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Part 1. Overview Information

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Purpose

The purpose of this notice of funding opportunity (NOFO) is to support planning and development, including pilot or feasibility research, in advance of a clinical trial testing interventions to improve health in Native American populations. Proposed research may address health promotion, disease prevention, treatment, recovery, or services research to inform intervention implementation and dissemination. Although the scientific literature or preliminary data may provide the rationale for conducting a clinical trial, investigators often lack critical information about the study population, recruitment challenges, intervention feasibility and acceptability, outcome measures, data and statistical challenges or operational risks necessary to finalize the trial protocol completely. Native American populations experience unique sociopolitical, historical, and environmental stressors and risks that may exacerbate health conditions and/or impact the effectiveness of existing solutions to address the conditions. They also possess unique strengths and resiliencies that can mitigate stressors and inform intervention strategies. Research with Native American populations requires engagement with tribal partners and communities to develop or adapt interventions and evaluate them with clinical trial protocols that are rigorous and culturally appropriate. Preparatory studies may fill information gaps, address unknowns, allow for strengthening of tribal partnerships, and pilot test the feasibility of the intervention and clinical trial design, thereby improving scientific rigor and cultural appropriateness of the future clinical trial. The inclusion of Native American investigators serving on the study team or as the PD(s)/PI(s) is strongly encouraged.

For the purposes of this NOFO, Native Americans include the following populations: Alaska Natives (AN), American Indians (AI); whose ancestral lands fall at least partially within the U.S. mainland border), and Native Hawaiians. The term Native Hawaiian means any individual any of whose ancestors were natives, prior to 1778, of the area which now comprises the State of Hawaii.

Background

Despite tremendous strengths, Native Americans have highly disparate rates of disease across many health outcomes such as chronic disease, substance use and addiction, cancer, mental illness, and sexually transmitted diseases. These disease outcomes in many cases can be traced to socio-structural factors and social and environmental determinants of health such as poverty, unemployment, pollution, and poor access to health care in combination with unique factors impacting Native people, such as historical trauma. In the face of these structural challenges, resiliencies and strengths within Native communities and individuals have been drawn upon to improve health outcomes.

A critical step towards ensuring scalable and sustainable interventions to reduce the health disparities impacting Native American communities is the development of scientifically rigorous and culturally appropriate clinical trials to test intervention efficacy, effectiveness, and implementation. Active and meaningful engagement of tribal communities and tribal leadership is essential to successful intervention development, adaptation, testing, implementation, and dissemination and to accelerate the translation of findings generated by the proposed research into practice. To this end, this R34 NOFO supports planning studies to strengthen community and tribal partnerships, develop and adapt interventions, collect intervention feasibility and acceptability data, test recruitment and retention strategies, and/or address clinical trial study design questions. Studies under this R34 planning grant are intended to address issues that will prepare the future clinical trial protocol for successful implementation and completion and facilitate rigorous full-scale testing of promising interventions to improve Native American health. Applicants must include specific milestones and/or study targets that, if met, will indicate readiness to conduct the planned future intervention efficacy, effectiveness, or implementation trial.

This NOFO is part of the Intervention Research to Improve Native American Health (IRINAH) initiative (see: https://cancercontrol.cancer.gov/native-american-intervention). The initiative also includes PAR-23-298, which uses the R01 Research Project Grant mechanism and PAR-23-299, which uses the R21 Exploratory/Developmental Grant mechanism. PAR-23-298 and PAR-23-299 have broader scope than this NOFO. Not all NIH Institutes and Centers (ICs) participate in all three NOFOs. Please speak with the Scientific Contact for the IC listed in Section VII below for the IC you wish to target to discuss which NOFO might be the best fit for your proposed project.

Scope

The activities proposed will depend on the stage of intervention development, the delivery setting, and the type of future trial proposed (e.g., efficacy, effectiveness, or implementation). Pilot tests of feasibility and acceptability of the intervention and/or future trial protocol are within scope of this NOFO.

Research should be designed in such a way that there is a high probability that interventions delivered can be scaled and sustained if the future trial finds the intervention to be effective. To ensure sustainability of intervention designs and service delivery strategies tested, applicants should, whenever possible, partner with tribes/communities and localities that use existing programming funds (e.g., funding from CDC, SAMHSA, Indian Health Services, Medicaid, Medicare and other insurance providers, and other program funding as appropriate) to support evidence-based programs and leverage those resources as the foundation for building infrastructure.

