Improving identification of HIV-associated neurocognitive disorder (HAND) in Latin America: A multimodal approach to HAND in Peru

PROJECT SUMMARY This is an application for a K23 award for Dr. Monica M. Diaz, a neurologist at the University of North Carolina at Chapel Hill School of Medicine. Dr. Diaz is establishing herself as an investigator in patient-oriented clinical research at the intersect of brain health and HIV in Latin America. Dr. Diaz has been based at least half- time in Peru since 2019 where she developed a mentored pilot study assessing HIV-associated neurocognitive disorder (HAND) in older people living with HIV in Peru. The K23 award will provide Dr. Diaz with the necessary support to develop expertise in 5 key areas: 1) Qualitative research methods and analysis, 2) clinical tool validation in international settings, 3) neuropsychological assessments, 4) advanced biostatistical skills, 5) implementation science frameworks and methodology. Dr. Diaz has assembled a team of core mentors (Dr. Gwenn Garden [expert in neurocognitive disorder assessments], Dr. Victor Valcour [expert in international assessments of HAND] and Dr. Clare Barrington [mixed-methods/qualitative research expertise in Latin America] who will guide Dr. Diaz in achieving her training goals and career development. Supporting Dr. Diaz and her core mentors are three collaborators: Dr. Maria Marquine (neuropsychologist with expertise in HAND in Latinos), Dr. Michael Hudgens (biostatistician with expertise in HIV observational data) and Dr. Patricia Garcia (implementation science expert on HIV in Peru). This multi-disciplinary mentorship team embedded within a highly collaborative training environment is crucial for Dr. Diaz’s development into an independent investigator with the goal of optimizing diagnostics and treatments for brain health in people with HIV in Latin America. HAND is a pressing issue in low-and-middle-income countries with increasing access to antiretroviral therapy, highlighting the urgent need to optimize diagnostics and prediction of HAND for early interventions. Dr. Diaz’s research plan outlined in this application leverages pilot data that demonstrated that nearly 30% of people living with HIV in Lima had HAND, yet diagnostics for HAND are limited in Latin America given a lack of regional normative data and experts in neuropsychological testing. The proposed research includes a prospective cohort of patients with HIV and HIV-negative controls from two socioeconomically-distinct HIV clinics in Lima. The study seeks to adapt and validate a tablet-based cognitive screening tool currently optimized for early Alzheimer’s screening to detect HAND in Peru (Aim 1). Known modifiable risk factors for cognitive impairment, including social determinants of health, will be used to build a predictive statistical model for HAND in Peru that can identify intervenable factors (Aim 2). These two tools will be implemented, evaluated and optimized through iterative rounds of interviewing with HIV care providers (Aim 3). This K23 award will provide Dr. Diaz with the mentorship and expertise necessary to become an independent investigator to improve brain health of underserved populations with HIV in Latin America. This proposal is a crucial step toward developing a large prospective study identifying frequency and risk factors for HAND in Latin America as a future R01 grant.