# Mental Health and Cognition in HIV Infection in Rakai Uganda

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2020 · $580,077

## Abstract

Mental health disorders including depression and neurocognitive impairment (NCI) are the most common central
nervous system (CNS) complications of HIV infection despite effective antiretroviral therapy (ART). It is estimated
that 40-50% of HIV+ individuals have at least one mental health disorder. Uganda, a low-income country in Sub-
Saharan Africa (SSA) has ~1.5 million people living with HIV (PLWH) many of whom are on ART. Despite ART
use, CNS complications, which are notably heterogeneous, persist among PLWH. Uganda provides a unique
setting for advancing our understanding of major depressive disorder [MDD] and NCI, because common
confounding conditions in the United States such as cerebrovascular disease risk factors and illicit drug use (e.g.,
narcotics, cocaine) are rare in Uganda. We propose to address the overarching hypothesis that there is
substantial heterogeneity in MDD and NCI in PLWH and that psychosocial determinants (e.g., sexual and physical
trauma, violence) are likely contributors to this heterogeneity. Addressing the heterogeneity in MDD and NCI is
critical to advancing our understanding of cognitive phenotypes. To accomplish our aims, we will use a novel
methodology for mental health in HIV research, the NIMH Research Domain Criteria (RDoC) framework, which
recognizes heterogeneity, to first examine behavioral phenotypes among PLWH followed by studies to
understand the functional consequences of these phenotypes and the underlying pathophysiology in these
phenotypes. Our study results should lead to more accurate diagnosis, prognosis, and targeted interventions for
MDD and NCI in HIV infection globally. We plan to cost-effectively leverage the established infrastructure and
data from our previous Rakai Neurology Cohort Study to examine the following aims: Aim 1: Examine separate
and interactive effects of HIV and psychosocial determinants on CNS dysfunction in PLWH. Hyp 1. Exposure to
sexual/physical trauma or violence will interact with HIV in this population and will be associated with greater
impairments/decline in declarative memory, cognitive control, and NVS. Aim 2: Examine effects of psychosocial
determinants and CNS dysfunction on ART adherence in PLWH. Hyp 2. Exposure to sexual/physical trauma or
violence and/or impairments/decline in declarative memory, cognitive control, and NVS will adversely affect ART
adherence. Exploratory Aim 3: Determine biomarkers that relate most strongly and reliably to CNS dysfunction
in the context of HIV and/or psychosocial determinants. Hyp 3: Different biomarkers of neuronal damage and
CNS inflammation will relate to patterns of impairment/decline in declarative memory, cognitive control, motor,
and NVS in the context of HIV and/or exposure to sexual/physical trauma or violence. We will also build capacity
to evaluate and conduct research in mental health disorders and introduce new measures of adherence to our
cohort. Our proposal addresses several high priority research topics for t...

## Key facts

- **NIH application ID:** 10000143
- **Project number:** 5R01MH120693-02
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Robert Harris Paul
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $580,077
- **Award type:** 5
- **Project period:** 2019-08-22 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10000143

## Citation

> US National Institutes of Health, RePORTER application 10000143, Mental Health and Cognition in HIV Infection in Rakai Uganda (5R01MH120693-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10000143. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*