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NCI Affordable Cancer Technologies Program

CGH Program/Initiative Type: Cancer Research and Research Networks

The Affordable Cancer Technologies (ACTs) Program supports innovative, impactful research that addresses key scientific issues in global cancer control, and leverages unique scientific opportunities afforded by global collaboration.

Prevention, early detection, diagnosis, and treatment are vital to successful cancer control. Unfortunately, many established cancer control technologies are not suitable for use in low-resource settings, either globally or in the U.S., due to expense, dependency on extensive medical infrastructure, or both. The ACTs Program supports resource-appropriate translational technology research and development for cancer, while ensuring affordability and potential impact in low-resource settings as essential design components.

The ACTs Program represents a continuum of technology development that begins with an existing prototype technology and ends with clinical implementation studies. Technologies supported through the ACTs Program are expected to be validated in real-world health settings in low- and middle-income countries (LMICs), which leads to the promise of additional  innovations. Examples of this are technologies that enable use by minimally trained health workers, are appropriate for use at the clinical point-of-need or allow robust adaptability to diverse environmental conditions and health systems. It is important to note that exploratory research is not supported by the ACTs Program.

Research Scope

The ACTs Program encourages investigators to adapt, engineer, and apply new technologies for global cancer control. All ACTs Program supported projects explicitly consider affordability and cost effectiveness in local health settings.

The ACTs Program requires investigators to focus on preventable and/or treatable cancers in an LMIC setting and demonstrate utility of the proposed technology to improve cancer outcomes.  This requires the project to focus on real-world implementation. Thus, end-user design and implementation science considerations are critical. Examples of these technologies include, but are not limited to:

  • New platforms for risk assessment, early detection, and in vitro diagnosis (e.g., lab-on-a-chip and biosensor technologies that allow performance of the chemical and biological assays outside of labs at point-of-care or point-of-need);
  • New imaging modalities (e.g., optical imaging, spectroscopy, and portable, hand-held ultrasound);
  • New treatment modalities (e.g., cryotherapy and photodynamic therapy); and
  • New decision tools (e.g., machine learning and artificial intelligence, image analysis, and robotics).

Furthermore, environmental conditions, such as heat, humidity, and erratic electricity, pose significant challenges for medical devices outside of clinical laboratory settings. ACTs supported technologies should seek to address these critical challenges by focusing on design-supported usability at the point-of-need. Such characteristics may include:

  • Ease of use: the device, technology, or assay must be suitable for use in the chosen setting by frontline healthcare workers/caregivers with minimal training in its operation and maintenance;
  • Operability in locations with limited clinical infrastructure (e.g., limited access to electricity, landline communication, refrigeration, or central water supply); or
  • Design for use at the community level and/or in non-traditional healthcare settings.

Desirable attributes for ACTs technologies may also include:

  • Rapid results (for diagnostic technologies);
  • Risk stratified approaches for risk assessment, early detection, or screening technologies;
  • Connectivity to the internet or telephone network (e.g., to allow for telemedicine);
  • Modular design to increase reliability, ease-of-use, and to simplify maintenance;
  • Incorporation of internal checks of device/assay performance, self-calibration, and error diagnosis;
  • Open source hardware or software; or
  • Standard readily available off-the-shelf components, such as power supplies, software, or approved imaging probes.

Frequently Asked Questions

What is an LMIC?
The NCI uses the World Bank Country and Lending Groups to categorize low- and middle-income countries (LMICs) for potential research sites and partnerships. Each ACTs grant must propose work in at least one LMIC project site and include LMIC investigators in the key personnel.

Can I propose work in an upper middle-income country?
While work in upper middle-income countries is permitted, they will not count towards the requirement for an LMIC project site.

Should I include LMIC site personnel in the application?
Research equity and parity in research collaboration is an essential aspect of the ACTs Program. All ACTs projects must conduct research in an LMIC and include LMIC investigators in the senior personnel. For projects including scientists in both high-income countries (HICs) and LMICs, key personnel should contribute intellectually to the development of the research proposal and planned research activities.

Does ACTs support traditional hypothesis-driven research?
No. ACTs supports pragmatic translational technology research only.

What is meant by the term ‘technology’?
In general, technology refers to instruments, devices, platforms, tools, and associated techniques or methods.

How much emphasis does the ACTs Program place on innovation?
The ACTs Program is focused on end-user design and the development of affordable and cost-effective technologies studied in local healthcare settings. Innovation for this program should be demonstrated through these design components, as well as the ultimate functionality and usability of the device or assay at the point-of-need.

