of quality NCD preventative, diagnostic, curative, rehabilitative, and palliative care services, that are available and accessible to all, independent of economic circumstances. Evidence for how to manage NCD multimorbidity is emerging, mostly from research in HICs.

This evidence suggests that primary healthcare , integrated and coordinated care, patient-centered interventions, digital health technology , and optimized medication therapy are key to improved management of NCD multimorbidity. However, implementing patient-centered strategies for treating NCD multimorbidity remains challenging and largely unexplored in disadvantaged contexts, especially in LMICs.

Adapting and scaling such models is critical to improving quality of life; reducing disability; reducing the burden of care taking on (typically female) family members and reducing health system costs. Applicants responding to this NOFO are invited to meet this challenge.

Research Objectives and Scope The aim of this NOFO is to invite applications for implementation research that will generate evidence about when, for whom, and under what circumstances, patient-centered approaches can improve integrated care for patients with NCD multimorbidity in LMICs and/or within AI/AN populations in the US.

Responsive applications will: Select one or more evidence-based interventions (or complex intervention) known to promote integrated multimorbidity management . Applicants should justify the choice of intervention(s) and provide evidence of the intervention’s effectiveness, acceptability, feasibility, and potential for long-term health and other impacts.

While it is recognized that the evidence for how to manage NCD multimorbidity is still emerging, particularly in LMICs, a period of testing the effectiveness of an intervention that your team has developed/adapted for local implementation is still appropriate.

Explore the implementation of these intervention(s) for a selected study population(s) based in one or more LMICs and/or within AI/AN populations in the US, taking into account the unique social, political, economic, and cultural context(s) in which the study will take place.

Applicants should justify why any adaptation will not compromise the known effectiveness of the selected intervention(s); Provide a research plan using validated implementation research frameworks or hybrid design research; Have an appropriate strategy for measuring implementation research outcomes and real-world multimorbidity effectiveness outcomes and indicators; Specifically address issues of effective implementation to ensure interventions reach the populations that need them the most; address health disparities , including addressing avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically or by other dimensions of inequality; address social determinants of NCDs in the relevant populations and assess culturally-tailored intervention strategies, including, for instance, studies that integrate tribal ecological knowledge (TEK) in AI/AN communities; Engage an appropriately expert and skilled research team which can ensure a suitable multidisciplinary approach and that demonstrates effective partnership and shared leadership between HIC and LMIC researchers, and/or non-Tribal Nation and AI/AN members of the project team and external collaborators/partners through a clear governance strategy, including written letters of support from these groups and associated Institutional Review Boards (IRBs), as appropriate; Provide a collaborator/partner engagement strategy with evidence of support/engagement from key partners for delivering patient-centered care and a pathway to sustain the proposed intervention after the project funding period ends; Provide opportunities for implementation research capacity building for early-career researchers and team members from lower-resourced environments, such as LMICs or AI/AN communities.

In addition, applicants are encouraged (though not required) to: Use mixed methods to answer research questions; Adopt a life course approach, adapting the intervention to one or more key life stage(s) critical for reducing the onset or progression of multimorbidity; Explore how to best implement digital technology interventions [In July 2021, the GACD held a workshop focusing on best practices for planning and delivering sustainable and effective digital health interventions for NCDs in LMICs and Indigenous communities.

A summary report, which may assist with application planning, is available here] ; Explain how the team will minimize their environmental footprint when conducting this research project.

NIH, through its partnership with GACD, is committed to supporting research undertaken through genuine multi-sectoral partnerships among a variety of academics, policymakers, local authorities, for-profit institutions, non-profit organizations, and community groups from HICs, LMICs, and/or AI/AN Tribal Nations. Where possible, research questions should be driven by local partners and other intended beneficiaries of the research project.

Study population and life course approach The NIH, in partnership with GACD, aims to address health disparities in LMICs and within AI/AN populations in the US. The study population should include patients with existing NCD multimorbidity ( e.g. , studies focusing on rolling out screening services for multiple NCDs).

The study population may also include patients with chronic infectious disease(s) ( e.g., studies that focus on integrating NCD management into an HIV or tuberculosis clinic) or a mixture of both.

Evidence-based interventions Study teams should develop an implementation research plan to assess patient-centered, evidence-based interventions focused on patient management or self-management, or interventions that transform communities, clinical practice, and/or health systems.

The following are potential interventions or strategies that applicants may consider in their implementation plan (please note that this is not an exhaustive list): Strategies for improving multimorbidity identification, stratification/staging, management, and/or monitoring such as investigating strategies for adapting and implementing the protocol(s) described in the WHO Package of Essential NCD Interventions ( WHO PEN ) that address multimorbidity management.

