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Foreign Agricultural Service

The U.S. Department of Agriculture, Foreign Agricultural Service, announces this Notice of Funding Opportunity (NOFO) to support the E (Kika) de la Garza Emerging Markets Program (EMP) by issuing new awards. The purpose of this program is to develop, maintain, or expand markets for exports of United States agricultural commodities and to promote cooperation and exchange of information between agricultural institutions and agribusinesses in the United States and emerging markets. This opportunity is available to U.S. entities to achieve the purposes of this program by: (1) making assessments of food and rural business systems needs; (2) making recommendations on measures necessary to enhance the effectiveness of food and rural business systems, including potential reductions in trade barriers; and (3) identifying and carrying out specific opportunities and projects to enhance the effectiveness of food and rural business systems in emerging markets.

NICHD - Eunice Kennedy Shriver National Institute of Child Health and Human Development

ABSTRACT Premature rupture of membranes (PROM) and preterm PROM (pPROM) affect up to 10% and 4% of pregnancies globally, respectively, leading to significant maternal and fetal health risks if not detected and managed promptly. These risks include maternal chorioamnionitis, neonatal sepsis, umbilical cord prolapse, placental abruption, and preterm labor. Current detection methods, such as the Nitrazine test and immunoassays for biomarkers like PAMG-1 and IGFBP-1, are effective but are often costly, invasive, and depend on the mother's ability to identify abnormal vaginal discharge. Such dependency on patient recognition is problematic, especially in persistent low-volume leakage where symptoms are easily mistaken for normal discharge, delaying diagnosis and treatment. These challenges are further compounded in rural or underserved areas, where limited access to healthcare can delay diagnosis and increase risks. Our research aims to develop a novel colorimetric detection system that functions as a vaginal insert for the early identification of premature rupture of membranes (PROM) and preterm PROM (pPROM). This insert is specifically designed to distinguish amniotic fluid from other vaginal discharges, offering an at-home, minimally invasive solution that integrates into a patient’s daily routine. By utilizing a pH-sensitive polymer, the device reacts to the presence of amniotic fluid by releasing a biocompatible dye, causing a visible color change in vaginal discharge. This allows for early detection, even with small leaks, enabling patients to seek timely medical care without frequent clinical visits. The system leverages the design of pessary devices, which are already widely used by pregnant women for long-term use, ensuring comfort and improving patient compliance. Placing the device close to the uterus maximizes contact with amniotic fluid while minimizing interference from other secretions. The device uses FDA-approved materials to ensure biocompatibility and safety for both mother and fetus. In contrast to costly and time-consuming biomarker assays, this solution provides a simple, cost-effective alternative by utilizing the pH difference between amniotic fluid and vaginal discharge. Ultimately, this system offers a user-friendly, accessible, and highly sensitive method to detect PROM and pPROM, improving maternal and fetal health outcomes, especially in low-resource settings. Aim 1: Optimize the formulation of a pH-responsive polymer with additives to ensure stability in an acidic vaginal environment while maintaining high sensitivity to amniotic fluid. Aim 2: Refine device designs, including geometric configurations and material placement, to enhance detection sensitivity and specificity, minimizing false positives and negatives. Aim 3: Assess the biocompatibility, stability, and effectiveness (i.e., sensitivity and selectivity) of the prototype devices for detecting amniotic fluid leakage using a mouse model

