HIV-associated Non-Communicable Diseases Research at Low- and Middle-Income Country Institutions (R21 Clinical Trial Optional) | PAR 23 191

Opportunity Information: Apply for PAR 23 191

The NIH funding opportunity PAR 23 191, titled "HIV-associated Non-Communicable Diseases Research at Low- and Middle-Income Country Institutions (R21 Clinical Trial Optional)," is a discretionary grant program designed to spark and support exploratory, locally relevant research on the growing burden of non-communicable diseases (NCDs) among people living with HIV (PLWH) in low- and middle-income countries (LMICs). Using the R21 mechanism, the program is geared toward early-stage, hypothesis-generating, and feasibility-focused studies that can open new directions for larger future projects. A key emphasis is that the research should be grounded in real LMIC clinical and public health needs, not simply imported questions from high-income settings, and it should help expand the ability of LMIC institutions to lead and sustain research in this area.

The central scientific focus is the interplay between HIV and NCDs. The opportunity encourages applicants to examine how HIV infection, HIV-related immune activation or inflammation, long-term antiretroviral therapy exposure, co-infections, and social or structural factors may influence the development, progression, and outcomes of NCDs. The announcement specifically highlights exploratory work to clarify etiopathogenesis (the mechanisms and pathways that lead to disease) and to identify practical approaches for better diagnosis, prevention, treatment, and integrated clinical care for PLWH who also have NCD comorbidities. In practical terms, that can include studies that test whether screening tools work well in HIV care settings, whether integrated service delivery models are feasible, or whether certain interventions show enough promise to justify larger trials later. Clinical trials are optional under this announcement, meaning applicants may propose clinical trial components if appropriate, but they are not required.

Another major goal is capacity building and network development in LMICs. Applicants are expected to address the needs of the collaborating LMIC institutions for developing the ability to conduct this type of research, which can include strengthening research infrastructure, data systems, regulatory and ethics capacity, workforce development, mentorship structures, or sustainable collaborations. Beyond a single project, the program aims to build a broader community of researchers working within and across LMICs so that knowledge, methods, and implementation lessons can be shared and scaled.

Team composition and collaboration are treated as essential to the program's intent. The NIH is looking for research teams that bring together the right mix of expertise to answer the proposed questions, including strong partnerships between HIV researchers and NCD researchers. The idea is to encourage cross-disciplinary work where investigators jointly develop new ideas and assess novel approaches to reduce long-term illness and disability from combined HIV and NCD burdens. The opportunity explicitly allows collaborative projects involving U.S. and LMIC investigators, but with an important requirement: a U.S. investigator must apply together with an LMIC investigator, and the work must be conducted at LMIC sites. LMIC eligibility is based on the World Bank country income classifications (low-income, lower-middle-income, and upper-middle-income) using gross national income per capita.

Projects are also expected to align with the NIH HIV/AIDS Research Priorities, as outlined in the NIH and Office of AIDS Research (OAR) priority documents linked in the notice. This means applicants should be able to clearly explain how the proposed NCD work fits within broader HIV research priorities, such as improving long-term health outcomes for PLWH, optimizing care delivery, reducing comorbidities, and addressing health disparities and implementation barriers in real-world settings.

From an eligibility standpoint, the program is broadly open to a wide range of organizations, reflecting NIH's intent to draw on diverse institutional strengths and reach. Eligible applicants listed include various levels of government (state, county, city/township, special districts), public and private institutions of higher education, independent school districts, federally recognized and other tribal governments and organizations, public housing authorities/Indian housing authorities, nonprofits (with and without 501(c)(3) status), for-profit organizations (other than small businesses), small businesses, and other entities. The notice also calls out additional eligible groups and institution types such as Alaska Native and Native Hawaiian Serving Institutions, AANAPISISs, Hispanic-serving Institutions, HBCUs, Tribally Controlled Colleges and Universities, faith-based and community-based organizations, U.S. territories or possessions, regional organizations, eligible federal agencies, and non-U.S. entities (foreign organizations). This wide eligibility is meant to support strong local leadership and broaden participation, particularly for institutions serving historically underrepresented or underserved communities.

Key administrative details include that the sponsoring agency is the National Institutes of Health, the funding instrument is a grant, and the activity category is listed under health (with broader categories noted in the source data). The opportunity has an award ceiling of $275,000. The original closing date provided is 2025-12-08. The opportunity was created on 2023-05-10. The CFDA (Assistance Listing) numbers associated with the opportunity include 93.121, 93.242, 93.279, 93.393, 93.394, 93.396, 93.399, 93.847, and 93.989, reflecting that multiple NIH institutes and programs may be involved in supporting or administering aspects of the research priorities covered by the announcement.

Overall, this grant opportunity is aimed at jump-starting well-justified, LMIC-centered exploratory studies that clarify how HIV and NCDs intersect biologically and clinically, while also strengthening LMIC research leadership, infrastructure, and cross-country collaboration. The expected outcome is a pipeline of new evidence, feasible interventions or care models, and stronger research networks that can ultimately improve integrated care and long-term health for PLWH living with NCD comorbidities in LMIC settings.

• 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): 93.121, 93.242, 93.279, 93.393, 93.394, 93.396, 93.399, 93.847, 93.989.
• This funding opportunity was created on 2023-05-10.
• Applicants must submit their applications by 2025-12-08. (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 $275,000.00 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.

Apply for PAR 23 191

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