Proposal Abstract The AIDS and Cancer Specimen Resource (ACSR) is a biorepository sponsored by the NCI, with a unique focus on cancer within the context of HIV/AIDS. Recent estimates indicate that 40.4 million people are living with HIV (PWH) worldwide, with two-thirds in sub-Saharan Africa (SSA) (25.6 million), 2.1 million in Latin America (LATAM), and more than 1.1 million in the U.S. Elevated rates of cancer have been observed among PWH since the beginning of the HIV pandemic. The ACSR's central office, based at the George Washington University (GW), oversees 4 US-based Regional Biorepositories (RBR), a site in Sub-Saharan Africa (South Africa), and a site in Latin America (Brazil). The primary objectives of the ACSR in the current funding period are: [Aim 1] to obtain, preserve, organize, and fairly distribute well-documented human cancer and control biospecimens obtained from PWH; [Aim 2] to support the AIDS Malignancy Consortium (AMC) clinical trials by maintaining biorepository functions in compliance with CAP accreditation practices; and [Aim 3] to restructure the ACSR in response to criticisms in the Summary Statement from review group ZCA1 RPRB-L (M2), National Cancer Institute Special Emphasis Panel, AIDS and Cancer Specimen Resource-UM1. While the traditional aims of the ACSR (i.e., Aims 1 and 2 of this proposal) will remain the same, structural, governance, and administrative changes will be undertaken during this one-year extension. The proposed changes are designed to [1] Acknowledge the effort required to maintain essential ACSR functions, including managing current collections, acquiring new/annotated specimens, promoting ACSR for research, and overseeing the AMC Biorepository Program; [2] Create a leadership structure that aligns with the core functions of the ACSR as a biobanking resource to reduce efforts outside that scope; [3] Establish increased accountability and transparency by connecting each core function to individual members of the revised MPI team; [4] Minimize the repetition of activities among the RBRs; and [5] Create a set of centralized metrics to track ACSR achievements. Finally, a primary criticism of the Review Section was the absence of an inventory for RBRs. In this extension year, there will be a special focus on managing ACSR specimens and annotation data by a newly established informatics/inventory team based at Moffitt Cancer Center.