NCI - National Cancer Institute

Project Summary & Abstract Background: Rural residents experience higher colorectal cancer (CRC) incidence and mortality rates than their urban counterparts. Adherence to CRC screening is essential for early detection, timely treatment, and reduced mortality. The fecal immunochemical test (FIT) is a preferred screening method among rural populations due to its non-invasive nature, affordability, and at-home convenience. Patient navigation plays a crucial role in increasing FIT completion rates but faces structural and logistical challenges. While adaptive, stepped-care patient navigation interventions have been developed to improve scalability and cost-effectiveness, they have not been failed to account for individual sociodemographic factors and evolving patient needs in real time, and have not determined the optimal timing or type of person-led navigation. The primary goal of this study is to optimize a novel adaptive patient navigation model using a two-stage Sequential Multiple Assignment Randomized Trial (SMART) to promote FIT screening among rural residents. In Stage 1, this study will evaluate chatbot-based navigation (FITtrack) versus standard SMS reminders as an initial assistive tool and determine the optimal timing for introducing additional person-led support. In Stage 2, this study will assess the optimal type of person-led support, comparing nurse navigators and peer navigators. Specific Aims: 1) Evaluate the feasibility and acceptability of the digital intervention (4-week SMS reminders, 4-week FITtrack chatbot, and 12- week FIT track chatbot), supplemental person-led navigation (nurse vs. peer), and adaptive interventions (digital intervention plus person-led navigation); 2) Evaluate the preliminary effectiveness of these interventions; 3) Understand step-specific challenges and supports needed in completing FIT. Innovation: This study is highly innovative as it tailors to individual sociodemographic factors and real-time needs through the integration of AI- based chatbot technology, utilizes a novel trial design (i.e., SMART) to inform the development of an adaptive model, and directly addresses the unique challenges faced by rural residents. Significance: Aligned with PA- 25-295, this study accelerates priority initiatives by identifying optimal type and timing of digital and person- assisted navigation approaches to improve CRC screening adherence among rural populations. Ultimately, these findings will support the development of a scalable, adaptive, and cost-effective patient navigation intervention, advancing cancer prevention and early detection efforts in populations with high cancer burden.

NIAID - National Institute of Allergy and Infectious Diseases

Abstract This developmental research grant award (R21) requests funds to characterize the social and transmission networks of Rosebud Sioux Tribe (RST) (Sicangu Lakota Oyate) community members to mitigate ongoing and future syphilis epidemics among American Indian/Alaska Native (AI/AN) populations and move towards elimination of congenital syphilis: A Sicangu-driven social network strategy for syphilis prevention (S4). In addition to classic transmission networks, we include social networks that confer influence, social support, diffuse information/innovation and can lead to syphilis prevention interventions that the team has experience implementing. AI/AN individuals in South Dakota (SD) are one of the most syphilis impacted communities and are at increased risk of syphilis transmission, including congenital syphilis. In 2020, 3% of all AI/AN babies born in South Dakota had congenital syphilis. AI/AN individuals are more likely to live in rural areas with limited access to prenatal care and hospital obstetric units, creating barriers to timely identification and treatment of syphilis. Earlier this year, The Great Plains Tribes requested emergency assistance from the federal government to declare a public health emergency and address the syphilis epidemic. Critical to public health is improving syphilis prevention among AI/AN communities and their larger social networks. Network analysis traditionally focuses on transmission dynamics and potential for future epidemics. Contact tracing and other strategies do not, however, fully include the larger social network and data can be limited due to the stigma associated with providing names, as well as mistrust in government and healthcare providers, particularly for AI/AN individuals. Social network analysis that this team has expertise in, can illuminate multiple networks and develop metrics tied not only to disease transmission but to diffusion of information, and among highly marginalized groups such as people who use substances. The PI has a track record of collaborative work implementing participant network recruitment protocols such as the Social Network Strategy to be used in S4. The PI and site-PI are joined by additional experts in AI/AN Health, Indigenous community leaders and local community members engaging in Talking Circles in these contexts. Accordingly, we aim to: Characterize the social networks of RST community members and measure features of their network structure— assortativity, density and bridging – most relevant to syphilis transmission and network intervention; Explore individual (ie. age, education), contextual (ie employment type), network and structural (stigma, health care access) factors associated with syphilis seropositivity. We will collect survey data and biologic samples to model potential factors associated with historic and recent syphilis transmission and; Determine individual and social network level factors associated with syphilis prevention behaviors (ie. condom use, drug treatment, doxyPEP) and network intervention (ie. information sharing, proportion approving of syphilis prevention), which could lead to future network interventions.