Projects may focus on integrating NCD care into clinics that typically focus on the management of infectious diseases, such as HIV or tuberculosis clinics, or the integration of NCD care into maternal and child health clinics; Strategies to streamline and improve quality of care among individuals with multimorbidity to reduce fragmentation of services, including task-sharing and/or the use of clinical decision-making tools; Strategies that optimize appropriate medication and (non-pharmacological) therapeutic prescribing, adherence, and/or reduced drug interactions/ adverse effects; Interventions that improve transitions through the health system, from community to primary to tertiary care and beyond, such as to home care or hospice; Health behavioral change interventions that target different risk factor clusters (e.g., exercise, nutrition, tobacco, alcohol and substance abuse).

It is expected that projects will focus on management of patients with existing multimorbidity and will not focus on prevention of multimorbidity (though projects focusing on the secondary prevention of increased severity of existing NCDs through risk factor management are appropriate).

Projects that focus on screening initiatives should focus specifically on screening for multimorbidity and also investigate strategies for the timely management or referral of identified cases. The NIH and GACD do not limit applicants to any particular design for testing effectiveness of the intervention; however, a validated implementation research framework should underpin the study.

For more information regarding selection of implementation research frameworks, please see the Fogarty International Center Toolkit: Overcoming Barriers to Implementation in Global Health . Addressing health disparities All projects should consider the social determinants of health and discuss their potential impact on the effective implementation of the intervention(s).

If there is a focus on a particular population (e.g. sex, race/ethnicity, Tribal Nation) then the reason for this should be justified. In order to promote health for all, studies can aim to address differences in intervention access, uptake, and effectiveness in socially disadvantaged groups and develop strategies for mitigating disparities.

To facilitate this process at the data analysis stage, studies can be designed to address such differences (e.g., capturing intersectional impacts on health outcomes). The proposed primary outcome measures should be implementation research outcomes to assess multimorbidity.

With regard to multimorbidity, applicants are encouraged to explore any combination of chronic diseases, which can include multimorbidity of NCDs and chronic infectious diseases. The specific combination of diseases should be justified using local or regional epidemiological data about their co-occurrence. Outcome measures should appropriately address implementation tackling multimorbidity, and not focus on one condition.

Applications may also contain a strategy for measuring other secondary outcomes (or proxy outcomes) that demonstrate the intervention’s real-world effectiveness in the local context and target populations. To improve data standardization, wherever feasible, applicants are encouraged to use measures developed by the GACD for monitoring patient-centered multimorbidity outcomes in LMICs.

Other health or non-health outcome measures, especially those identified as important by patient participants and/or critical for advancing health for all, are also welcome.

Collaborator and community engagement For implementation research to have a strong likelihood of being taken up into policy or practice and informing the scale-up of effective interventions, it is vital that project teams engage the appropriate interested, affected, or relevant parties and collaborators . These include decision makers such as policymakers, ministry officials, non-governmental organization leaders and community leaders.

It is important to include collaborators/partners who can help sustain the project’s implementation, facilitate scale up, and use the knowledge generated from the project after the award ends. Collaborators/partners also include patients, their family members, and caregivers. Their contributions should be nurtured through meaningful engagement from the outset, not only as participants in the research undertaken.

Patient engagement throughout the research project is critical to developing patient-centered models of care. Applicants should show evidence of appropriate collaborator/partner engagement and include letters of support from proposed partners where possible.

All partners should be engaged at every stage of the research project, from initial ideation of research questions, throughout the duration of the project, and afterward during the knowledge translation phase. Applicants should also provide a clear plan for continuing to engage with partners.

More information about collaborator and community engagement , including links to resources for planning such engagement, can be found on the GACD resources webpage .

Implementation research capacity building Implementation research is a relatively young discipline and the NIH and GACD are dedicated to increasing research capacity and capability in this field among researchers, health professionals, and public health leaders through skill building, knowledge sharing, and networking.

As such, a key element of this program is to provide opportunities within each funded project to build implementation research capacity especially, but not exclusively, in lower resourced environments, such as LMICs or AI/AN communities, and among early-career researchers from these communities.

Effective partnership and governance Considerations extend to the governance of project teams in order to ensure fair and equal collaboration, especially between HIC/LMIC and/or non-Tribal Nation and AI/AN members (both collaborations within the research teams and with community partners). NIH-aligned resources for planning effective research partnerships are available on the GACD call webpage .