Can multiple HIC institutions be part of the application?
Yes. We recognize that multidisciplinary teams needed for a successful ACTs application may require key personnel and experts from a variety of institutions.   

Can multiple LMIC institutions be part of the application?
Yes. Multi-site validation requiring sites in multiple LMICs can be an important component of some ACTs projects. When including multiple LMICs, it is essential that individuals from those institutions are represented in the key personnel and contribute intellectually to the research studies. 

How should the Milestones and Timelines section of the application be structured?
ACTs applications must include a specific section labeled Milestones and Timelines as a part of the Research Strategy portion of the application. Specific aims may not be regarded as milestones (unless they include quantitative end points). Specific aims describe the goals and intended path of the research, while milestones are a way of determining whether an applicant has successfully reached the specified goals. Milestones should be clearly stated and presented in a quantitative manner (e.g., numerical specifications of sensitivity and specificity or a count of some desired detection target, etc.), and include all of the following:

  • A timeline (Gantt chart) identifying milestones throughout the duration of the project is required.
  • Milestones are goals that create go/no-go decision points in the project and must include clear and quantitative objective criteria for success.
  • Annual milestones should function as indicators of a project's continued progress, revealing emergent difficulties, and will be used to evaluate the application in peer review and in consideration of continued funding for awarded projects in non-competing award years.
  • Milestones should be well described, quantitative, and scientifically justified.

Examples of possible milestones/quantitative performance measures:

  • Detection of a targeted cancer cell in 109 normal cells;
  • Demonstration that the measured analyte is highly correlated (Pearson correlation coefficient r >0.95) for a cancer question in a given human biospecimen when analyzed on different days. This should include mean, standard deviation, and relative standard deviation for repeatability targets superior to next best approach (if applicable);
  • Reduction of sequence read errors to one in 5,000,000 base pairs;
  • Demonstration that the technology gives the same result in 95 out of 100 assays;
  • Demonstration that the technology has >95% analytical and clinical sensitivity and specificity;
  • Demonstration that the technology has high positive and negative predictive value; and
  • Demonstration that the technology can be n-fold faster, n-fold more sensitive, or n-fold more specific, etc. than the current "gold standard" technology.

Note: Applications lacking quantitative milestones, as determined by NCI program staff, will be returned to the applicant without review.

For applications including both HIC and LMIC investigators, is it expected the HIC PD/PI have worked in an LMIC?
No. Previous work in the LMIC is not expected for the HIC PI in applications including both HIC and LMIC investigators. Nevertheless, in such instances, evidence of past collaborations will strengthen the application.

What is the impact of 2 CFR 200.216,(Prohibition on certain telecommunication and video surveillance services or equipment) on international collaborations and direct foreign awards?
NIH Guide Notice NOT-OD-21-041 summarizes new requirements for grant and contact recipients regarding use of federal funds prohibited telecommunications providers. Please also refer to the FAQs for the guide notice and the Office of Management and Budget FAQs on these requirements.

For all awards at NIH, please note the following points:

  • This requirement applies to grants and contracts and both direct and indirect costs.
  • A grantee can use a prohibited provider as part of their grant; however, they cannot use NIH or USG funds to pay for their services or equipment.  Grantee organizations must re-budget funds accordingly.
  • There is no waiver process, nor exemptions or exceptions.

Who can apply to this RFA? Are industry applicants welcome? Are foreign institutions eligible?
Eligibility is addressed in Section III of the FOA. Eligibility is inclusive of applications from industry and foreign institutions.

What is the guidance for travel expenses?
Please refer to the Travel Expense Guidance from NIH Grants Policy Statement:

Is new technology development allowed or encouraged?
Investigators are required to adapt, apply, and/or engineer an existing prototype or existing device/assay/treatment for use in a low-resource setting. Projects making use of technologies for which an initial proof-of-concept has not already been demonstrated in cancer-relevant biological system/ technologies not ready for advanced development and validation without substantial further developmental efforts are not responsive to this RFA.

Are technologies that have been commercialized eligible?
Investigators are required to adapt, apply, and/or engineer an existing prototype or existing device/assay/treatment for use in a low-resource setting.  This may include devices that have already been commercialized.

Can you comment on level of validation required for something to “count” as a validated biomarker?
Validation data should be sufficient to convince a peer review panel that the proposed translational technology research with the device or assay can go forward without the need for additional validation of new biomarkers.

