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GACD: Primary and Secondary Prevention of Cancer Funding Call

Call Focus: Implementation Research

Regional Focus: Low- and middle-income countries

The Medical Research Council and the National Institute for Health Research, in partnership with the Global Alliance for Chronic Diseases (GACD), are seeking to generate new knowledge on interventions and their implementation for the prevention of cancer in low and middle income countries (LMIC).

Collectively the MRC and NIHR will invest up to £6 million for this initiative. This amount is expected to fund several awards.

Proposals to this initiative cannot be submitted via JeS and must instead be submitted to the GACD portal which can be found via the GACD website.

Applications must be submitted by 16:00 GMT+1 on Thursday 30th April 2020.

Background

This request for applications is issued under the auspices of the Global Alliance for Chronic Diseases (GACD). Members of the GACD include:

  • Argentina’s Secretariat of Government of Health
  • Australian National Health and Medical Research Council
  • Brazil’s São Paulo Research Foundation
  • Canadian Institutes of Health Research
  • Chinese Academy of Medical Sciences
  • Research & Innovation Directorate General of the European Commission
  • Indian Council of Medical Research
  • Japan’s Agency for Medical Research and Development
  • New Zealand Health Research Council
  • South African Medical Research Council
  • Thailand’s Health System Research Institute
  • UK Medical Research Council
  • US National Institutes of Health

The following principles of the GACD are reflected in this request for applications:

  • Committed to improving health gains while reducing health disparities in LMICs.
  • Focused on research topics where the need for evidence to inform policy, programmes and practice is most urgent.
  • Pursuing knowledge translation and exchange approaches that are designed to maximise the public health benefits of research findings.
  • Identifying common approaches for implementation, integration and scaling up within different health systems.

It is expected that learning from individual projects will provide evidence that will support local decision-making. Cumulative learning across funded projects is expected to provide a basis for evidence-informed recommendations for national and international organisations.

To learn more about the GACD, please visit the GACD website.

Aim

With the burden of chronic non-communicable diseases rapidly increasing, the Global Alliance for Chronic Diseases (GACD) is launching a call for proposals with a focus on implementation research which examines interventions that aim to prevent cancer in low- and middle-income countries (LMIC) as defined in the DAC list of ODA recipients[AH-UM2].

Through the launch of a global call, the GACD aims to develop a global network of researchers that can enhance the cumulative learning across the individual projects, and work towards understanding how socio-economic, cultural, geopolitical and policy contexts have influenced results and how findings might be adapted and applied in different settings.

The funded researchers will form part of a Network which will meet annually to discuss their research and share information in order to develop approaches, standardise data collection, and wherever feasible to use these standardised approaches in their respective projects.

To learn more about the GACD, please visit the GACD website.

Challenge

The Global Alliance for Chronic Diseases (GACD) funding call will focus on implementation research proposals for the primary and/or secondary prevention of cancer in Low- and Middle-Income Countries (LMICs).

Cancer is becoming one of the most important public health problems worldwide and a leading cause of premature death. In 2018, an estimated 18.1 million people were diagnosed with cancer and 9.6 million died from it. Predictions suggest that 30 million people will die from cancer each year by 2030, of which 75% will be in LMICs. This increase may be attributed to aging societies, high prevalence of cancer risk behaviours, as well as the epidemiologic transition and socio-economic inequalities that result in untimely care seeking, care provision and poor quality care in many LMIC settings.

It is estimated that 30 – 50% of all cancers are preventable. Specifically, one-third of global cancer deaths are attributable to behavioural risk factors, such as tobacco and alcohol use, low fruit and vegetable intake, obesity and lack of physical activity. Tobacco use alone accounts for around 22% of cancer mortality. Around 25% of cancer incidence in LMICs is attributable to vaccine-preventable infections (HPV and HBV).

One challenge to reducing this burden of cancer in populations experiencing disparities worldwide is to overcome barriers in implementation of basic cancer prevention and care strategies. Implementation of effective, evidence-based interventions has been central to cancer control in many HICs. Yet, in LMICs such interventions are under-used or have limited impact because of implementation challenges that have yet to be identified, researched and addressed.

Implementation science is the study of strategies to make evidence-based interventions successful in real-world settings, with the aim of improving access to, and use of, these interventions in populations. In order to achieve the United Nations’ Sustainable Development Goal 3.4 (‘to reduce premature mortality from NCDs by one third by 2030…’) , implementation research and healthcare efforts are needed to identify and scale-up the best strategies to prevent and control cancers in LMIC countries.

Scope

Proposals must focus on implementation research for the primary and/or secondary prevention of cancer in LMICs. Proposals must build on evidence-based interventions (including cost-effectiveness) for the respective population groups under defined contextual circumstances. Research activities should focus on their implementation in real-life settings. The proposed interventions should be gender-responsive.