Examples of appropriate research activities include the following, but this list is not intended to be exhaustive:

  • Activities to further develop and establish meaningful and trusted partnerships with Native communities.
  • Develop culturally grounded study designs in collaboration with Native American community partners to ensure acceptability and feasibility in Native communities, including developing and/or selecting an intervention, defining the appropriate study population, outcome, study endpoint, and control or comparison group to use in the subsequent efficacy, effectiveness, or implementation trial.
  • Determine the acceptability and feasibility of the intervention for study participants, Native American communities, and tribal partners, including standardization across sites and measures of intervention fidelity when appropriate.
  • Adapt, standardize, and/or validate an intervention or assessment originally designed for non-Native populations for Native populations.
  • Develop a novel intervention grounded in Indigenous Knowledge (see: https://www.whitehouse.gov/ostp/ostps-teams/climate-and-environment/indigenous-knowledge/), empirical and/or theoretical evidence, and/or adapt or standardize an intervention currently used in Native American communities to plan for a future efficacy or effectiveness trial.
  • Develop inclusive and culturally appropriate recruitment and retention strategies that engage Native communities.
  • Develop culturally informed study protocols, data and safety monitoring plans, analytical plans, and data management and sharing plans.
  • Standardize and test the effectiveness of training tools for implementation of the intervention or clinical trial protocol.
  • Employ qualitative methods, including talking circles, interviews, or focus groups as needed to address study aims and the development, testing and validation of quantitative survey tools. Qualitative or mixed methods research may also be helpful to assess community or tribal approval and commitment and to contextualize quantitative research findings as appropriate.
  • Planning activities to assess the potential feasibility and acceptability of implementation strategies to be utilized in a future implementation research trial in Native American communities, including planning for hybrid effectiveness implementation studies.

This R34 NOFO will not support research testing intervention efficacy or effectiveness. Efficacy or effectiveness research could be submitted to the companion IRINAH NOFOs (PAR-23-298 and PAR-23-299).

Preliminary data are not required for this NOFO.

Non-responsive Applications

Applications with the following attributes will be deemed non-responsive and will not be reviewed:

  • Applications that include exclusively mechanistic or etiological research, include only analysis of existing data and/or do not include an intervention or proposal to develop an intervention.
  • Applications that do not include a Milestones and study targets section within the Research Strategy (see Section IV below)
  • Applications that propose efficacy or effectiveness testing of an intervention
  • Applications that only propose to write a protocol or manual
  • Applications that propose research objectives that are not aligned with the mission of any of the participating ICs.
  • Applications that do not propose community-engaged projects
  • Applications that do not propose research with Native Americans

Additional Considerations for Proposed Research

Applicants are encouraged to consult American Indian and Alaska Native Research in the Health Sciences: Critical Considerations for the Review of Research Applications, which can be found at https://dpcpsi.nih.gov/sites/default/files/Critical_Considerations_for_Reviewing_AIAN_Research_508.pdf

Coordination across projects. Although the studies supported by the IRINAH initiative will not use a common study protocol, investigators are expected to meet regularly to participate in activities in support of advancing research on Native American Health. Such activities could include participating in cross-cutting interest groups, sharing and discussion of measures, and developing collaborative publications and products. An annual meeting will be held of all investigators with optional attendance by community partners who are funded by the IRINAH initiative; monthly or bi-monthly phone calls will also be held. Locations of the annual meeting will vary depending on sites funded through the initiative. Project budgets should include costs for one or more study team members to attend the annual meeting.

Conceptions of Health. While the absence of a particular disease is a critical outcome, the concept of health within many Native American communities embodies wellness and is broader than the absence of disease. All four elements of life physical, emotional, mental, and spiritual are intricately woven together and interact to support a strong and healthy person. In this holistic perspective, illness results from imbalance and wellness from balance in these elements. For Native people who identify strongly with tribal or indigenous culture, working with traditional healers or engaging in traditional cultural practices may be a core strategy to address disease or improve wellness. For this NOFO, investigators are encouraged to consider Native concepts of health and Native traditional practices as appropriate and approved by the community.

