Implementing Comprehensive HIV services in Syringe Service Program (SSP) Settings (R34 - Clinical Trial Required) | RFA DA 23 007

Opportunity Information: Apply for RFA DA 23 007

The NIH grant opportunity "Implementing Comprehensive HIV services in Syringe Service Program (SSP) Settings (R34 - Clinical Trial Required)" (Funding Opportunity Number RFA-DA-23-007; CFDA 93.279) supports early-stage, implementation-focused research to develop and pilot practical, sustainable ways to integrate comprehensive HIV prevention and HIV care into syringe services program settings. The core problem it targets is that SSPs have expanded rapidly across the United States and now operate in a wider range of organizational homes, including local and state health departments and federally qualified health centers (FQHCs), not just the more traditional community-based organizations (CBOs) and AIDS service organizations. Because SSPs vary widely in staffing, clinical capacity, and local resources, there is a clear need for tested service delivery models that reliably bring HIV prevention and treatment closer to people who inject drugs (PWID) and their networks.

The opportunity is motivated by gaps that show up in both newer and more established SSPs. Newer SSPs, which are often opening in rural areas, may have limited experience delivering broader substance use services and may also lack on-site HIV care capacity. More established SSPs often do provide HIV testing, but many do not directly deliver additional HIV prevention and treatment services (for example, initiating or maintaining prevention interventions or HIV treatment) and instead rely heavily on external referrals. The referral-only approach can break down in practice, especially when follow-up is limited, transportation is difficult, stigma is high, or clients have unstable housing or other barriers. In that context, SSPs represent an important and underused point of ongoing contact because participants may return regularly for supplies and harm reduction support, creating repeated opportunities to engage, re-engage, and sustain people across the HIV prevention and treatment continua.

A major theme of the announcement is that SSPs are uniquely positioned to reach not only PWID but also their network members, including people who do not inject drugs, who may still be at elevated HIV risk. That frequent, lower-barrier touchpoint can make it possible to do more than one-time testing. The grant is essentially calling for models that help SSPs move toward comprehensive, integrated HIV services that can be maintained over time within real-world operational constraints, rather than short-term demonstration projects that disappear when a study ends.

The announcement also reflects the changing public health environment affecting SSP operations. COVID-19 forced many programs to restructure service delivery (for example, altering hours, moving to mobile or decentralized distribution, reducing face-to-face contact), and some SSPs closed. These disruptions highlighted the importance of resilient service models that can function under stress and still connect people to prevention and care. At the same time, CDC is developing stronger infrastructure to monitor SSP programs, survey clients, and build technical assistance approaches for SSPs. NIH is positioning this R34 research program as complementary to that CDC work, and also aligned with SAMHSA's broader support for SSP-related services, by generating evidence on what implementation strategies actually improve HIV prevention and care outcomes in these settings.

This is an R34 mechanism, which generally supports planning, development, and pilot testing work that can lead to a larger effectiveness-implementation or scale-up study later. The title specifies "Clinical Trial Required," meaning applicants are expected to include a clinical trial component as defined by NIH policy (for example, prospective assignment to an intervention and assessment of health-related outcomes), even though the focus is implementation and service delivery rather than testing a new drug. In practical terms, projects under this opportunity would be expected to test an integrated service model or implementation strategy in SSP environments and measure outcomes relevant to HIV prevention and/or treatment engagement.

Eligibility is broad and includes many types of U.S.-based organizations and government entities. Eligible applicants listed include state, county, city/township, and 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; other Native American tribal organizations (including those other than federally recognized tribal governments); public housing authorities/Indian housing authorities; nonprofits with or without 501(c)(3) status (excluding higher education institutions in those categories); for-profit organizations (other than small businesses) and small businesses; and other organizations. The opportunity also highlights additional eligible applicant categories often emphasized in NIH funding, such as Historically Black Colleges and Universities (HBCUs), Hispanic-serving institutions, tribally controlled colleges and universities (TCCUs), Alaska Native and Native Hawaiian serving institutions, and Asian American Native American Pacific Islander serving institutions (AANAPISIs), along with faith-based and community-based organizations, U.S. territories or possessions, regional organizations, and eligible federal agencies.

Foreign participation is restricted in the usual NIH way for opportunities focused on U.S. service settings. Non-domestic (non-U.S.) entities and non-domestic components of U.S. organizations are not eligible to apply. However, foreign components, as defined in the NIH Grants Policy Statement, are allowed, meaning a U.S. applicant can include certain well-justified foreign elements if they meet NIH requirements, even though the applicant organization itself must be domestic.

Administratively, the funding instrument is a grant under a discretionary program within the health and education activity category, administered by the National Institutes of Health. The original closing date shown is August 11, 2023, and the funding opportunity was created February 25, 2022. The announcement as provided does not specify an award ceiling or the expected number of awards in the included fields, so applicants would normally confirm those details in the full notice and any accompanying NIH institute-specific budget guidance.

In plain terms, this opportunity is aimed at helping SSPs evolve from primarily syringe distribution and HIV testing referral hubs into stronger, integrated access points for HIV prevention and HIV care, using implementation science and clinical trial methods to determine what works, for whom, and under what conditions, especially in newer, rural, or otherwise resource-limited SSP settings and in a post-COVID operational landscape.

• The National Institutes of Health in the education, health sector is offering a public funding opportunity titled "Implementing Comprehensive HIV services in Syringe Service Program (SSP) Settings (R34 - Clinical Trial Required)" and is now available to receive applicants.
• Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.279.
• This funding opportunity was created on 2022-02-25.
• Applicants must submit their applications by 2023-08-11. (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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