MENTAL HEALTH AND HIV/STD PREVENTION IN RURAL SETTINGS

NIH Guide, Volume 26, Number 38, November 21, 1997

RFA:  MH-98-004

P.T.

National Institute of Mental Health

Letter of Intent Receipt Date:  December 22, 1997
Application Receipt Date:  January 21, 1998

PURPOSE

The National Institute of Mental Health (NIMH) is requesting research
applications to increase the knowledge base on the HIV and STD risk factors of
persons living in rural areas and test viable HIV/STD prevention programs in
rural/tribal settings.  The term "rural" refers to non-urban settings with
populations of approximately 50,000 or less.  This Request for Applications (RFA)
solicits applications to conduct pre-intervention, preventive intervention, or
health services research appropriate for rural areas.

HEALTHY PEOPLE 2000

The Public Health Service (PHS) is committed to achieving the health promotion
and disease prevention objectives of "Healthy People 2000," a PHS-led national
activity for setting priority areas.  This RFA, Mental Health and HIV/STD
Prevention in Rural Settings, is related to the priority areas of mental health
and mental disorders and HIV infection. Potential applicants may obtain a copy
of "Healthy People 2000" (Full Report: Stock No. 017-001-00474-0 or Summary
Report: Stock No. 017-001-00473-1) through the Superintendent of Documents,
Government Printing Office, Washington, DC 20402-9325 (telephone 202-512-1800).

ELIGIBILITY REQUIREMENTS

Applications may be submitted by domestic and foreign, for- profit and non-profit
organizations, public and private, such as universities, colleges, hospitals,
laboratories, units of State and local governments, and eligible agencies of the
Federal government.  Foreign institutions are not eligible for First Independent
Research Support and Transition (FIRST)(R29) awards or Small Grant (R03) awards.
Racial/ethnic minority individuals, women, and persons with disabilities are
encouraged to apply as Principal Investigators.

MECHANISM OF SUPPORT

This RFA will use the National Institutes of Health (NIH) research project grant
(R01), the FIRST (R29) award, and the Small Grant (R03) award.  Responsibility
for the planning, direction, and execution of the proposed project will be solely
that of the applicant.  The total project period for an application submitted in
response to this RFA may not exceed five years.  The anticipated award date is
July, 1998.

Because the nature and scope of the research proposed in response to this RFA may
vary, it is anticipated that the size of an award will vary also.

This RFA is a one-time solicitation.  Future unsolicited competing continuation
applications will compete with all investigator-initiated applications and be
reviewed according to the customary peer review procedures.

Because the small grants and FIRST awards have special eligibility requirements,
application formats, and review criteria, applicants are strongly encouraged to
consult with program staff (listed under Inquiries) and to obtain the appropriate
additional announcements for those grant mechanisms.

FUNDS AVAILABLE

In fiscal year 1998, a minimum of $750,000 has been set aside for this RFA for
a minimum of two to three awards. Support may be requested for a period of up to
five years, except for the R03 mechanism which is limited to 2 years.
Noncompeting continuation awards will be made subject to availability of funds
and progress achieved.

RESEARCH OBJECTIVES

Background

The urgency of the AIDS crisis demands that priority be given to research
addressing preventive interventions that reduce the incidence of HIV/STD
infection and minimize its negative consequences. The rapidly rising epidemic in
rural America, that is, in cities of approximately 50,000 or fewer people has
largely been ignored.  However, between 1991 and 1995, in the rural South for
example, HIV infection in African American women increased by 170 fold and in
White women by 23 fold.  Migrant and itinerant farm workers are other groups in
which seroprevalence is disproportionately increasing.  Yet little HIV-related
information is available about the men and women who live in rural America and
account for 25 percent of the population, and approximately 33 percent of persons
who live in poverty.  This increased risk for HIV is against a background of
increasing stress for persons living in rural America resulting from fewer
economic options due to farm foreclosures and failing businesses.

Areas of Interest

Proposed research should be field-based and practical, and should provide the
potential to directly impact HIV/STD prevention programs in rural settings.  The
following sections suggest areas of research to meet the health promotion and
disease prevention objectives outlined above. Researchers need not limit
themselves to these topics.