Community Engagement. The appropriate conduct of research with Native American populations has been widely documented; research must be conducted in a community-engaged manner, where the community has an equal voice as a research partner. The research should be consistent with community desires and informed by these at every step of the process. Community based participatory research (CBPR) approaches are one way to ensure appropriate engagement with communities in research and the cultural appropriateness of the intervention, study design and overall approach. Where communities desire to do so, researchers should incorporate a CBPR approach. Communities may choose to pursue approaches other than CBPR, and other forms of community-engaged research are acceptable for this NOFO. The community/tribe(s) should be appropriately involved in the study design and overall approach.

Culturally Appropriate Research and Preparatory Activities. Native communities and experts on Native American research have made clear the importance of culture in addressing health outcomes. Investigators are encouraged to consider culturally unique etiological factors or targets for intervention, relying on culturally relevant theories to frame research, considering culturally specific world views and Indigenous Knowledge as they relate to the research approach and design, culturally sensitive research processes, and culturally appropriate measurement strategies and processes.

Strength-Based Focus. Since many communities place a high value on the strengths and resilience of Native peoples, investigators are encouraged to incorporate community/cultural strengths and resilience. It is appropriate to consider community resilience in addition to the resilience of individuals.

Interventions. Interventions must be consistent with community cultural values, and be supported by theory or empirical knowledge, which can originate from Indigenous Knowledge or from culturally appropriate non-Native paradigms. Interventions may include traditional health, medical, and/or cultural practices independent of or in concert with practices that have been tested in research with non-Native populations. Intervention delivery should, whenever possible and scientifically or otherwise appropriate, employ individuals from the community. Such interventionists could include behavioral professionals, community health workers, counselors, nutritionists, nurse practitioners, physician assistants, or traditional healers.

Beyond the Individual Reflecting the importance of community and relations, researchers should consider proposing studies that address community, institutional, familial, peer network, or other factors that directly influence health outcomes or that impact individual’s abilities to enact health preserving practices. This could include multi-level intervention approaches or addressing and reporting on changes in known contextual influences while intervening to create individual level change. However, the interventions should not be so intensive or time-consuming that they would exceed the resources of the participants/community to participate or affect sustainability. Please see the NIMHD Minority Health and Health Disparities Research Framework as one example (https://www.nimhd.nih.gov/about/overview/research-framework/).

Future Clinical Trial Design Considerations: Investigators are encouraged to work with Tribal partners and communities to identify potential research designs that will provide robust evidence of intervention efficacy or effectiveness in the future clinical trial. Rigorous research designs are expected, but investigators are not required to conduct randomized controlled trials in the future trial. Applicants are strongly encouraged to consult the NIH Research Methods Resources page (https://researchmethodsresources.nih.gov/) and to ensure that they have appropriate statistical expertise on the study team to address any non-independence or other potential sources of bias in the study design.

If participants are assigned to study arms for the future trial, other potentially appropriate study designs with randomization include parallel group or cluster-randomized trials, individually randomized group-treatment trials, and stepped wedge group or cluster-randomized trials. When it is not possible to assign participants to study arms for the future trial, alternative rigorous research designs that provide robust evidence of intervention effectiveness include, but are not limited to, multiple baseline or repeated measures designs, interrupted time series studies, or stepped-wedge cluster randomized trials in which all subjects receive the intervention.

In these studies, special methods may be warranted for analysis and sample size estimation, particularly for small or hard to reach populations where traditional experimental randomization is not possible without impacts on bias or contamination. Planning activities proposed under this NOFO may include working to incorporate such methods into the clinical trial protocol and research design.

Research Objectives

Participating NIH ICs have identified priority research areas below. Applicants are encouraged to speak with IC representatives for technical assistance (see Agency Contacts in Section VII). Applicant organizations with limited research experience are strongly encouraged to develop applications in collaboration with research organizations.

Applicants should ensure that the IC they wish to target participates in the IRINAH NOFO to which they wish to submit. Applications that do not align with the missions of any of the participating ICs will be considered non-repsonsive.

National Institute on Drug Abuse (NIDA)

The National Institute on Drug Abuse (NIDA) is interested in culturally appropriate prevention, treatment, recovery, implementation, and dissemination research focused on substance use among Native adolescents and adults. NIDA is interested in a wide array of substances including but not limited to nicotine, psychostimulants/methamphetamines, opioids, cannabis, synthetic drugs, and psychoactive prescription drugs. Research at the intersection of HIV and substance use, including research that incorporates HIV prevention and/or care, also is welcome. Investigators are encouraged to propose research in urban, rural, and reservation settings and research that utilizes existing infrastructure, community resources, service systems (public and private), and health and wellness providers.