As such, the GACD and NIH encourage effective governance arrangements within research teams, with input from partners and community representatives to drive contextually-informed, effective research and data ownership. Compliance with international standards and best practices It is expected that all research conducted under and funded by this initiative will comply with relevant internationally accepted standards and best practices.

These include: Standards for Reporting Implementation Studies ( StaRI ) Statement; International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use Guideline for Good Clinical Practice ( ICH-GCP ) and relevant NIH guidelines; Standards relevant to specific study designs including SPIRIT and CONSORT for clinical trials, and STROBE for observational studies; Ethics and other governance requirements as applicable in the countries where the research will be conducted; Registration of all clinical trials before recruitment of the first trial participant in clinicaltrials.

gov ; and Reasonable measures to ensure that sponsors, researchers, and institutions publish or otherwise disseminate the analysis of data and interpretation of research results (i.e., the findings) in a findable, accessible/interpretable, and timely manner without undue restriction.

Expected Impacts of this Initiative The projects funded in response to this NOFO will collectively: Contribute to the United Nations Sustainable Development Goal 3.

4 to reduce premature mortality from NCDs by one third by 2030 ; Decrease the fragmentation of care for patients living with multiple chronic conditions, and ensure continuity of care across all stages of disease progression; Expand the availability of effective, efficient, integrated, patient-centered , safe, and timely care for patients living with NCD multimorbidity ; Reduce health disparities; and Improve local capacity for implementation research , data collection and harmonization, and collaborator/community engagement for NCD multimorbidity management.

NIH IC-Specific Priorities Potential applicants are strongly encouraged to contact NIH IC program staff (listed below) early in the application process to discuss the alignment of their technical proposal with the goals of this NOFO, the NIH IC, and the GACD program.

NIH ICO-specific priorities include the following: Fogarty International Center (FIC) NOTE: While the Fogarty International Center manages this program on behalf of NIH, FIC does not accept applications for this funding opportunity. Applications may only be submitted to partner ICs for funding consideration.

National Cancer Institute (NCI) The National Cancer Institute leads, conducts, and supports research to improve cancer prevention, detection, diagnosis, treatment, and survivorship. Currently, cancer is a leading cause of premature death worldwide.

Approximately one-third of global cancer deaths are attributable to behavioral risk factors, such as tobacco and alcohol use, low fruit and vegetable intake, obesity, lack of physical activity as well as the socioeconomic inequalities that result in delayed diagnosis or care provision. Predictions suggest that, by 2030, 30 million people will die from cancer each year, of whom 75% will be in LMICs.

A key challenge to reducing the global burden of cancer in LMICs, and in other populations experiencing cancer health disparities, is the poor implementation of cancer prevention and control strategies that have been proven to work.

NCI encourages implementation research applications that pursue innovative approaches to adapt, integrate, scale-up and sustain these interventions, in accessible, affordable and effective ways, to promote cancer prevention, early diagnosis, treatment and survivorship in people living with multiple long-term conditions in low-resource contexts.

Investigators are encouraged to contact NCI Scientific/Research staff before submitting applications to discuss the match to NCI priorities.

National Eye Institute (NEI) National Heart, Lung, and Blood Institute (NHLBI) The National Heart, Lung, and Blood Institute encourages innovative implementation research that is within scope of NHLBI’s Strategic Vision , and aligns with in-country national heart, lung, blood, and sleep (HLBS)-related non-communicable disease programs and policies for national population impact.

NHLBI is interested in supporting interventions in integrated management of HLBS multimorbidities: implementation research focused on integrating interventions in clinical, community, and public health settings for optimizing management and care for patients coping with multiple conditions.

NHLBI is interested in interventions that demonstrate a commitment to patient-centered approaches that can improve integrated care for HLBS multimorbidity care. Multi-disciplinary and multi-sectoral partnerships among academics, policymakers, local authorities, for-profit institutions, non-profit organizations, and community groups from HICs, LMICs, and/or AI/AN Tribal Nations. are encouraged.

Applications are encouraged that: leverage one or more evidence-based interventions known to reduce NCD multimorbidity risk factor(s) linked to fragmented models of care for HLBS diseases.

Applications should clearly explain the choice of intervention(s) and provide evidence of the intervention’s effectiveness, feasibility, acceptability, environmental sustainability , and potential for long-term health and other impacts; address adaptability and fidelity of the intervention(s) for a selected study population(s) based on HLBS multimorbidities, taking into account the unique social, political, economic, and cultural context(s); provide a research plan for investigating innovative implementation strategies [e.g. how to promote the uptake, scale-up and spread of these intervention(s) in the selected study population(s)] using validated implementation research frameworks; address issues of effective implementation to ensure interventions reach the populations that need them the most; have an appropriate strategy for measuring implementation research and effectiveness outcomes; demonstrate a commitment to partner and community engagement; provide opportunities for implementation research capacity building within project teams; demonstrate effective partnerships and shared leadership between HIC-LMIC members of the project team, and between the project team and external partners; conduct implementation research on how best to increase the uptake of multisectoral interventions for HLBS multimorbidities that cut across health, environmental, social, employment, housing, and/or other sectors; and explore how to best implement interventions harnessing digital technology adaptations (e.g., Artificial Intelligence, Big Data, telemedicine).

