In sub-Saharan Africa, the catastrophic intersection between the HIV epidemic and the endemic nature of Kaposi's sarcoma-associated herpesvirus (KSHV) infection has resulted in Kaposi's sarcoma (KS) becoming the most common malignancy amongst adults ~ and an important threat in children - in many parts of the region. Our work in Uganda in the context of R01 CA119903, as well as the findings of others, has shown us that the single largest obstacle to prevention of KS morbidity and mortality in Africa is late diagnosis. We therefore hypothesize that the fastest route to the greatest public health impact on cancer in Africa is by detection of KS in its earliest stages, at a time when antiretroviral therapy (ART) alone is most effective. While early KS diagnosis in Africa is attractive, there are challenges at many levels - all of which can be remedied with training. Therefore, the overarching aim of this training grant is to build a multidisciplinary research team poised to promote and investigate early KS diagnosis in Uganda and to perform research on the epidemiology, clinical course, and treatment of KS in the ART era.
Our specific aims are to: 1) Train several hundred community health workers and traditional healers in Uganda in the promotion of early recognition of KS in the community and of early presentation to health care providers; 2) Instruct several hundred health care providers in Uganda in the clinical recognition of early KS and in the conduct of simple bedside skin punch biopsies for the pathologic confirmation of KS; 3) Educate four Ugandan pathologists in the field of dermatopathology and arm them with suitable reagents for the specific and sensitive histopathologic diagnosis of KS; 4) Comprehensively train five emerging Ugandan scientists in the methods of clinical research to transform them into independent principal investigators to study a variety of aspects of KS;and 5) Develop a cadre of three Ugandan ciinicai research coordinators in order to play a vital support role on multidisciplinary research teams that investigate KS in the ART era. At the conclusion of this three year training program, we will have assembled a multidisciplinary team of health care professionals and researchers which is able to a) study the optimal approach to encourage early diagnosis of KS;b) understand which patients still develop KS in the ART era;c) document the impact of early KS diagnosis on survival;and d) conduct clinical trials to optimize the treatment of early diagnosed KS. Once established, our approach to early KS detection can be used as a model for other cancers as well.

Public Health Relevance

Kaposi's sarcoma (KS) is the most common type of cancer in Africa, and now that antiretroviral therapy for HIV is available in Africa, there is hope that the suffering caused by KS can be alleviated. Yet, this can only be achieved if KS is diagnosed at early stages. Therefore, this project's goal is to train an array of Ugandan health care professionals and researchers in order to promote early diagnosis of KS and to study its impact. Once established, our approach to early KS detection can be used as a model for other cancers as well.

National Institute of Health (NIH)
National Cancer Institute (NCI)
International Research Training Grants (D43)
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Special Emphasis Panel (ZCA1-RTRB-8 (M2))
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Dominguez, Geraldina
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University of California San Francisco
Public Health & Prev Medicine
Schools of Medicine
San Francisco
United States
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Freeman, Esther; Semeere, Aggrey; Wenger, Megan et al. (2015) Pitfalls of practicing cancer epidemiology in resource-limited settings: the case of survival and loss to follow-up after a diagnosis of Kaposi's sarcoma in five countries across sub-Saharan Africa. BMC Cancer 16:65
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