NIDA applicants are strongly encouraged to review the guidelines and adhere to the requirements applicable to their research listed in the Special Considerations for NIDA Funding Opportunities and Awards. Upon award, these considerations will be included in the Notice of Grant Award.

National Cancer Institute (NCI)

The National Cancer Institute (NCI) is not participating in this NOFO. Please do NOT submit R34 applications directed to NCI, as they will not be funded. However, NCI encourages applicants to incorporate aims that fit within the scope of this NOFO into their IRINAH R01 applications (submitted through PAR-23-298). For further clarification, potential applicants are encouraged to contact the NCI Scientific Staff listed in PAR-23-298.

National Institute on Alcoholism and Alcohol Abuse (NIAAA)

Although abstinence from alcohol is prevalent among Native American populations, there are also higher rates of alcohol use disorder (AUD) compared to other racial and ethnic groups in the United States. We need to engage communities and continue building a body of culturally appropriate empirically supported prevention, treatment, recovery, and health services research within Native American populations, and how they can be modified to better address societal and cultural needs and health disparities. The National Institute on Alcoholism and Alcohol Abuse (NIAAA) is interested in novel prevention and clinical interventions as well as research that seeks to understand processes of recovery and health services usage among Native American populations.

National Institute of Mental Health (NIMH)

The National Institute of Mental Health (NIMH) is interested in applications relevant to priorities described in this NOFO and that support the NIMH Strategic Plan for Research. NIMH is interested in applications relevant to preventive and treatment interventions in Native American, Alaska Native, and Native Hawaiian communities in both non-AIDS and AIDS research areas. NIMH is particularly interested in exploring the mechanisms by which policies and relevant interventions lead to better access/engagement and mental health outcomes.

Examples of specific areas of interest for NIMH are included below, but not limited to:

a) Non-AIDS-related Research Areas

  • Based on empirical evidence of the need for tailored approaches, develop and test new preventive, treatment, and services interventions and/or strategies for implementing interventions with established effectiveness, to determine whether the engagement of novel targets improves clinical and/or implementation and sustainment outcomes;
  • Optimize and test evidence-based interventions that preempt, prevent and treat mental disorders, including interventions to reduce suicide, consistent with research priorities noted by the National Action Alliance for Suicide Prevention’s Research Prioritization Task Force;
  • Empirically identify barriers and facilitators of engagement in mental health treatment and services that are unique to Native American, Native Hawaiian, and Alaska Native people and communities; develop interventions that address those factors; and test their effectiveness in increasing engagement and improving mental health outcomes;
  • Test strategies to increase use of evidence-based mental health care for individuals in hard-to-reach communities, including mobile and IT interventions (see NIMH workgroup report for guidance on technology development research: https://www.nimh.nih.gov/about/advisory-boards-and-groups/namhc/namhc-workgroups/namhc-bssr-workgroup-charge.shtml);
  • Initial development of a project to assess which factors promote resilience and prevent mental disorders to develop preventive intervention targets at individual or other levels;
  • Test innovative, empirically guided strategies for implementing integrated primary health care and mental health care in settings predominantly serving American Indian, Native Hawaiian, and Alaska Native communities in order to improve access, engagement, and continuity, equity, and value of mental health services while simultaneously addressing commonly occurring medical comorbidities;
  • Initial development of a project to assess whether and to what extent financing mechanisms, policies, regulations, and healthcare system rules optimize patient-level outcomes (including suicidal behavior and other mental health crises), and identify mutable factors and policy interventions that can improve mental health outcomes;
  • Initial development of a project to identify malleable factors underlying the development and/or course of mental illness to serve as potential therapeutic targets and inform development of interventions tailored for Native American, Native Hawaiian, and Alaska Native populations;
  • Examine responding to existing treatments in support of developing culturally informed study designs and conduct the initial development of a project to identify reasons for nonresponding; develop strategies to overcome these factors impeding treatment response to improve outcomes.