The R01 Clinical Trials Optional mechanism allows for more traditional funding approaches to mechanistic and non-clinical trials research for HLBS disease prevention and control at regional and/or national levels within LMICs and AI/AN Tribal Nations.

For clinical trials research, NHLBI will utilize the companion funding opportunity: PAR-25-223 Implementation Research for Multi-morbidity Management in the Context of Non-communicable Diseases in Low- and Middle-Income Countries and US Tribal Populations (R61/R33 Clinical Trial Required).

National Institute on Aging (NIA) The National Institute on Aging mission is to support and conduct genetic, biological, clinical, behavioral, social, and economic research on aging; foster the development of research and clinician scientists in aging; provide research resources to facilitate innovative aging research; and disseminate information about aging and advances in research to the public, health care professionals, and the scientific community, among a variety of audiences.

NIA’s interest in this program is to support research to identify and understand barriers to the adoption, integration, scale-up, and sustainability of health interventions related to evidence-based practices to encourage healthy lifestyle behaviors related to life course aging and health, including Alzheimer’s Disease and Alzheimer’s Disease Related Dementias (AD/ADRD), in LMICs and AI/AN Tribal Nation population in the United States.

The NIA Health Disparities Research Framework provides insights about NIA priority populations, multilevel factors for analysis, and that integrates the life course theory.

Applicants are strongly encouraged to use the NIA Health Disparities Research Framework to a) better delineate causal pathways for an intervention, b) broaden the scope of proposed adaptable intervention targets (by reviewing difference cells among the four key domains which provide examples of level of analysis a research team might consider (e.g., individual level, community level, structural level), and c) to potentially identify team members who possess relevant expertise to achieve the intervention’s proposed goals and objectives.

For clinical trial proposals, implementation strategies studied should be limited to the studies of strategies that have evidence of efficacy, as well as evidence that the intervention can be delivered in the community with fidelity.

NIA is especially interested in receiving applications that fall within Stage V of the NIH Stage Model for Behavioral Intervention Development that focus on the mechanisms that promote the successful implementation of interventions, consistent with the NIH Science of Behavior Change emphasis on mechanisms of change. Information about the NIH Stage Model and behavioral intervention development can be found at: https://www. nia.

nih. gov/research/dbsr/stage-model-behavioral-intervention-development . Information regarding NIH’s Science of Behavior Change (SOBC) program can be found at: https://commonfund.

nih. gov/behaviorchange NCD prevention in vulnerable aging and older adults across the life course: implementation research focused on interventions that address common age-related disease risk factors, reduce health risk and/or enhance positive health and lifestyle behaviors, and develop/test implementation strategies to support the uptake, integration, and scale up of these interventions.

Studies can also examine how and why these interventions work.

Studies that implement strategies to address environmental factors that contribute to multi-morbidity conditions (e.g., cardiovascular and metabolic disorders, diabetes, epilepsy, mental health disorders and musculoskeletal conditions) that advance aging and age-related neurological disorders (including Alzheimer’s Disease and Alzheimer’s Disease Related Dementias (AD/ADRD)); as well as studies that implement strategies to improved environments that mitigate multimorbidities to promote healthy aging or reduce risk of AD/ADRD.

Studies that test the effectiveness of implementation strategies of interventions to reduce health disparities related to multi-morbidity conditions (e.g., cardiovascular and metabolic disorders, diabetes, epilepsy, mental health disorders and musculoskeletal conditions) and aging and age-related neurological disorders (including AD/ADRD) among vulnerable populations (e.g., indigenous populations, rural-dwelling older adults) in LMICs.

Studies to design, develop, and test informed strategies to improve uptake and integration of evidence-based interventions that mitigate risk for multi-morbid conditions associated with advanced aging and age-related neurological disorders (including AD/ADRD).

Implementation studies that explore strategies to support the integration of technology, tools, or techniques into epidemiologic or population-based research for data collection and analysis. Integrated management of multi-morbidity: implementation research focused on integrating interventions in clinical settings for optimizing assessment and management and care for patients coping with multiple age-related diseases and/or conditions.