The aim should be to adapt and scale-up the implementation of these intervention(s) in accessible, affordable and equitable ways in order to improve the prevention and early diagnosis of cancer in real-life settings. Interventions should meet conditions and requirements of the local health and social system context and address any other contextual factors identified as possible barriers.

Each proposal should:

  • Focus on implementation research addressing prevention and/or early diagnosis strategies derived from existing knowledge about effective interventions.
  • For screening interventions, the local capacity and accessibility of confirming diagnoses and treatment must be ensured. The health care pathway for referral of positive cases must be included.
  • Include a strategy to test the proposed model of intervention and to address the socioeconomic and contextual factors of relevance to the targeted region and community.
  • Lead to a better understanding of key barriers and facilitators at local, national and/or international level that affect prevention and/or early diagnosis of cancer.
  • Align with the priorities in national/regional cancer control programme, if any.
  • Propose a pathway to embed the intervention into local, regional or national health policy and practice, addressing:
    • A strategy to include policy makers and local authorities (possibly by inclusion within the research team), as well as other relevant stakeholders such as community groups, patient groups, formal and informal carers and any other group, where ever relevant from the beginning of the project, which will contribute to the sustainability of the intervention after the end of project.
    • Relevance of project outcomes/evidence for scaling up the intervention at local, national and/or international level, including consideration of the social, cultural and economic contexts.
  • Include assessments of accessibility, reach, equity and health economic assessments as an integral part of the proposed research.

The following types of projects do not fall within the scope of this funding call:

  • Etiological work, mechanistic, or epidemiological research, which is not part of a wider study to develop implementation science approaches.
  • Replication of effectiveness studies and clinical trials testing the efficacy or effectiveness of new or established pharmacological agents (or combination of agents).
  • Clinical trials of new diagnostic tools, devices or pharmacological agents. Phase I or Phase II trials.

Research funded under GACD involves regular exchange of research findings and information across participating projects by means of cross-project working groups and annual joint meetings. Wherever feasible, projects should harmonise and standardise their data collection and exchange that data. Applicants must budget for the annual costs of two team members’ participation in one Annual Scientific Meeting (location to vary annually). Applicants must budget their involvement in GACD working groups and other GACD wide activities, beyond the lifecycle of their research project.

GACD funders explicitly encourage applications involving team members from more than one GACD member country, and will support successful proposals through co-funding between the appropriate funding agencies. Applicants will be required to meet the eligibility criteria for the relevant funding agencies and the agency’s specific funding conditions. Any applicants interested in submitting a co-funded application must contact MRC international prior to submission.

The GACD’s calls for applications have a specific focus on implementation research. We have put together a list of some resources that may help you in preparing your proposals, which are available on the GACD Implementation Science page.

Expected Impact

  • Advance local, regional or national cancer prevention and/or early diagnostic health policies, alleviating the global burden of cancer;
  • Improve affordability and tailor to local settings prevention and/or early diagnosis;
  • Establish the contextual effectiveness of cancer intervention(s) for prevention and/or early diagnosis, including at health systems level;
  • Provide evidence and recommendations to national programmes and policies focusing on prevention, screening, and/or early diagnosis;
  • Inform health service providers, policy and decision makers on effective scaling up of cancer interventions for prevention and/or early diagnosis at local, regional, and/or national levels, including affordability aspects for users and health providers;
  • Reduce health inequalities and inequities, including, but not limited to, consideration of characteristics such as socioeconomic circumstances, gender and age, where relevant in the prevention and/or early diagnosis of cancer at both local and/or global levels;
  • Maximise the use of existing relevant programmes and platforms (e.g. research, data, and delivery platforms);
  • Contribute to the United Nations’ Sustainable Development Goal 3.4[AH-UM3].

Common indicators

The GACD funding agencies aim to harmonise the research and outcomes assessment of GACD funded projects in order to maximise the potential for learning across the network and the impact of the initiative as a whole. To this end:

  • All funded teams are expected to use explicit indicators and measures of project context, reach, outcomes evaluation and scale-up potential in their plans and protocols;
  • All teams should include Implementation Research outcomes (e.g. feasibility, fidelity and/or adaptation, spread and/or penetration, acceptability, sustainability, uptake, and cost effectiveness) and where relevant, include Service outcomes: (e.g. Efficiency, Safety, Effectiveness, Equity, Patient-centeredness, Timeliness);
  • Shortly after notification of award, grantees will be given the opportunity to agree upon a common set of implementation and outcome indicators to employ across all projects, as well as sets of additional indicators that may be used by groups of similar types of projects.
  • GACD maintains a data dictionary of common indicators agreed by GACD programmes, this is an evolving document and where appropriate programmes are encouraged to use the indicators and measures in this document.

Annual network meetings

Applicants must budget for the costs of having two team members participate in one annual face-to-face meeting of the GACD Research Network (location to vary annually). Attendance at this meeting is mandatory for two team members, with at least one participant from the LMIC team where relevant. Teams are strongly encouraged to include one junior team member in each annual meeting.