NIA - National Institute on Aging

Project Abstract Dementia prevalence in Sub-Saharan Africa is projected to increase by over 300% within the next 25 years as the population aged 60 years and older triples to more than 235 million. Beyond the demographic transition and population growth, a major driver of these increases is the growing burden of communicable and non- communicable diseases, which contributes to disability and adverse brain health outcomes. Currently, there are limited data on Alzheimer's Disease and related dementias to inform healthcare and research policies within resource-strained health systems in SSA. This gap is especially evident in French-speaking African countries (30-40% of SSA), which are critically underrepresented in ADRD research. Indeed, our recent review highlights the cultural, ethnic, linguistic, and socioeconomical challenges to dementia research in this setting. In Cameroon, ADRD mortality has increased by over 130% in 20 years and ADRD represents 12.4% of outpatient neurology consultations. Our prior work highlights the urgent need to develop and validate scalable and accessible assessment tools for ADRD to establish a robust infrastructure to support dementia diagnosis, care, and research nationwide. The growing field of digital cognitive tools offers an innovative opportunity for developing easily accessible and highly accurate neuropsychological tools for cost- and time-efficient case identification. Standardized administration, automated scoring/interpretation, and cross platform integration features can address several challenges and support the development of dementia registries – a valuable resource for dementia research and care. The main objectives of this proposal are to culturally adapt and validate a brief multi-domain digital cognitive assessment tool in Cameroon and to develop and pilot the infrastructure needed for improved dementia care and research. Specifically, we plan to culturally adapt TabCAT-BHA digital cognitive assessment in Cameroon, evaluate demographic effects on performance and generate regression-based norms in a community representative sample of healthy adults in rural and urban areas (Aim 1). Concurrently, we will examine TabCAT-BHA’s diagnostic accuracy to detect mild cognitive impairment (MCI) and dementia in the existing BRAIN Cohort and examine its neuroanatomical validity to domain specific regional patterns of brain atrophy on MRI (Aim 2). Finally, as an exploratory aim, we will determine implementation barriers to cognitive testing and dementia diagnosis in a clinical setting in Cameroon to develop the infrastructure needed for improved dementia care and research (Aim 3). These proposed studies will begin to fill the data gap on dementia research in French-Speaking Sub-Saharan Africa (FS-SSA) and provide the first ever neuroimaging data in people living with dementia in Cameroon and set the stage for more comprehensive dementia studies in FS-SSA. For future research following this proposal, we anticipate that valid digital neuropsychological tools coupled with blood biomarkers that still need validation in this setting, could be a scalable and sustainable path for ADRD research, diagnosis and care (R01 proposal)

NINR - National Institute of Nursing Research

Dating violence (DV) is common among U.S. high school age adolescents and has significant and lifelong negative health consequences, including suicide behaviors. Native American (NA) adolescents are at increased risk for violence victimization and/or perpetration in their dating violence, given their high rates of violence exposure in their homes and communities. Key challenges for dating violence prevention are the lack of services, fear of stigma and discrimination, and limited trust in and access to skilled professionals. The Fort Peck Reservation is home to the Assiniboine and Sioux Tribes in rural Montana. The reservation community reports high rates of violence and suicide behavior with underfunded and limited health and social service, especially for adolescents. The wide range of negative health and social outcomes associated with violence experienced by reservation-based NA adolescents underscores the call for innovative and targeted behavioral health interventions using appropriate technology. myPlan Teen, is an evidence-based healthy relationship and dating violence prevention intervention for adolescents and is delivered through a secure and confidential web based and mobile app. myPlan Teen provides adolescents with immediate access to information about healthy and unhealthy behaviors, safety strategies tailored to their situation with links to youth friendly resources, to reduce confusion, feelings of isolation and stigma associated with unhealthy relationships. In our CDC funded randomized control trial (RCT) with a national sample of 609 adolescents aged 15-17, we found adolescents randomized to myPlan Teen had a significant increase in use and helpfulness of safety behaviors compared to control group (adolescent health website). Further adolescents who used myPlan Teen reported a significant reduction in physical/sexual violence perpetration and suicide behaviors compared to control group. To advance the relevance and use of myPlan Teen with NA adolescents, our interdisciplinary team in partnership with Tribal Health leaders and Youth Advisory Board (YAB) will adapt myPlan Teen by integrating culturally relevant content, including tribal identity and communal mastery for NA adolescents to build healthy relationships, develop safety skills and access culturally relevant resources. Following the adaptation process, the team will evaluate the effectiveness of the culturally adapted myPlan Teen app on health and safety outcomes with 550 NA adolescents. In addition, we will examine the mechanisms by which myPlan Teen improves health and safety outcomes. The study will advance violence prevention interventions with NA adolescents and inform future processes to adapt and disseminate a digital intervention with adolescents nationally.

