Global Research Endeavors to Advance Treatment of Neurological Disorders in Africa (GREAT Neurology)

神经系统疾病的负担不成比例地影响资源有限的热带环境， 提供护理或研究的能力严重不足。这项全球研究计划旨在推动我们的 了解非洲常见的神经系统疾病，为当地预防提供信息， 治疗这些病症，同时还阐明更广泛相关的病理生理过程。这 将通过继续Birbeck博士的神经艾滋病毒和脑疟疾研究来完成 此外，还为从事广泛研究工作的年轻临床科学家提供支持和指导。 研究活动包括： ·脑型疟疾：在一项对CNS疟疾儿童的前瞻性队列研究中，我们将研究 结构损伤和神经系统发病率中神经炎症的实验室评估急性 炎症、系列神经成像和长期神经学结果。新研究人群 将包括儿童在一个随机对照试验（RCT）的积极退烧药，以及更多的 代表性非RCT人群。SARS-CoV-2复合感染对寄生虫的影响 清除率，与疟疾死亡和神经系统后遗症相关的炎症因子和结构 将确定包括局部缺血、出血和血栓形成的损伤。 ·神经艾滋病毒：鉴于艾滋病毒治疗的广泛可用性，神经艾滋病毒护理的下一个挑战是 非洲包括与慢性低度炎症相关的非传染性疾病。利用 我们的农村和城市艾滋病毒诊所网络，我们将研究艾滋病毒相关的加速老化， 神经系统鉴于其高度炎症状态，SARS-CoV-2可能会导致这种情况 负担在儿童中，我们最近报道了亚临床脑血管疾病的高发病率 (CVD)尽管长期以来，有效地治疗艾滋病毒。我们将继续进行进一步的成像研究，包括在 未感染艾滋病毒但暴露于艾滋病毒的儿童和社区控制，以确定心血管疾病的危险因素， 抗逆转录病毒疗法的代谢影响，并评估早发性心血管疾病 和SARS病毒2型感染。在感染艾滋病毒的成年人中，将评估SARS-Co-V2感染的 在一项监测认知功能的5年前瞻性队列研究中， 损伤、精神症状、中风、神经病和癫痫。 这项研究将在赞比亚和马拉维进行，Birbeck博士在那里工作了25年以上。这 研究计划奖还将提供基础设施，指导和充满活力的奖学金环境 以及与美国和非洲学者的实习接触。

The burden of neurological disorders disproportionately impacts resource-limited tropical settings resulting in grossly insufficient capacity for care provision or research. This global research program aims to advance our understanding of common neurological disorders in the African context to inform the local prevention and treatment of these conditions while also elucidating pathophysiological processes more broadly relevant. This will be accomplished through the continuation of Dr. Birbeck's neuro-HIV and cerebral malaria investigations plus support and mentorship for young clinician scientists engaged in a broad range of research endeavors. Research activities include-- • Cerebral malaria: In a prospective cohort study of children with CNS malaria, we will examine the role of neuroinflammation in structural injury and neurologic morbidity with laboratory assessments of acute inflammation, serial neuroimaging, and long term neurological outcomes. The novel study population will include children in a randomized controlled trial (RCT) of aggressive antipyretics as well as a more representative non-RCT population. The effects of co-infection with SARS-CoV-2 on parasite clearance, inflammatory factors associated with malarial death and neurologic sequelae and structural injuries including ischemia, bleeding, and thromboses will be ascertained. • Neuro-HIV: Given the widespread availability of HIV therapies, the next challenge in neuro-HIV care in Africa includes noncommunicable disorders associated with chronic low grade inflammation. Utilizing our network of rural and urban HIV clinics, we will study HIV-associated accelerated aging of the nervous system. Given its highly inflammatory state, SARS-CoV-2 could potentially contribute to this burden. Among children, we have recently reported high rates of subclinical cerebrovascular disease (CVD) despite long-standing, effectively treated HIV. We will pursue further imaging studies including in HIV uninfected but exposed children and community controls to identify risk factors for CVD, examine the metabolic impact of antiretroviral therapies and assess the relationship between premature CVD and infection with SARS-Co-V2. Among adults with HIV, SARS-Co-V2 infection will be evaluated for its possible role in accelerated aging in a 5-year prospective cohort study monitoring for cognitive impairment, psychiatric symptoms, strokes, neuropathies and seizures. This research will be undertaken in Zambia and Malawi where Dr. Birbeck has worked for over 25 years. This research program award will also provide infrastructure, mentorship and a vibrant environment for scholarship and trainee engagement with both US and African academics.