Strengthening the HIV Pre-Exposure Prophylaxis (PrEP) Care Continuum through Behavioral, Social, and Implementation Science (R21 Clinical Trial Optional) | PA 18 271

Opportunity Information: Apply for PA 18 271

The grant opportunity "Strengthening the HIV Pre-Exposure Prophylaxis (PrEP) Care Continuum through Behavioral, Social, and Implementation Science (R21 Clinical Trial Optional)" (Funding Opportunity Number PA-18-271) is a National Institutes of Health (NIH) discretionary grant aimed at improving how PrEP is delivered, started, and sustained in real-world settings. It uses the NIH R21 mechanism, which is generally intended for early-stage, exploratory, or developmental research that can generate actionable evidence, pilot data, or proof-of-concept findings. The focus is not simply on biomedical efficacy, but on the behavioral, social, and practical implementation factors that determine whether people who could benefit from PrEP actually access it, use it consistently, and remain engaged in care over time.

A central theme of the FOA is the "PrEP care continuum," meaning the sequence of steps and systems that move a person from awareness and interest, to access and initiation, to adherence and persistence, and then to ongoing monitoring and support. The announcement encourages projects that first identify where the continuum is breaking down (the gaps) and why those breakdowns occur (the determinants). These determinants can include individual-level issues like stigma, risk perception, side-effect concerns, mental health, substance use, medical mistrust, or competing life priorities, as well as interpersonal and structural barriers such as discrimination, transportation, housing instability, lack of culturally competent care, insurance and cost barriers, clinic workflow problems, limited provider knowledge, and policy constraints. In other words, applicants are being pushed to examine both what is happening and what is driving it, rather than treating low uptake or poor persistence as purely personal choice.

In addition to diagnosing problems, the FOA explicitly supports developing and testing interventions that strengthen PrEP delivery, use, and outcomes. "Interventions" here can be broad and can include patient-facing strategies (for example, navigation, counseling, digital reminders, peer support, stigma reduction approaches, or adherence support) as well as clinic- and system-level approaches (for example, provider training, decision support tools, telehealth workflows, same-day PrEP start models, pharmacy-based PrEP support, streamlined laboratory monitoring, or integrated sexual health services). Because this is framed as behavioral, social, and implementation science, competitive projects would typically emphasize feasibility, acceptability, uptake, equity, sustainability, and real-world fit, rather than only measuring traditional clinical endpoints. The FOA also notes that clinical trials are optional, meaning applicants can propose studies that include intervention testing in a clinical-trial-like format, but they can also propose non-trial study designs if those better answer the implementation or behavioral questions.

A major priority of this opportunity is reducing disparities in PrEP uptake and use, specifically racial/ethnic disparities and age-related disparities. This reflects the reality that groups with substantial HIV prevention needs have not benefited equally from PrEP due to inequities in access, information, trust, and health system responsiveness. Projects responsive to the FOA would typically be expected to take disparities seriously at the design level, such as by selecting populations and settings where inequities are pronounced, using culturally grounded approaches, addressing structural barriers, and measuring equity-relevant outcomes (for example, whether an intervention narrows gaps in initiation, retention, or adherence between groups). Age-related disparities can include challenges faced by adolescents and young adults, such as confidentiality concerns, consent laws, limited youth-friendly services, and heightened stigma, as well as different barriers faced by older adults, such as provider assumptions about sexual activity, comorbidities, or different patterns of healthcare engagement.

From an administrative standpoint, this is a grant (FundingInstrumentType: Grant) in the health category (FundingActivityCategory: Health) under CFDA number 93.242, and it is issued by the NIH. The listed award ceiling is $200,000, which signals that the FOA is supporting relatively contained, focused projects consistent with the exploratory R21 scope. The original closing date in the provided source data is January 7, 2020, and the creation date is November 29, 2017, which is useful for understanding the vintage of the announcement and confirming whether it is still active or has been reissued in updated form.

Eligibility is broad and includes a wide range of public and private entities, which is consistent with NIH policy for many research announcements. Eligible applicants include state, county, and local governments; special district governments; independent school districts; public housing authorities/Indian housing authorities; public and state-controlled institutions of higher education; private institutions of higher education; federally recognized Native American tribal governments; Native American tribal organizations that are not federally recognized tribal governments; nonprofits with and without 501(c)(3) status; for-profit organizations (other than small businesses); small businesses; and other organizations. The FOA also highlights additional eligible applicant types that NIH is explicitly welcoming, including Alaska Native and Native Hawaiian Serving Institutions, Asian American Native American Pacific Islander Serving Institutions (AANAPISIs), Hispanic-serving Institutions, Historically Black Colleges and Universities (HBCUs), Tribally Controlled Colleges and Universities (TCCUs), faith-based and community-based organizations, eligible federal agencies, U.S. territories or possessions, and non-U.S. (foreign) entities and regional organizations. That emphasis signals an interest in supporting work rooted in communities and institutions that often serve populations most affected by HIV disparities, and in enabling research that can be conducted in diverse geographic and cultural contexts.

Taken together, this FOA is essentially a call for practical, equity-centered research that can improve the real-world functioning of PrEP programs. It invites applicants to map where people are being lost along the PrEP continuum, explain the behavioral and structural reasons behind those losses, and then build and test interventions that make PrEP easier to access, easier to start, easier to continue, and more equitable across race/ethnicity and age groups.

• The National Institutes of Health in the health sector is offering a public funding opportunity titled "Strengthening the HIV Pre-Exposure Prophylaxis (PrEP) Care Continuum through Behavioral, Social, and Implementation Science (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.
• 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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