Implementation Research on Noncommunicable Disease Risk Factors among Low- and Middle-Income Country and Tribal Populations Living in City Environments (R01 Clinical Trial Optional) | PAR 23 042

Opportunity Information: Apply for PAR 23 042

The NIH Funding Opportunity Announcement PAR 23-042, developed in collaboration with the Global Alliance for Chronic Diseases (GACD), supports R01 grant applications that focus on implementation research aimed at reducing risk factors for common noncommunicable diseases (NCDs). The emphasis is not on inventing entirely new clinical interventions, but on figuring out how to get proven, evidence-based interventions, tools, policies, and guidelines adopted and used effectively in real-world settings. The opportunity is centered on disadvantaged populations living in city environments, specifically (1) people in World Bank-defined low- and middle-income countries (LMICs) and/or (2) American Indian and Alaska Native (AI/AN) Tribal Nation populations living in cities within the United States. For this program, "cities" is meant broadly and includes formal urban centers as well as informal settlements, slums, and periurban areas, reflecting the reality that health systems, infrastructure, and living conditions vary widely across urban settings.

The core goal is to generate practical, decision-ready evidence that helps policymakers, public health leaders, health systems, and community organizations prevent and manage NCDs by addressing their underlying risk factors. The FOA calls for studies that identify and overcome barriers that commonly block progress in urban environments, such as limited access to primary care, fragmented services, affordability issues, supply chain problems, workforce constraints, cultural and linguistic mismatches, stigma, competing policy priorities, and weak governance or data systems. Projects are expected to look closely at how interventions can be adopted, adapted to local context, integrated into existing services, scaled up beyond a pilot site, and sustained after the study period, which are often the hardest parts of moving from "what works" in theory to "what works" at population level.

A major theme is rigorous dissemination and implementation (D and I) research. Applicants are encouraged to test strategies that improve uptake and long-term use of evidence-based approaches, and to strengthen D and I methods and measurement in the process. That can include studying which implementation strategies are most effective (for example, task-sharing, training models, audit and feedback, decision support tools, community health worker integration, policy enforcement approaches, or financing and incentive models), how to measure implementation outcomes (like reach, fidelity, acceptability, feasibility, equity, cost, penetration, and sustainability), and how context influences success or failure. The focus on methods and measures signals that NIH is looking for projects that are not only locally useful but also generalizable enough to inform future implementation efforts in other urban settings facing similar constraints.

The announcement is structured as an R01 mechanism with "Clinical Trial Optional," meaning projects may include a clinical trial component but do not have to. This flexibility fits implementation research, where study designs can range from pragmatic trials and cluster randomized studies to stepped-wedge designs, mixed-methods evaluations, and quasi-experimental approaches, depending on what is most realistic and informative in the target setting. Regardless of design, the expectation is that applicants will produce actionable evidence on how to reduce NCD risk in city contexts, especially among populations that experience disproportionate health burdens and fewer resources.

Eligibility is broad and includes many organization types that are positioned to do community- and system-focused work. Eligible applicants listed include state, county, and city or township governments; 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; tribal organizations other than federally recognized tribal governments; public housing authorities and Indian housing authorities; nonprofits with or without 501(c)(3) status; for-profit organizations (other than small businesses); small businesses; and other entities. The FOA also explicitly highlights additional eligible applicants such as 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 or community-based organizations, regional organizations, non-U.S. entities (foreign organizations), and U.S. territories or possessions. This range reflects the reality that implementation research in cities often requires partnerships across universities, health systems, public agencies, and trusted community organizations, including organizations rooted in Tribal and underserved communities.

In short, PAR 23-042 funds implementation research that tackles the "last mile" problems of NCD prevention and control in urban environments: how to make proven approaches workable, scalable, and durable in LMIC cities and among AI/AN Tribal Nation populations living in U.S. cities. The intended payoff is evidence that can guide real-world policy and practice, improving prevention and management of NCDs by reducing exposure to key risk factors and strengthening the systems responsible for delivering effective interventions where they are needed most.

• The National Institutes of Health in the education, environment, health sector is offering a public funding opportunity titled "Implementation Research on Noncommunicable Disease Risk Factors among Low- and Middle-Income Country and Tribal Populations Living in City Environments (R01 Clinical Trial Optional)" and is now available to receive applicants.
• Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.113, 93.233, 93.242, 93.279, 93.307, 93.393, 93.837, 93.838, 93.839, 93.840, 93.853, 93.866, 93.989.
• This funding opportunity was created on 2022-12-07.
• Applicants must submit their applications by 2023-03-09. (Agency may still review applications by suitable applicants for the remaining/unused allocated funding in 2026.)
• 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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