Aga Khan Development Network

One of the largest private development networks ($700M+/yr). Supports education, health, rural development, architecture, and civil society in Asia and Africa.

Aga Khan Foundation

Supports community development in Asia and Africa through education, health, rural development, and civil society strengthening. Part of the Aga Khan Development Network.

Aga Khan Foundation

Global development network funding health, education, rural development, and civil society across Asia and Africa.

Health and Human Services Department

In compliance with the requirement for opportunity for public comment on proposed data collection projects of the Paperwork Reduction Act of 1995, HRSA announces plans to submit an Information Collection Request (ICR), described below, to the Office of Management and Budget (OMB). Prior to submitting the ICR to OMB, HRSA seeks comments from the public regarding the burden estimate, below, or any other aspect of the ICR.

Alaska Department of Commerce, Community, and Economic Development (DCCED)

The Village Safe Water program funds design, construction, and improvement of water and sewer systems in rural Alaska communities, addressing critical sanitation infrastructure needs for Alaska Native villages.

Alaska Department of Education and Early Development (DEED)

DEED provides grants to Rural Education Attendance Areas and school districts for school improvement initiatives, teacher retention programs, and educational technology in Alaska's most remote communities.

Alaska Division of Economic Development

The Division of Economic Development supports small business growth in Alaska through grants for business planning, market development, export promotion, and rural economic diversification projects.

Agriculture Department

The Rural Housing Service (RHS or Agency), an agency within the United States Department of Agriculture, Rural Development (RD), is amending two program funding opportunities to remove references to the prior Administration's key priorities and DEI (diversity, equity, and inclusion)-related scoring criteria to bring them into compliance with the Executive Order, "Ending Radical and Wasteful Government DEI Programs and Preferencing", issued on January 20, 2025. The following funding notices are covered by this amendment: Notice of Funds Availability for the Multifamily Housing Preservation and Revitalization Demonstration Program and for Section 515 Subsequent Loans for Preservation Activities for the Fiscal Year 2024, and Consolidated Multifamily Housing Technical Assistance Grant Program Notice of Funding Availability Fiscal Year 2024. This notice also confirms that previous Administration key priorities will not be considered during application scoring and makes clear that applicants who already have applied need not reapply.

Agriculture Department

The United States Department of Agriculture, Rural Development (RD), which is comprised of the Rural Business-Cooperative Service (RBCS), Rural Utilities Service (RUS), and Rural Housing Service (RHS), announces that it is amending 14 program funding opportunities to remove references to the prior Administration's key priorities and DEI (diversity, equity, and inclusion)-related scoring criteria to bring them into compliance with the Executive Order, "Ending Radical And Wasteful Government DEI Programs And Preferencing", issued on January 20, 2025. This notice also confirms that previous Administration key priorities and discretionary points will not be considered during application scoring and makes clear that applicants who already have applied need not reapply. This notice also corrects the Rural Energy for America funding notice to include an omitted funding source.

