HEAL Initiative: Behavioral Research to Improve MAT: Behavioral and Social Interventions to Improve Adherence to Medication Assisted Treatment for Opioid Use Disorders (R61/R33 Clinical Trial Optional) | RFA AT 19 006

Opportunity Information: Apply for RFA AT 19 006

The National Institutes of Health (NIH) released this funding opportunity announcement under the HEAL (Helping to End Addiction Long-term) Initiative to support research aimed at improving how well people with opioid use disorder (OUD) adhere to medication assisted treatment (MAT). The core goal is to test and better understand behavioral and social interventions that can increase uptake and continued use of MAT, since consistent engagement with medications like buprenorphine, methadone, and naltrexone is strongly tied to better clinical outcomes and reduced overdose risk. The opportunity uses the R61/R33 phased award mechanism and is labeled "clinical trial optional," meaning applicants can propose either clinical trial work or non-trial research, as long as the project fits the purpose and meets NIH standards for rigor.

The FOA emphasizes adherence across the full treatment continuum. Proposed projects may focus on MAT initiation (getting people started on medication), implementation (supporting day-to-day engagement such as attending appointments, taking medication as prescribed, and staying connected to care), and persistence (longer-term retention and prevention of premature discontinuation). NIH is looking for research that can identify what gets in the way of adherence and what helps, and then develop and evaluate interventions that directly address those barriers and facilitators. Both descriptive studies (to map determinants and mechanisms) and intervention studies (to test strategies that improve adherence) are within scope.

A major priority in this announcement is an ecological, multi-level view of adherence. Applications are viewed more favorably when they tackle determinants at more than one level of influence rather than focusing only on the individual patient. The FOA explicitly calls out patient-level factors (motivation, symptoms, co-occurring mental health conditions, stigma, practical barriers), caregiver or family factors (support, relationship dynamics, caregiving burden), provider and healthcare system factors (access to MAT prescribers, clinic workflow, treatment culture, follow-up capacity, insurance and administrative hurdles), and community factors (transportation, local resources, housing instability, employment pressures, criminal justice involvement, and community stigma). Interventions might therefore include combinations of patient-facing behavioral supports, family engagement approaches, provider training or decision support, and system or community-linked services that make it easier for people to start and stay on MAT.

Scientific rigor is repeatedly highlighted as essential. NIH signals that successful applications should be built around strong study designs, adequate and justified sample sizes, and outcome measures that are valid and meaningful for MAT adherence. In practice, that means clear definitions of adherence and retention, reliable measurement strategies (for example, pharmacy fill data, clinical records, toxicology when appropriate, validated self-report tools, visit attendance, or medication possession ratios), and analytic plans that match the design and endpoints. The emphasis on rigor also implies careful attention to bias, attrition, implementation fidelity, and real-world feasibility, especially since adherence research often involves complex patient populations and service settings.

The R61/R33 structure typically supports a staged approach where early work can focus on developing, refining, or piloting an intervention and demonstrating feasibility, followed by a larger and more definitive phase to test effectiveness, mechanisms, or implementation outcomes. Applicants generally need to lay out clear milestones that justify moving from the initial phase to the later phase, such as meeting recruitment targets, demonstrating intervention fidelity, achieving acceptable retention rates, or showing preliminary signals on adherence-related outcomes. This format is well suited to behavioral and social intervention research because it allows iterative improvement before scaling up to a bigger evaluation.

Eligibility is broad and includes many types of U.S.-based organizations. Eligible applicants include state, county, city, township, and special district governments; independent school districts; public and state-controlled universities; private institutions of higher education; federally recognized Native American tribal governments; tribal organizations that are not federally recognized; public housing authorities and Indian housing authorities; nonprofits with and without 501(c)(3) status; for-profit organizations (other than small businesses); small businesses; and other qualified entities. The FOA also explicitly highlights additional eligible applicant types 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, eligible federal agencies, regional organizations, tribal governments other than federally recognized, and U.S. territories or possessions. At the same time, it clearly excludes non-domestic (non-U.S.) entities and foreign institutions, and it does not allow foreign components of U.S. organizations as defined by NIH policy, meaning the funded work must be carried out within allowable domestic settings.

Administratively, this is a discretionary NIH grant opportunity (Funding Opportunity Number RFA-AT-19-006) aligned with multiple CFDA program numbers, reflecting NIH’s cross-institute involvement in opioid-related research. The original closing date listed for this specific announcement was February 8, 2019, and it was created on December 10, 2018, indicating it was a time-limited call tied to HEAL priorities at that time. Even though this particular FOA had a set deadline, the themes and expectations described in it are consistent with NIH’s broader direction in OUD treatment research: interventions that are practical in real care settings, attentive to social and system barriers, and evaluated with strong methods and outcomes that matter for keeping people on effective medications.

• The National Institutes of Health in the education, health, income security and social services sector is offering a public funding opportunity titled "HEAL Initiative: Behavioral Research to Improve MAT: Behavioral and Social Interventions to Improve Adherence to Medication Assisted Treatment for Opioid Use Disorders (R61/R33 Clinical Trial Optional)" and is now available to receive applicants.
• Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.213, 93.242, 93.273, 93.279, 93.307, 93.865, 93.866.
• This funding opportunity was created on 2018-12-10.
• Applicants must submit their applications by 2019-02-08. (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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