HNRC investigators have rapidly expanded their international focus in recognition of significantresearch questions and methodological issues pertaining to NeuroAIDS in developing countries. Thepertinent scientific questions include how human genetic factors, HIV clade differences, andsocioeconomic, cultural, and environment differences (e.g., nutritional deficiencies and exposure to coinfectingpathogens) affect the epidemiology, phenomenology, pathogenesis, and treatment of neuroAIDS.Methodological issues include development of valid assessments of neurocognitive function in non-Englishlanguage and non-Western cultures, and in illiterate or semiliterate persons. Addition of an InternationalCore to the HNRC is proposed to identify opportunities for international research and to facilitate partneringbetween HNRC investigators and scientist-clinicians in resource-limited settings to build capacity toundertake neuroAIDS research that is responsive to the needs and circumstances of those settings, guidedin each case by the two main principles: 1) public health importance and 2) focused, feasible (pragmatic)partnering. The Core will assist in coordinating scientific consultation, mentoring, and technical assistancedesigned to develop collaborative, investigator-initiated, fundable international research programs onNeuroAIDS. Examples of collaborations underway in the current review period, which will be expanded anddiversified over the next 5 years through the International Core's activities, include the first systematic studyof HIV neurocognitive complications in two risk groups in China; a developmental study of NeuroAIDS inBrazil; feasibility assessments for a future study on the incidence and course of neurocognitive impairmentin serodiscordant couples in Pune, India and added exploratory discussions with investigators in Romaniaand South Africa. Alongside its outreach and partnering activities, the International Core also willcoordinate resources to promote training in research methodology, experience and skills building in U.S.and foreign scientific administration and regulatory requirements for international research, an internationalresearch section of the HNRC web site that consolidates information and facilitates access to resources, aprogram of on-site training and developmental grants for international colleagues (in coordination withDevelopmental Core), and improved communications and data management capacity at collaboratinginternational sites.
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