U.S. Mission to Tajikistan

Purpose of Public Diplomacy Grants: PDS Embassy Dushanbe invites proposals for programs that strengthen ties between the United States and Tajikistan in priority program areas (see below) in order to highlight shared values and promote bilateral cooperation. All proposed programs must include an American element, either through a connection with American expert/s, organization/s, or institutions/s, usage of American educational/informational resources, or any other activities that promote or contribute to increased mutual understanding between the people of the United States and people of Tajikistan. Competitive proposals will promote continued and sustainable cooperation between the people of the United States and Tajikistan even after the project concludes. Competitive proposals will include partnership with Tajik governmental bodies, and to organizations that have a demonstrated track record of implementing such programs. Examples of programs could include, but are not limited to: Academic or professional exchanges, lectures, seminars, trainings, speaker programs, or workshops; and Artistic, cultural, or sports workshops, masterclasses, joint performances, and/or exhibitions. PDS welcomes proposals that support one of the following priority program areas: TOPIC 1: Counter Gender-based Violence (GBV) Domestic violence (DV) and gender-based violence (GBV) remains a serious issue in Tajikistan and much of the world. In a USAID-funded survey in Tajikistan, 97% of men and 60% of women believed spousal abuse was justified. Cases of GBV and DV are underreported because victims wish to avoid humiliation, reprisal, or social stigmatization, or believe it may have been warranted. Further, authorities wishing to promote traditional gender roles frequently dismiss domestic violence as a family matter or only gave a warning or fine. Government resources for survivors are also limited. Project Audience(s) may include: Religiously or socially conservative communities, especially Tajik men (18-50 years old) High school students (14-18 years old.) Youth and emerging leaders (18-35 years old.) University teachers and students. Labor migrants and spouses of labor migrants. Tajik advocacy groups. Government bodies. Independent media including bloggers and vloggers Countering Gender-Based Violence Project Goal: Empower civil society and communities in Tajikistan to prevent and prosecute cases of Domestic Violence (DV) or Gender-Based Violence (GBV) through community-led initiatives. Project Objectives (may address one or more of the following): Messaging campaigns or awareness raising activities, such as sports diplomacy, should engage and target both men and women. Having men as the face of campaigns, or having men speak to men standing against GBV, demonstrates solidarity and emphasizes that eradicating gender-based violence is the collective responsibility of everyone, regardless of gender. Improve collaboration between civil society, independent media, and the government to identify and address gaps in existing laws and policies that criminalize GBV/DV, provide protections for victims, and establish legal frameworks for persecution. Raise awareness among vulnerable populations about laws, rights, and support services concerning early marriage, domestic abuse, harassment, divorce, alimony, and other civil rights. TOPIC 2: Promoting Women s Economic Empowerment and Entrepreneurship Due to the high rate of male labor migration and unemployment, more Tajik women are exploring ways to financially support their households and communities. However, women entrepreneurs' activities are highly dependent on the effectiveness of the business environment in the country. Moreover, the mountainous regions throughout the country challenge the development of entrepreneurship, as does lack of information, limited access to financing for starting a business, and other socio-economic conditions. Nevertheless, successful small business development creates new employment opportunities in Tajikistan and helps women support themselves and their families. Small businesses are fast becoming the main source of income for women in Tajikistan. Proposed projects should enhance women s participation, promotion, and longevity in the Tajik economy and ability to assume leadership positions. Projects should clearly support the protection of economic rights for women and increase respect for women s rights in society to improve their independence and proactive role in Tajik society. Project Audience(s) may include: Women from rural areas (including the spouses of labor migrants) and women entrepreneurs. Small businesses in rural areas. Business associations. Financial and government institutions. Tourism agencies (including guesthouse and small hotels). Community leaders and youth demonstrating leadership potential in these areas. Women s Economic Empowerment Project Goal: Increase the capacity of women from underserved, rural communities, including the spouses of labor migrants, to participate or increase their participation in the Tajik economy. Improve women's economic opportunities in Tajikistan by increasing the capacity of women to start, establish, or expand their own companies. Project Objectives (may address one or more of the following): Develop the business and technical skills of women in rural communities to increase employability, launch and/or improve their own businesses. Establish and conduct activities with a professional network for women from under-represented communities, including the spouses of labor migrants, to support mentorship relationships and collaborative initiatives among network members that go beyond the conclusion of project activities. o Projects could connect women s entrepreneurship in the development of tourism around newly recognized UNESCO heritage