Systems Linkages and Care Initiative to High Risk Populations Demonstration Sites | Apply Online

Opportunity Summary:

The Systems Linkages and Care Initiative to High Risk Populations Demonstration Sites (HRSA-11-098) was a discretionary grant opportunity from the Health Resources and Services Administration (HRSA) under CFDA 93.928, Special Projects of National Significance. Its core purpose was to help Ryan White HIV/AIDS Program Part B grantee organizations design and test new, practical ways to find people who are HIV-positive but not connected to care, get them linked to medical services, and keep them engaged over time. The program was built around the reality that a significant portion of people living with HIV in the United States were either unaware of their infection or, despite being diagnosed, were not receiving ongoing HIV care due to barriers like stigma, fear, unstable housing, mental health or substance use issues, distrust of systems, or previous negative experiences with providers.

The target populations were narrowly defined to focus on individuals who are at high risk for HIV and/or already infected but falling outside the care system in specific ways: people who have HIV but do not know their status, people who know they are HIV-positive but were never successfully referred into care, and people who know their status but refused referral or chose to stay out of care. In other words, the initiative was not primarily about routine clinical improvements for people already in stable treatment; it was about building stronger system-level pathways to identify, diagnose, link, and retain hard-to-reach individuals who were not showing up in traditional healthcare settings.

Applicants were expected to demonstrate that their service area had a high incidence of new HIV cases and that they had credible access to the out-of-care populations they proposed to serve. HRSA was looking for projects that could leverage existing resources and form effective partnerships across the public health and community landscape. That included coordination with surveillance systems, counseling and testing programs, community-based organizations, health departments, and other stakeholders who can identify people likely to be HIV-positive and not in care, engage them in testing or re-engagement efforts, and actively navigate them into sustained, quality HIV medical services.

A central theme of the opportunity was systems integration. HRSA emphasized models that connect parts of the public health system that often operate in silos, such as HIV surveillance data, testing and counseling services, referral networks, and clinical care providers. The goal was to create more seamless and accountable linkage and retention processes, rather than relying on passive referrals or one-time handoffs that frequently fail for people facing complex barriers. The initiative aimed to surface innovative and replicable strategies that can be adopted more broadly, especially those that demonstrate measurable success in bringing people into care who have never been in care or who have been persistently disconnected.

The award structure anticipated up to 8 grants, with an estimated total funding level of $8,000,000, and there was no cost sharing or matching requirement. Eligibility was limited to Ryan White Part B grantees of record, specifically the lead administrative agencies for all 50 states, as well as the District of Columbia, Puerto Rico, and several U.S. territories and affiliated jurisdictions including the U.S. Virgin Islands, Guam, American Samoa, the Northern Mariana Islands, Palau, the Federated States of Micronesia, and the Marshall Islands. This eligibility limitation signaled that HRSA wanted recipients with existing Ryan White infrastructure, authority, and partnerships to implement system-level linkage and retention interventions.

A major condition of funding was participation in a four-year, comprehensive, multi-site evaluation. This evaluation requirement was not an add-on; it was a key deliverable intended to identify which approaches work, under what conditions, and with which populations. The purpose was to generate evidence strong enough to support national dissemination and replication, meaning funded sites were expected to document implementation processes, outcomes, and lessons learned in a way that could inform future policy and program design beyond their local area.

Administratively, the opportunity was posted February 2, 2011, with an application closing date of April 4, 2011, and it was later archived June 3, 2011. The funding instrument type was a grant, and the activity category was health. HRSA provided a standard call center contact for technical assistance accessing the full announcement.

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