HNRC investigators have rapidly expanded their international focus in recognition of significant research questions and methodological issues pertaining to NeuroAIDS in developing countries. The pertinent scientific questions include how human genetic factors, HIV clade differences, and socioeconomic, cultural, and environment differences (e.g., nutritional deficiencies and exposure to coinfecting pathogens) affect the epidemiology, phenomenology, pathogenesis, and treatment of neuroAIDS. Methodological issues include development of valid assessments of neurocognitive function in non-English language and non-Western cultures, and in illiterate or semiliterate persons. Addition of an International Core to the HNRC is proposed to identify opportunities for international research and to facilitate partnering between HNRC investigators and scientist-clinicians in resource-limited settings to build capacity to undertake neuroAIDS research that is responsive to the needs and circumstances of those settings, guided in 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 assistance designed to develop collaborative, investigator-initiated, fundable international research programs on NeuroAIDS. Examples of collaborations underway in the current review period, which will be expanded and diversified over the next 5 years through the International Core's activities, include the first systematic study of HIV neurocognitive complications in two risk groups in China;a developmental study of NeuroAIDS in Brazil;feasibility assessments for a future study on the incidence and course of neurocognitive impairment in serodiscordant couples in Pune, India and added exploratory discussions with investigators in Romania and South Africa. Alongside its outreach and partnering activities, the International Core also will coordinate 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 international research section of the HNRC web site that consolidates information and facilitates access to resources, a program of on-site training and developmental grants for international colleagues (in coordination with Developmental Core), and improved communications and data management capacity at collaborating international sites.
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