sites. o Increase awareness of tourism initiatives and employment opportunities centered around newly designated UNESCO heritage sites. o Projects could seek to increase participation of women from underserved and target communities in the fields of Science, Technology, Engineering, and Mathematics (STEM). Increase women s knowledge and understanding about their legal rights in society and how to advocate for the respect of those rights. o Increase women s knowledge and understanding about their legal rights in the workplace, including rights related to employment, equal pay, job security, and access to economic opportunities. o Equip Tajik women with the ability to advocate for the recognition and enforcement of these rights. Promote women s economic empowerment and entrepreneurship through support from start-up hubs, corporate social responsibility, and/or access to finance. Emphasis should be placed on strengthening chambers of commerce, entrepreneurs, and core private sector industries through interactions or linkages with U.S. counterparts. o Facilitate access to funding resources and financing opportunities for women entrepreneurs to launch and grow their businesses. o Strengthen organizational capacities of chambers of commerce to support business development of aspiring female entrepreneurs. o Facilitate interactions and linkages between women entrepreneurs, chambers of commerce, startup hubs, and private sector industries in Tajikistan and their U.S. counterparts. TOPIC 3: Sharing America with Tajikistan The United States values innovation, creativity, critical thinking, freedom of expression, democratic principles, economic growth, and security. The United States supports a sovereign and independent Tajikistan, which includes support for a well-informed, discerning public who can inoculate itself against disinformation. Both the United States and Tajikistan have rich cultural traditions as shown in literature and storytelling, theater and performing arts, film, music, dance, sport, and education. Educational, cultural, and other exchange activities are a great way to engage the public, especially at-risk youth and those with neutral views or misconceptions about the United States, in order to bridge our cultures, deepen understanding, and discuss topics of mutual importance. Proposed projects should strengthen understanding between the United States and Tajikistan and advance areas of mutual interest by leveraging the experiences and lessons learned from the United States, while respecting cultural differences. Project Audience(s) may include: Tajik audiences who have not had exposure to the United States before. Youth 16-35. Academia, professors, and teachers. Civil society, non-government organizations, and associations/organizations promoting shared values or areas of mutual interest. Information professionals (media outlets, managers, editors, journalists, influencers). Religious and community leaders. Entrepreneurs and business community advocacy organizations. National and subnational government officials. Project Goal: To share American values, such as freedom of expression, respect for human rights, and celebrate/promote respect for diversity and social inclusion, while also improving access to objective information and increase media literacy and critical thinking skills to analyze mis and disinformation aimed at the United States. Project Objectives (may address one or more of the following): Raise awareness about shared U.S.-Tajik values and partnerships through trainings, workshops, masterclasses, joint performances, or other projects by U.S. and/or Tajik experts. Increase access to American content by Tajik audiences (such as book translations) that promote U.S. democratic and rights-based values. Increase collaboration between local, state, and civil society actors/stakeholders on well-defined social issues affecting both the United States and Tajikistan by sharing U.S. models of government-community engagement, or by working with U.S. experts/peers. Increase the effectiveness of individuals, organizations, and coalitions working to advance and/or advocate for respect and the promotion of human rights. Strengthen the ability of Tajik media professionals to develop accurate and fact-based informational media campaigns through digital skills building and training initiatives based on U.S.-best practices. Increase production and publication of objective, fact-based and editorially diverse media content by Tajik media professionals. Increase critical thinking skills, especially for youth and publics with a neutral or view or misconceptions about the United States, to identify and critically analyze sources of misinformation and disinformation. In addition to the specific requirements listed above by program area, all proposals must: 1. Clearly indicate the primary activity area to which it is being submitted for consideration. 2. Focus on the key public diplomacy audiences and activities specified in the areas, provide programs for underserved geographic regions of Tajikistan, as well as non-elite schools (if applicable); 3. Clearly delineate how elements of their program will have a multiplier effect and be sustainable beyond the life of the grant; 4. Provide a traditional and/or social media plan for marketing program activities and outcome, if applicable 5. Identify the cities/districts in which activities will take place. 6. Identify specific outcomes to be achieved by the end of the grant period. 7. Identify any tools (surveys, beneficiary interviews, focus groups, etc.) that will be developed for Monitoring and Evaluation purposes. Applicants must also demonstrate competency to manage all financial aspects of the project, including participant costs and transparent arrangements of sub-grant relationships with partner organizations, if applicable.

