Structural Community Governance: Importance for Community-Academic Research Partnerships.

Community based participatory research (CBPR) emphasizes democratic knowledge production and joint action between academics and communities to promote health equity through multilevel interventions. While much scholarship has expressed a commitment to collaboration between researchers and communities, effective methods of structural governance between community and academic stakeholders is under explored. We fill this gap by presenting a conceptual and empirical analysis describing multiple dimensions of structural governance in CBPR partnerships. First, we integrate public policy evidence on effective collaborative governance designs with the emerging literature in CBPR to create a conceptual model. Next, we utilize internet surveys of 179 federally funded community engaged research projects to construct and assess a measure of structural governance across multiple dimensions using confirmatory factor analysis. We explore whether antecedent factors such as the stage of the partnership and ethnic composition are associated with these dimensions and we examine associations for each of these components on positive perceptions of community involvement of research and collective empowerment. We develop a robust multidimensional measure of structural governance that is positively associated with perceptions of increased community involvement in research and collective empowerment.

White matter measures are near normal in controlled HIV infection except in those with cognitive impairment and longer HIV duration.

The objective of the current study was to quantify the degree of white matter (WM) abnormalities in chronic and virally suppressed HIV-infected (HIV+) persons while carefully taking into account demographic and disease factors. Diffusion tensor imaging (DTI) was conducted in 40 HIV- and 82 HIV+ men with comparable demographics and life style factors. The HIV+ sample was clinically stable with successful viral control. Diffusion was measured across 32 non-colinear directions with a b-value of 1000 s/mm2; fractional anisotropy (FA) and mean diffusivity (MD) maps were quantified with Itrack IDL. Using the ENIGMA DTI protocol, FA and MD values were extracted for each participant and in 11 skeleton regions of interest (SROI) from standard labels in the JHU ICBM-81 atlas covering major striato-frontal and parietal tracks. We found no major differences in FA and MD values across the 11 SROI between study groups. Within the HIV+ sample, we found that a higher CNS penetrating antiretroviral treatment, higher current CD4+ T cell count, and immune recovery from the nadir CD4+ T cell count were associated with increased FA and decreased MD (p < 0.05-0.006), while HIV duration, symptomatic, and asymptomatic cognitive impairment were associated with decreased FA and increased MD (p < 0.01-0.004). Stability of HIV treatment and antiretroviral CNS penetration efficiency in addition to current and historical immune recovery were related to higher FA and lower MD (p = 0.04-p < 0.01). In conclusion, WM DTI measures are near normal except for patients with neurocognitive impairment and longer HIV disease duration.