What is the expectation for showing path to future commercialization, FDA clearance, etc.?   Is a detailed plan expected or somewhat of a high-level approach?
Because this initiative is translational in nature and the goal of the program is ultimately high uptake of interventions in the community, addressing the path to commercialization and regulatory clearances is valuable and will be considered at a high level by reviewers, but this program will ultimately be primarily judged on the core design and engineering components of the project as well as the clinical validation studies in LMICs, not on proposed commercially-driven activities.

Must applicants address FDE Investigational Device Exemption (IDE) requirements even though work is taking place at foreign sites? Is demonstration of regulatory approvals in the LMIC setting sufficient?
This is project-specific and should be discussed with local IRBs, regulatory agencies, and key stakeholders. The ACTs-supported technology must comply with the applicable regulations and international standards/guidelines [such as Good Laboratory Practice (GLP), Good Manufacturing Practice (GMP), WHO guidelines, FDA Investigational New Drug (IND), FDA Investigational Device Exemption (IDE)or local regulations in LMICs].

Program Management

As a trans-divisional initiative, the ACTs Program management team includes representatives from many Divisions, Offices, and Centers of the National Cancer Institute. The trans-divisional, interdisciplinary nature of the management team is a unique feature and strength of the ACTs Program which promotes a more consolidated and balanced representation of technology interests and needs across the NCI.

Division, Office, or Center Representative(s) Email
Center for Global Health Paul C. Pearlman, Ph.D.
Division of Cancer Control and Population Sciences Rao L. Divi, Ph.D.
Division of Cancer Prevention Jacob Kagan, Ph.D.
Christos Patriotis, Ph.D.
Jo Ann Rinaudo, Ph.D.
Matthew Young, Ph.D.
Vikrant Sahasrabuddhe, M.B.B.S., M.PH., Dr.PH.
Division of Cancer Treatment and Diagnosis Biorepositories & Biospecimen Research
Lokesh Agrawal, Ph.D.
Diagnostic Biomarkers & Technology
Miguel R. Ossandon, Ph.D.
Brian Sorg, Ph.D., M.B.A.
Cancer Imaging
Houston Baker, Ph.D.
Pushpa Tandon, Ph.D.
Radiation Oncology
Bhadrasain Vikram, M.D.
Office of HIV and AIDS Malignancy Rebecca Liddell Huppi, Ph.D.
Center to Reduce Cancer Health Disparities Tiffany Wallace, Ph.D.
Center for Strategic Scientific Initiatives Tony Dickherber, Ph.D.
SBIR Development Center Ming Zhao, Ph.D.

Previously Funded Awards

Click on any project title for a more detailed description of the project. For a list of CGH's current funding opportunities, visit Funding for Global Research and Training.