Review criteria

Relevance and Quality of Project

  • Proposal fits well within the purpose and scientific remit of the funding call;
  • The selected intervention is evidence-based and the proposed work uses established implementation science models to explore adaptation and scale-up across relevant communities/context;
  • There is a strong scientific rationale for the proposed methodology to address questions or gaps in knowledge that arise from scale-up. Success is likely to lead to significant new understanding that is relevant for scientists and knowledge-users;
  • The proposed implementation and scale-up plans are appropriate and feasible to answer the needs of knowledge-user(s) and are considered best in the international field of implementation science research;
  • There is clear anticipation of system barriers (health care and other sectors) to the implementation of the interventions and a high quality of plan to manage them;
  • The relevance of the ethical considerations that might arise in the proposed program of research, and how the team plans to address them, including issues of equity and possible conflicts of interest, are well justified.

Quality of Team

  • The multidisciplinary team members have a high-quality track record in fields related to the proposed implementation research and the team has the right balance of expertise given the goal(s) of the research project;
  • There is evidence that the research will be jointly managed by researchers from HICs and LMICs, where applicable;
  • Early career investigators are part of the team and a strong training plan for research capacity-building is included;
  • There is sound evidence that stakeholders, such as decision-makers and service delivery partners, have been actively involved in the research process including the selection and adaptation of the intervention and the research design;
  • There will be demonstrable engagement with the public and/or patient and community groups or other relevant stakeholder groups.

Feasibility of Project

  • Major scientific, technical or organizational challenges have been identified, and realistic plans to tackle them are outlined;
  • Proposed intervention strategies are relevant to the socio-political, cultural, policy and economic contexts of the study settings and the proposal demonstrates understanding of the contextual factors (e.g. health systems, intersectoral policy, governance, leadership) affecting implementation, indicating how those factors and their impact will be analysed;
  • Inequities and equity gaps, including age and gender, have been taken into account;
  • Appropriate measures of evaluation have been included. Projects that are able to track long-term clinical, public health, policy and/or health system outcomes are expected;
  • There is a clear governance plan, including evidence of ultimate accountability, shared strategic leadership, transparency in decision making, management of conflicts of interest, clearly defined roles/responsibilities/contributions, demonstrating that all key participants are highly engaged and committed;
  • There is an appropriate collaboration plan, including but not limited to communication and coordination, management and administration, conflict prevention/resolution, quality improvement, budget and resource allocation and publication approach amongst team members.

Potential Impact

  • The expected impacts, as listed in the scope above, are identified;
  • The project demonstrates alignment with international and/or national commitments to advance primary and/or secondary cancer prevention strategies;
  • The project appropriately leverages existing programs and platforms (e.g. research, data, delivery platforms), if relevant;
  • There is potential for sustaining intervention at scale;
  • There is potential for the translation of the findings into different settings.

Eligibility

This funding opportunity is jointly supported by the MRC and NIHR. MRC will be the awarding body.

Studies funded should focus upon countries with low or middle income economies. OECD definitions of low and middle income economies can be found at DAC List of ODA Recipients[AH-UM5] 

The MRC-NIHR-GACD call funds partnership working between UK researchers and researchers based in low and/or middle income countries. The Principal Investigators applying for this call must be hosted by a UK institution which is eligible for MRC funding[AH-UM6]. However, the expectation is that projects will be collaborative endeavours, with shared scientific and intellectual leadership. All projects submitted must include co-investigators from the low or middle income country(ies) where the work will take place.

The MRC will not fund research focussed on vulnerable populations in high income countries through this call. Applications to the MRC must focus on low- and middle-income countries.

It is not permitted for the same person to be Principal Investigator on more than one proposal submitted to this call.

If a co-investigator is based in one of the GACD partner countries, then the proposal may be eligible for co-funding. If the co-investigators are based in one of these countries, it is essential that you contact MRC international as soon as possible so that we can discuss potential co-funding arrangements. Please include your name, your research institution, your co-investigators’ names and research institutions, the intended title of your project and an estimation of the costs that would be required for each investigator.

How to apply

Many funding agencies will be participating in this GACD initiative, some of whom will be using a common portal submission system to receive applications. The MRC is participating in the use of this portal and as such applications must be submitted via the GACD Portal.

Please ensure you read the information available on the GACD website[AH-UM7].

Please refer to the MRC Guidance for applicants[AH-UM8]  for any other funder specific information.

Applications must be submitted by 16:00 GMT+1 on Thursday, 30th April 2020.

Applications will be reviewed by an international panel of representatives from all participating funding agencies in autumn. UK applications will only be in competition with other UK applications, but a fully international panel will ensure all funders are consistent in their review process.

Contact

Please refer all queries to: MRC international