b) AIDS-related Research Areas

  1. Develop and test interventions to address the HIV prevention, care, and treatment needs based on the mechanisms that are driving new infections and poor health outcomes among those living with HIV (e.g., factors like intersectional stigma, mental health, social/sexual networks, access to and quality of health care, experiences of trauma);
  2. Conduct implementation science research to focus on barriers, facilitating factors, and outcomes of scaling-up HIV prevention and care interventions with known efficacy; and improve uptake and effectiveness of efficacious interventions, particularly for individuals in rural/remote Tribal communities;

All applications that propose clinical trials should follow the NIMH’s experimental therapeutics approach to intervention development and testing (see https://www.nimh.nih.gov/funding/opportunities-announcements/clinical-trials-foas/index.shtml). That is, the scope of work must include specification of targets/mechanisms and assessment of intervention induced changes in the presumed targets/mechanisms that are hypothesized to account for the intervention’s outcomes. In this manner, the results of the trial will advance knowledge regarding therapeutic change mechanisms and be informative regardless of trial outcomes (e.g., in the event of negative results, information about whether the intervention was successful at engaging its targets can facilitate interpretation).

Both non-AIDS and AIDS applications that propose adaptations to existing interventions should provide an empirical rationale for the need for and focus of the adaptation, consistent with NAMHC Workgroup Report recommendations on intervention adaptation (https://www.nimh.nih.gov/sites/default/files/documents/about/advisory-boards-and-groups/namhc/reports/fromdiscoverytocure.pdf).

NIMH encourages a deployment-focused model of intervention and services design and evaluation that takes into account the perspective of relevant stakeholders (e.g., service users, providers, administrators, payers) and the key characteristics of the settings (e.g., resources, including workforce capacity; existing clinical workflows) that are intended to implement optimized mental health interventions. This attention to end-user perspectives and characteristics of intended clinical and/or community practice settings is intended to ensure the resultant interventions and service delivery strategies are acceptable to consumers and providers, the approaches are feasible and scalable in the settings where individuals are served, and the research results will have utility for end users.

NIMH encourages research on potentially scalable preventive, therapeutic, and services interventions that focuses on practice-relevant questions. Accordingly, collaborations between academic researchers and clinical or community practice partners or networks are encouraged. When possible, studies should capitalize on existing infrastructure (e.g., practice-based research networks such as the NIMH-sponsored Mental Health Research Network (MHRN), electronic medical records, administrative databases, patient registries, institutions with Clinical and Translational Science Awards) to increase the efficiency of participant recruitment (i.e., more rapid identification and enrollment) and to facilitate the collection of moderator data (e.g., clinical characteristics, biomarkers), longer-term follow-up data, and broader, stakeholder-relevant outcomes (e.g., mental health and general health care utilization, value and efficiency of intervention approaches).

Potential applicants are strongly encouraged to consult with relevant Institute Scientific/Research Staff as far as possible in advance of any application to discuss the match to current Institute priorities.

National Institute of Environmental Health Sciences (NIEHS)

The mission of the National Institute of Environmental Health Sciences (NIEHS) is to discover how the environment affects people in order to promote healthier lives. The NIEHS is interested in applications that support the initial development of a culturally appropriate clinical trial or research project in preparation for health promotion or disease prevention interventions addressing the health impacts of environmental exposures that disproportionately impact Native American populations. Examples of activities NIEHS will support with this R34 include, but are not limited to:

  • Developing inclusive research teams where Native American investigators and/or community members have significant leadership roles (e.g., key personnel, Multiple Principal Investigators);
  • Activities to establish and sustain authentic, trusted partnerships with tribal communities;
  • Activities to build capacities of academics and Native American partners to engage in collaborative research;
  • Co-development of research designs that respect Native American cultural values, are inclusive of Tribal Ecological Knowledge/Indigenous Knowledge, and are feasible in Native American communities;
  • Co-development of recruitment strategies, study protocols, data safety and data management and sharing plans, data analyses, and study milestones with Native American partners

National Institute of Dental and Craniofacial Research (NIDCR)

The prevalence of oral diseases in Native American communities is amongst the highest in the U.S. Oral diseases share common behavioral and physiologic risk and protective factors with many other diseases and conditions, while those impacting health disparities and inequities are also known to be influenced by a range of social determinants of health such as education, employment, housing and food security, and distance to health care facilities. The National Institute of Dental and Craniofacial Research (NIDCR) is interested in prognostic research to identify new upstream risk and protective factors of dental caries, periodontal disease, or oral and pharyngeal cancer, and their interactions with other common risk factors of comorbid conditions affecting Native American population; developmental/exploratory research to engage with Native American communities and design intervention strategies to address social determinants of health contributing to oral health disparities and inequities; pilot testing feasibility, acceptability, and scalability of evidence-based/community-informed intervention strategies to address oral health risk factors and overcome barriers for adaptation. These R34 projects should inform multi-disciplinary and community-based implementation research that will promote oral health and disease prevention across the lifespan in Native American populations through holistic and sustainable interventions.