Year Award Type FOA Title PI/Project Leader Institution
2020 R43 PAR-18-801 Optimizing delivery of ethyl cellulose ethanol for ablation of cervical precancer ASIEDU, MERCY NYAMEWAA CALLA HEALTH FOUNDATION
2020 R41 PAR-18-802 Serum Detection of Medulloblastoma Metastasis LI, YUANCHENG 5M BIOMED, LLC
2020 R41 PAR-18-802 Clinical Cytophone platform for detection of circulating melanoma cells SUEN, JAMES CYTOASTRA, LLC
2019 R44 PAR-18-801 Innovations in cervical cancer diagnosis for low resource settings using advanced optical imaging and machine learning diagnostic algorithms JUNKER, MARLEE CALLA HEALTH FOUNDATION
2019 R43 PAR-18-801 Broad Spectrum Thermostable Single dose Papillomavirus-like Particles (VLP) for the prevention of all HPV-associated cancers WANG, JOSHUA WEIYUAN PATHOVAX, LLC
2019 R41 PAR-18-802 Identifying hereditary cancer patients in low-resource community cancer settings using an innovative informatics solution WELCH, BRANDON M ITRUNSINMYFAMILY.COM, INC.
2019 R44 PAR-18-801 Practical Implementation of an Ultra-rapid FLASH Radiation Therapy Linac Beamline BHARADWAJ, VINOD TIBARAY, INC.
2017 UG3 RFA-CA-15-024 Field-deployable platform for prognostic hepatic cancer screening in low-resource settings PORTER, MARC D UNIVERSITY OF UTAH
2017 UG3/UH3 RFA-CA-15-024 Facile screening for esophageal cancer in LMICs MELTZER, STEPHEN J JOHNS HOPKINS UNIVERSITY
2017 UG3/UH3 RFA-CA-15-024 Digital PCR quantification of BCR-ABL for CML diagnosis and monitoring in a LMICs setting CHIU, DANIEL T UNIVERSITY OF WASHINGTON
2017 UG3/UH3 RFA-CA-15-024 Rapid Point of Care Detection of HPV-Associated Malignancies ANDERSON, KAREN S ARIZONA STATE UNIVERSITY-TEMPE CAMPUS
2017 UG3/UH3 RFA-CA-15-024 Smartphone Enabled Point-of-Care Detection of Serum Markers of Liver Cancer CHILKOTI, ASHUTOSH DUKE UNIVERSITY
2017 UG3/UH3 RFA-CA-15-024 A cost-effective radiation treatment delivery system for the low- and middle-income countries FORD, ERIC C UNIVERSITY OF WASHINGTON
2017 UG3/UH3 RFA-CA-15-024 Point of care, real-time urine metabolomics test to diagnose colorectal cancers and polyps in low- and middle-income countries KINGHAM, T PETER SLOAN-KETTERING INST CAN RESEARCH
2016 UH2/UH3 RFA-CA-15-001 The Radiation Planning Assistant (RPA) for Radiation Therapy Planning in Low- and Middle-Income Countries COURT, LAURENCE E UNIVERSITY OF TX MD ANDERSON CAN CTR
2016 UH2/UH3 RFA-CA-15-001 Early Stage Diagnosis of Kaposi's Sarcoma in Limited Resource Settings using KS-Detect ERICKSON, DAVID CARL CORNELL UNIVERSITY
2016 UH2/UH3 RFA-CA-15-001 Cytology-Free POC Cervical Cancer Diagnostics for Global Health WEIDEMAIER, KRISTIN BECTON, DICKINSON AND COMPANY
2016 UH2/UH3 RFA-CA-15-001 Smartphone for molecular cancer diagnostic in Africa WEISSLEDER, RALPH MASSACHUSETTS GENERAL HOSPITAL
2016 UH2/UH3 RFA-CA-15-001 Low-cost Mobile Oral Cancer Screening for Low Resource Setting LIANG, RONGGUANG UNIVERSITY OF ARIZONA
2016 UH2/UH3 RFA-CA-15-001 Development and clinical validation of a multi-type HPV E6/E7 oncoprotein test for cervical cancer screening and triage in low- and middle-income countries HERRERO, ROLANDO INTERNATIONAL AGENCY FOR RES ON CANCER
2016 UH2/UH3 RFA-CA-15-001 Development, field testing and evaluation of the efficacy of a hand-held, portable and affordable thermo-coagulator to prevent cervical cancer in low- and middle-income countries SANKARANARAYANAN, RENGASWAMY INTERNATIONAL AGENCY FOR RES ON CANCER
2014 UH2/UH3 RFA-CA-13-015 Low Cost Automated Ultrasound for Breast Cancer Detection and Diagnosis LOVE, SUSAN M DR. SUSAN LOVE RESEARCH FOUNDATION
2014 UH2/UH3 RFA-CA-13-015 Improving specificity of HPV Screen-and-Treat in South Africa KUHN, LOUISE COLUMBIA UNIVERSITY HEALTH SCIENCES
2014 UH2 RFA-CA-13-015 Active Viral Hepatitis Diagnostics to Support Prevention/Treatment of HCC MURPHY, ROBERT L NORTHWESTERN UNIVERSITY
2014 UH2/UH3 RFA-CA-13-015 Performance, safety, and efficacy of a new cyrotherapy device for cervical dyspla ANDERSON, JEAN JOHNS HOPKINS UNIVERSITY
2014 UH2/UH3 RFA-CA-13-015 Low-cost Enabling Technology for Image-guided Photodynamic Therapy (PDT) of Oral HASAN, TAYYABA MASSACHUSETTS GENERAL HOSPITAL
2014 UH2/UH3 RFA-CA-13-015 Point-of-Care Diagnostic Tools to Improve Global Cervical Cancer Control Programs SCHMELER, KATHLEEN RICE UNIVERSITY
2014 UH2/UH3 RFA-CA-13-015 CryoPen: An Innovative Treatment for Cervical Precancer in Low-Resource Setting CREMER, MIRIAM CLEVELAND CLINIC LERNER COM-CWRU