A. Pre-Intervention Studies of HIV/STD in Rural Populations

In order to design and test effective prevention programs, it is necessary to
understand the diverse nature of HIV/STD transmission within at-risk groups in
rural settings:

o Prevalence of HIV risk behaviors within at-risk populations living in rural
settings, including African- Americans Latinos, rural reservation-based Native
Americans, migrant workers, women, and teenagers;

o Description of rural social network configurations and identification of points
and sites for intervention, which may include church congregations, school
groups, the Cooperative Extension Service, tribal, and civic groups;

o Documentation of migration patterns of seropositive and at-risk rural and
transient populations and their effects on the spread of HIV;

o Study of knowledge, attitudes and behaviors (KABs) associated with the risk of
contracting and spreading HIV and STDs;

o Evaluation of perceptions of risk of HIV/STDs and its association with high
risk behaviors;

o Investigation into the barriers/opportunities for discussing issues related to
sexual activity;

o Analysis of the impediments to the utilization of HIV/STD testing and
counseling;

o Examination of the role of self-disclosure and confidentiality in high risk
behaviors and health seeking behaviors;

o Exploration of the negative mental health consequences of HIV infection in the
context of the stress of rural or tribal living;

o Study of the impact of lack of support networks in the spread of HIV/STD
infection;

o Identification of strategies to implement an HIV/STD prevention program given
the social, cultural, and economic diversity of rural populations.

B. Intervention Studies

In designing or adapting HIV/STD interventions aimed at decreasing the spread of
HIV/STD infection and minimizing mental and physical health outcomes of HIV/STD
infection, investigations are needed to:

o Test the effectiveness of outcome-based rural HIV/STD preventive intervention
programs in the context of specific or diverse rural community characteristics;

o Test strategies to enlist the support of community leaders in AIDS prevention
and overcoming stigma;

o Develop and test innovative community-wide interventions suitable for rural
settings, and in the case of Indian Reservations sensitive to traditional Native
American concepts of healing;

o Develop and test effective media campaigns and ads.

C. Mental and Physical Health Services Delivery

In underserved rural areas, health and mental health patients face immense
challenges in securing critical services in a confidential manner.  Indeed, in
some settings even services as basic as clean running water, mail service, and
ambulance and fire department services are lacking.  In order to address HIV/STD-
related service delivery in rural settings, research efforts are needed to study
the:

o Availability and access to a range of services, service providers, and related
local resources, and the effect of insufficient or lack of insurance coverage in
precipitating inadequate health or mental health care;

o Problems associated with large geographic distances between the patient's home
and provider/service agencies, and effective ways to address such problems;

o Experience of rural health and mental health care providers and tribal
practitioners with HIV/AIDS patients;

o Applicability of effective HIV/STD preventive intervention techniques developed
in urban settings to rural settings.

D. Methodological issues

Methodological development may be necessary to collect meaningful data on
populations living in rural settings and to analyze data collected from multiple
sources.

o Recruitment and retention strategies in rural populations that may be
geographically scattered, particularly in sparsely populated states and on tribal
reservations, and are sensitive to issues of confidentiality;

o Measurement and evaluation strategies tailored to risk assessment and
interventions in rural settings, e.g., methods for analyzing small samples, and
appraisal of interviewer/client rapport;

o Issues in generalizing findings from one rural setting to another or to
International Third World settings given population diversities;

o Development and testing of theories and models appropriate to HIV/STD
prevention research with rural at-risk populations.

INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN SUBJECTS

It is the policy of the NIH that women and members of minority groups and their
subpopulations must be included in all NIH supported biomedical and behavioral
research projects involving human subjects, unless a clear and compelling
rationale and justification is provided that inclusion is inappropriate with
respect to the health of the subjects or the purpose of the research.  This new
policy results from the NIH Revitalization Act of 1993 (Section 492B of Public
Law 103-43).