National Institute of Nursing Research (NINR)

The National Institute of Nursing Research (NINR) supports research to solve pressing health challenges and inform practice and policy – optimizing health and advancing health equity into the future. NINR discovers solutions to health challenges through the lenses of health equity, social determinants of health, population and community health, prevention and health promotion, and systems and models of care. Drawing on the strengths of nursing’s holistic, contextualized perspective, core values, and broad reach, NINR funds multilevel and cross-sectoral research that examines the factors that impact health across the many settings in which nurses practice, including homes, schools, workplaces, clinics, justice settings, and the community. Observational, intervention, and implementation research are of interest.

National Center for Complementary and Integrative Health (NCCIH)

The mission of the National Center for Complementary and Integrative Health (NCCIH) is to define, through rigorous scientific investigation, the usefulness and safety of complementary and integrative health interventions and their roles in improving health and health care. In the context of this NOFO, NCCIH is particularly interested in encouraging applications that develop and conduct pilot feasibility trials of culturally appropriate mind and body or natural product approaches for symptom management (e.g. pain, stress, anxiety, depression) or for health promotion and well-being in Native American populations. Mind and body approaches include meditation approaches (e.g., mindfulness), hypnosis or guided imagery, meditative movement approaches (e.g., yoga, tai chi, qi gong), body-based approaches (e.g., progressive muscle relaxation, acupressure), music or art-based therapy, or a combination of these approaches (e.g., mindfulness based stress reduction). NCCIH is also interested in investigating the use of natural products, including botanicals, dietary supplements, and probiotics in AI/AN populations. NCCIH will also support research on Traditional Medicine approaches, which may include mind and body and/or natural product approaches.

NCCIH will not fund research proposing efficacy or effectiveness clinical trials through this NOFO (please see NCCIH Clinical Trial Funding Opportunities instead). Investigators are strongly encouraged to discuss their research plans with NCCIH program staff prior to submitting their application.

The Office of Research on Women’s Health (ORWH)

The Office of Research on Women’s Health (ORWH) is part of the Office of the Director, NIH, and works with the 27 NIH ICs to advance rigorous research of relevance to the health of women. ORWH does not award grants but co-funds women’s health-related applications and research projects that have received an award from one of the participating NIH Cs listed in the announcement. Applications seeking ORWH co-funding, in response to this NOFO, should ensure that the proposed work is aligned with at least one goal and objective outlined in the Trans-NIH Strategic Plan for Women’s Health Research (https://www.nih.gov/women/strategicplan).

For this announcement, ORWH is interested in research projects that address health disparities in American Indian/Alaskan Native (AI/AN) and Native Hawaiian (NH) women and support culturally appropriate prevention and treatment interventions across the lifespan. These projects should also, when possible, leverage indigenous knowledge and expertise in the research questions being explored, and consider tribal input in implementation strategies, intervention methods, and evaluation processes. Interdisciplinary partnerships to advance maternal health research, reduce preventable causes of maternal morbidity, and propose clinical interventions to improve pregnancy outcomes within populations of AI/AN and NH women are of particular interest. Projects that build the capacity of AI/AN and NH investigators to conduct this research are also encouraged.

The Office of Disease Prevention (ODP)

The ODP is the lead office at the NIH responsible for assessing, facilitating, and stimulating research in disease prevention. In partnership with the 27 NIH ICs, the ODP strives to increase the scope, quality, dissemination, and impact of NIH-supported prevention research. For additional information about ODP, please refer to the ODP Strategic Plan for Fiscal Years 2019 2023.

The ODP provides co-funding for, but does not award, grants. ODP only accepts co-funding requests from NIH ICs. Therefore, applications likely to receive co-funding must be relevant to the objectives of at least one of the participating NIH Institutes and Centers (IC) listed in this announcement. Please contact the relevant IC Scientific/Research Contact(s) listed for questions regarding the IC’s research priorities and funding.