Arkansas Development Finance Authority (ADFA)

ADFA provides financing and grants for small businesses in Arkansas, supporting capital investment, job creation, and business expansion in both urban and rural areas of the state.

Arkansas Rural Development Commission

The Rural Development Commission supports projects that improve quality of life in rural Arkansas communities, funding healthcare access, broadband expansion, workforce development, and essential services for underserved areas.

Government of British Columbia

The Rural Dividend Fund supports economic diversification, workforce development, community infrastructure, and innovation projects in rural BC communities.

Birla Foundation

Funds education, healthcare, and rural development across India through Aditya Birla Group philanthropy.

Blandin Foundation

Community leadership and broadband development in rural Minnesota

NCATS - National Center for Advancing Translational Sciences

Modified Project Summary/Abstract Section Although health disparities between rural and urban communities have been known for decades2–5, there is evidence individuals from rural areas are less likely to participate in translational research and clinical trials6. Rural communities face higher mortality than urban communities for the six leading causes of death in the US–heart disease, cancer, unintentional injuries, COVID-19, stroke, and chronic lower respiratory disease.20–23 This has been referred to as the ‘rural mortality penalty’ as rural areas show slower declines in mortality compared to urban areas.14,24 Barriers to research participation among rural populations include participation costs (e.g., travel time, monetary), limited Internet connectivity, and socio-cultural barriers (e.g., perceived lack of anonymity)6. NCATS’s More Treatments for All People More Quickly initiative outlines the need to develop effective treatments that can reach underserved populations, which highlights the need for a research tool that can collect data and administer interventions in the privacy of participants homes regardless of Internet connectivity. Given the ubiquity of smartphones (~90% ownership in rural areas), the planned research will test the Wear-IT app,7 a smartphone research platform that can reduce barriers for rural populations by 1) ensuring a fast and responsive experience even when Internet is limited; and 2) delivering automatic, personalized interventions. Wear-IT is unique in the mHealth space due to its on-device processing model which allows for real-time responsiveness when Internet is unavailable7 with data uploaded to the cloud for more computationally intense processing when a participant passively encounters better connectivity (e.g., travel to town, WiFi). Wear-IT can flexibly assess complex clinical targets through multi-modal ecological momentary assessments (EMA) including video, photo, geolocation, and survey responses. On-device processing of multi-modal EMA or sensor data (e.g., step count) also enables delivery of just-in-time adaptative interventions (JITAI)7, which aim to provide personalized information or support at the exact moment it is needed.8 The proposed study will demonstrate the translational and clinical utility of Wear-IT by assessing diet-related health behaviors in 100 rural families with children from the Appalachian region. Using Federal Communications Commission fixed and mobile Broadband coverage data, targeted recruitment will ensure half the families (n = 50) have at-home Broadband and half (n = 50) have poor/no at-home Internet. Parents will use the Wear-IT app for three weeks. During the 3-week period, parents will receive EMA prompts and JITAI messages related to the three diet-related health behaviors: 1) home food environment; 2) home meals; and 3) food shopping (Figure 1). Assessing the acceptability and feasibility of Wear-It in rural communities will help to increase rural representation in health research and clinical trials, which is the first step in addressing persistent health disparities in rural communities.

FIC - John E. Fogarty International Center for Advanced Study in the Health Sciences

This IRSDA K-award will provide me with mentored research and career development training to build expertise in translating global health findings to benefit U.S. populations and underserved healthcare systems. I will learn to validate neurocognitive impairment (NI) screening tools and analyze inflammatory biomarkers that predict NI in meningitis patients with or without HIV in rural, northern Uganda, an area of high meningitis burden within Africa’s meningitis belt. Meningitis affects over 2.5 million people globally each year, and causes significant disability, with 20-32% of survivors experiencing long-term morbidity and 14-38% developing prolonged NI, yet data on NI burden in meningitis patients remain scarce. Despite evidence that inflammation in central nervous system infections is associated with NI, limited information is available about the biomarkers involved in NI development. This study seeks to fill the gaps in our understanding of the burden and pathogenesis of NI by identifying which brain injury biomarkers are expressed in patients with NI and can be used to predict NI development among meningitis patients with and without HIV. This study will be embedded within my primary mentor’s existing Meningitis Diagnosis and Treatment Program (MEN-DTP) at Lira Regional Referral Hospital in northern Uganda, which focuses on understanding mortality due to various meningitis etiologies in an area with high meningitis and HIV burden. Aim 1 is to validate neurocognitive assessment tools to determine the burden of NI among meningitis patients living with and without HIV, including follow-up for two years to assess long- and short-term NI burden. Aim 2 is to identify clinical parameters and immune/inflammatory biomarkers predictive of NI. Serum and CSF samples will be collected from meningitis patients who do or do not develop NI to identify biomarkers specifically associated with NI. Investigating immunologic and brain injury biomarkers will provide insights into inflammatory pathways activated by meningitis that lead to NI in those with or without HIV. Our neurocognitive assessments will help determine the true burden of NI and enable timely diagnoses and interventions. Our findings from this high-burden setting will inform neurocognitive assessment and early intervention strategies to improve care for meningitis patients that could be implemented in underserved U.S. populations and globally.

Bush Foundation

Leadership development for rural community leaders in the upper Midwest