Implementation Research for Multi-morbidity Management in the Context of Non-communicable Diseases in Low- and Middle-Income Countries and US Tribal Populations (R61/R33 Clinical Trial Required) | PAR 25 223

FAQs: NIH PAR-25-223 (Implementation Research for Multi-morbidity NCD Care)

What is PAR-25-223 trying to fund?

PAR-25-223 is a planned NIH grant opportunity supporting implementation research that improves how noncommunicable diseases (NCDs) are managed when people are living with multiple chronic conditions at the same time (multi-morbidity). The focus is on generating practical, real-world evidence about strategies that improve delivery of integrated, coordinated care in settings facing resource, access, and equity barriers.

What makes this opportunity different from studies that describe the problem?

This program emphasizes moving beyond documenting needs or gaps. Projects are expected to test and evaluate scalable approaches that can actually be implemented in real care environments, with the goal of improving multi-morbidity care delivery rather than producing descriptive findings alone.

What types of diseases and care challenges are in scope?

The opportunity targets noncommunicable diseases (NCDs), specifically in the context of multi-morbidity (more than one chronic condition in the same person). It is designed for situations where single-disease programs may not work well because patients have multiple conditions requiring coordinated management.

Which settings or care sites are intended for this research?

Studies are intended to be carried out in the places where care is delivered, such as community clinics, primary care settings, local health systems, and health systems serving Tribal communities, along with other local health delivery structures relevant to the priority contexts.

What are the two priority contexts for this funding opportunity?

The program is specifically aimed at (1) World Bank-defined low- and middle-income countries (LMICs), and (2) American Indian and Alaska Native (AI/AN) Tribal Nation populations in the United States.

Is this opportunity only for international work?

No. While one priority context is LMICs, the other is AI/AN Tribal Nation populations in the United States. Projects can be responsive to either priority context as described in the opportunity summary.

How is this opportunity connected to the Global Alliance for Chronic Diseases (GACD)?

The opportunity is being developed in collaboration with the Global Alliance for Chronic Diseases (GACD), reflecting a shared emphasis on implementation research and practical evidence for improving chronic disease care in settings with significant barriers to access and equity.

Does the project need to include a clinical trial?

Yes. The announcement is described as a "Clinical Trial Required" funding opportunity. Projects are expected to include a clinical trial component, meaning applicants should be prepared to test an intervention or an implementation strategy using a prospective, structured research design.

What does "Clinical Trial Required" mean in practical terms for applicants?

Based on the summary, it means the proposed research is expected to prospectively test an intervention or implementation strategy using a structured design, rather than only observing existing practice or conducting purely descriptive work.

What is the funding mechanism for PAR-25-223?

The mechanism is an R61/R33 phased innovation award. This supports a two-stage approach: an early phase focused on launching and refining the approach and a later phase for expanded, more rigorous evaluation after milestones are met.

What happens during the R61 phase?

The R61 phase is designed for launching and refining the approach, addressing feasibility milestones, strengthening partnerships, finalizing delivery workflows, and confirming that recruitment, measurement, and implementation processes will work in the intended settings before moving to a larger trial phase.

What happens during the R33 phase?

The R33 phase supports the expanded study and more rigorous evaluation once predefined milestones from the R61 phase are achieved. It is intended to enable a stronger test of the intervention or implementation strategy at a larger or more definitive scale.

Why does this opportunity use a phased R61/R33 structure?

The phased structure is meant to reduce risk and encourage teams to demonstrate feasibility, readiness, and workable implementation processes before proceeding to a more intensive and rigorous evaluation phase.

Who is eligible to apply?

Eligibility is broad. Eligible entities include state, county, and city governments; public and private institutions of higher education; nonprofits with or without 501(c)(3) status; for-profit organizations other than small businesses; and small businesses.

Are Tribal governments and Tribal organizations eligible?

Yes. The opportunity explicitly highlights Tribal governments (federally recognized) and other Tribal organizations as eligible, aligning with the priority focus on AI/AN Tribal Nation populations and Tribal health settings.

Are community-based or faith-based organizations allowed to apply?

Yes. The opportunity explicitly highlights faith-based or community-based organizations, signaling that community-rooted applicants and partners are appropriate for this implementation-focused program.

Can non-U.S. organizations apply?

Yes. The opportunity explicitly highlights non-U.S. entities and regional organizations, which fits the priority context that includes LMIC settings.

Are U.S. territories or possessions included as eligible applicants?

Yes. U.S. territories or possessions are explicitly highlighted among eligible organizations.

Are minority-serving institutions specifically encouraged or eligible?

Yes. The summary explicitly highlights several institution types, including Tribally Controlled Colleges and Universities (TCCUs), Alaska Native and Native Hawaiian Serving Institutions, Asian American Native American Pacific Islander Serving Institutions (AANAPISI), Hispanic-serving Institutions, and Historically Black Colleges and Universities (HBCUs).

Do applicants need to be a traditional academic medical center?

No. The practical takeaway described in the summary is that applicants are not limited to traditional academic medical centers. Community-rooted and Tribal-serving organizations can be central applicants or key partners.

What is the maximum award amount listed?

The listed award ceiling is $500,000.

When is the closing date shown for this opportunity?

The original closing date shown is January 7, 2026.

When was the notice created?

The notice was created on October 25, 2024.

Which NIH program category and type is this listed under?

It is listed as a discretionary NIH grant in the health category.

Which CFDA program numbers are associated with this opportunity?

Multiple CFDA program numbers are associated with participating NIH Institutes and Centers: 93.233, 93.242, 93.313, 93.837, 93.838, 93.839, 93.840, and 93.989.

How many awards will NIH make under this opportunity?

The summary does not specify the number of expected awards.

What kind of evidence is NIH looking for from funded projects?

The program aims to generate practical, real-world evidence about what strategies work to deliver better NCD care for people with multi-morbidity, especially in settings with major resource, access, and equity barriers.

What does NIH mean here by "implementation research"?

In this opportunity, implementation research is framed as testing and evaluating strategies for delivering improved, integrated, and coordinated multi-morbidity NCD care in real service environments, with attention to feasibility, acceptability, and the potential for adoption, sustainability, and scale.

What themes tend to describe a strong application for this program?

Based on the summary, strong applications generally (1) focus on multi-morbidity management rather than isolated single-condition solutions, (2) show clear responsiveness to local context (LMIC health systems or AI/AN Tribal health settings), (3) include meaningful stakeholder engagement, and (4) are designed to produce evidence that can be adopted, sustained, and potentially scaled to improve outcomes and reduce inequities.

Does the program emphasize equity and access barriers?

Yes. The program is explicitly aimed at settings that often face major resource, access, and equity barriers, and it is oriented toward approaches that can improve care delivery in those real-world contexts.

What is the overall goal of this NIH initiative?

The overall goal is to combine implementation science with practical chronic disease care improvement to produce actionable evidence that improves integrated care for people living with multiple chronic diseases, with particular focus on LMICs and AI/AN Tribal Nation populations.