All investigators proposing research involving human subjects should read the
"NIH Guidelines For Inclusion of Women and Minorities as Subjects in Clinical
Research," which have been published in the Federal Register of March 28, 1994
(FR 59 14508-14513) and in the NIH Guide for Grants and Contracts, Volume 23,
Number 11, March 18, 1994.

Investigators also may obtain copies of the policy from the program staff listed
under INQUIRIES.  Program staff may also provide additional relevant information
concerning the policy.

LETTER OF INTENT

Prospective applicants are asked to submit, by December 22, 1997,  a letter of
intent that includes a descriptive title of the proposed research, the name,
address, and telephone number of the Principal Investigator, the identities of
other key personnel and participating institutions, and the number and title of
the RFA in response to which the application may be submitted.  Although a letter
of intent is not required, is not binding, and does not enter into the review of
a subsequent application, the information that it contains allows NIMH staff to
estimate the potential review workload and avoid conflict of interest in the
review.

The letter of intent is to be sent to:

Willo Pequegnat, Ph.D.
Office on AIDS
National Institute of Mental Health
5600 Fishers Lane, Room 18-101
Rockville, MD 20857
Telephone:  (301) 443-6100
FAX:  (301) 443-9719
Email:  WPEQUEGN@NIH.GOV

APPLICATION PROCEDURES

The research grant application form PHS 398 (rev. 5/95) is to be used in applying
for these grants.  These forms are available at most institutional offices of
sponsored research or from the Office of Extramural Outreach and Information
Resources, National Institutes of Health, 6701 Rockledge Drive, MSC 7910,
Bethesda, MD 20892-7910; telephone (301) 435-0714; fax (301) 480-0525; Email:
ASKNIH@OD.NIH.GOV.

The RFA label available in the PHS 398 (rev. 5/95) application form must be
affixed to the bottom of the face page of the application.  Failure to use this
label could result in delayed processing of the application such that it may not
reach the review committee in time for review.  In addition, the RFA title and
number,(Mental Health and HIV/STD Prevention in Rural Settings) (MH-98-004), must
be typed in section 2 of the face page of the application form and the YES box
must be marked.

Submit a signed, typewritten original of the application, including the
Checklist, and three signed, photocopies, in one package to:

CENTER FOR SCIENTIFIC REVIEW (formerly Division of Research Grants)
NATIONAL INSTITUTES OF HEALTH
6701 ROCKLEDGE DRIVE, ROOM 1040 - MSC 7710
BETHESDA, MD  20892-7710
BETHESDA, MD  20817 (for courier/overnight mail service)

At the time of submission, two additional copies of the application must be sent
to:

Willo Pequegnat, Ph.D.
Office on AIDS
National Institute of Mental Health
5600 Fishers Lane, Room 18-101
Rockville, MD  20857

Applications must be received by January 21, 1998.  If an application is received
after that date, it will be returned to the applicant without review and can
later be submitted under the regular AIDS receipt dates.  The Center for
Scientific Review (CSR) will not accept any application in response to this RFA
that is essentially the same as one currently pending initial review, unless the
applicant withdraws the pending application.  The CSR will not accept any
application that is essentially the same as one already reviewed.  This does not
preclude the submission of substantial revisions of applications already
reviewed, but such applications must include an introduction addressing the
previous critique.

REVIEW CONSIDERATIONS

Upon receipt, applications will be reviewed for completeness by the NIH Center
for Scientific Review (CSR)and for responsiveness by NIMH staff.  Incomplete
and/or non- responsive applications will be returned to the applicant without
further consideration.  Applications that are complete and responsive to the
Request for Applications will be evaluated for scientific and technical merit by
an appropriate peer review group convened in accordance with the review criteria
stated below.  As part of the initial merit review, all applications will receive
a written critique and undergo a process in which only those applications deemed
to have the highest scientific merit will be discussed, assigned a priority
score, and receive a second level review by the appropriate national advisory
council or board, when applicable.

Review Criteria

The goals of NIH-supported research are to advance our understanding of
biological systems, improve the control of disease, and enhance health.  In their
written comments reviewers will be asked to discuss the following aspects of the
application in order to judge the likelihood that the proposed research will have
a substantial impact on the pursuit of these goals.  Each of these criteria will
be addressed and considered in assigning the overall score, weighting them as
appropriate for each application.

o Significance: Does this study address an important problem?  If the aims of the
application are achieved, how will scientific knowledge be advanced?  What will
be the effect of these studies on the concepts or methods that drive the study
of AIDS/STD prevention in rural settings?

o Approach: Are the conceptual framework, design, methods, and analyses
adequately developed, well-integrated, and appropriate to the target populations
and aims of the project?  Does the applicant acknowledge potential problem areas
and consider alternative tactics?  Does the conceptual and theoretical framework
for the research include cultural relevance to the target population and evidence
of familiarity with research literature?

o Innovation: Does the project employ novel concepts, approaches or methods?  Are
the aims original and innovative?  Does the project challenge existing paradigms
or develop new methodologies or technologies?

o Investigator: Is the investigator appropriately trained and well suited to
carry out this work?  Is the work proposed appropriate to the experience level
of the principal investigator and other researchers (if any)?  Do the
qualifications and experience of the principal investigator and staff reflect
expertise in rural communities, prevention research, statistics, cultural
competence, AIDS, STDs, and other areas specific to the questions under
investigation?  Does the investigator have access to target population(s) and a
history of working with similar populations?

o Environment: Does the scientific environment in which the work will be done
contribute to the probability of success? Do the proposed experiments take
advantage of unique features of the scientific environment or employ useful
collaborative arrangements?  Is there evidence of institutional support?

In addition to the above criteria, in accordance with NIH policy, all
applications will also be reviewed with respect to the following:

o The adequacy of plans to include both genders, minorities, and their subgroups
as appropriate for the scientific goals of the research.  Plans for the
recruitment and retention of subjects will also be evaluated.

o The reasonableness of the proposed budget and duration in relation to the
proposed research.

o The adequacy of the proposed protection for humans, animals or the environment,
to the extent they may be adversely affected by the project proposed in the
application.

AWARD CRITERIA

The following criteria will be used in making funding decision:

o scientific merit as determined during the peer review process and availability
of funds:

o balance among target populations with priority given to understudied
populations;

o balance among theoretical and multicultural approaches; and

o balance among geographic areas.

INQUIRIES

Inquiries concerning this RFA are encouraged.  The opportunity to clarify any
issues or questions from potential applicants is welcome.

Direct inquiries regarding programmatic issues to:

Willo Pequegnat, Ph.D.
Office on AIDS
National Institute of Mental Health
Parklawn Building, Room 18-101
Rockville, MD  20857
Telephone:  (301) 443-6100
FAX:  (301) 443-9719
Email:  WPEQUEGN@NIH.GOV

Direct inquiries regarding fiscal matters to:

Diana S. Trunnell
Grants Management Branch
National Institute of Mental Health
Parklawn Building, Room 7C-08
Rockville, MD  20857
Telephone:  (301) 443-2805
FAX:  (301) 443-6885
Email:  Diana_Trunnell@nih.gov

AUTHORITY AND REGULATIONS

This program is described in the Catalog of Federal Domestic Assistance
No.93.242.  Awards are made under authorization of the Public Health Service Act,
Title IV, Part A (Public Law 78-410, as amended by Public Law 99-158, 42 USC 241
and 285) and administered under PHS grants policies and Federal Regulations 42
CFR 52 and 45 CFR Part 74.  This program is not subject to the intergovernmental
review requirements of Executive Order 12372 or Health Systems Agency review.
Awards will be administered under PHS grants policy as stated in the Public
Health Service Grants Policy Statement (April 1, 1994).

PHS strongly encourages all grant and contract recipients to provide a smoke-free
workplace and promote the nonuse of all tobacco products.  In addition, Public
Law 103-227, the Pro-Children Act of 1994, prohibits smoking in certain
facilities (or in some cases, any portion of a facility) in which regular or
routine education, library, day care, health care or early childhood development
services are provided to children.  This is consistent with the PHS mission to
protect and advance the physical and mental health of the American people.


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