This capacity building program in Rwanda will extend the partnership of the Albert Einstein Cancer Center and the National University of Rwanda to develop two new resources for the investigation of AIDS related malignancies (ARM) in Africa: 1.) a multidisciplinary team investigating operational, clinical and translational questions in cervical cancer in HIV+ women;2.) extension of the population-based cancer registry (PBCR) to allow linkage to the computerized HIV tracking system. Cervical cancer, an AIDS-defining malignancy, is the most common cause of cancer deaths in women worldwide if not prevented through screening programs. The pathogenicity of human papillomavirus (HPV) is enhanced in HIV-infected women, whose HPV-related cervical lesions are more prevalent, more likely to progress, less likely to regress, and more likely to become cancer. We will train a team of 5 HPV investigators, a nurse leader and 3 laboratory technicians who by the end of the three years of funding will be able, with the AECOM HPV research teams, to carry out HPV clinical, operational and translational studies. At least 3 investigators will receive masters level training in clinical research. Capabilities will include population based observational studies;assessment of screening approaches;clinical trials of treatments for cervical precancers;cervicovaginal soluble mucosal immunology;and HPV molecular virology. One investigator will be trained in cervical pathology, and "virtual microscopy" capability will be developed and tested so that continued training may be provided remotely. The laboratory technicians will be trained in tissue specimen processing, soluble mucosal immunology, and HPV DNA typing. All trainees will receive enhanced training in research ethics. We will also build upon our prior work in training nurses and physicians in developing and maintaining a cancer registry. We will train at least one physician in cancer epidemiology, in a two-year masters program. Rwanda already has a well-developed electronic system for monitoring the care of HIV+ Rwandans. We will train both the epidemiologist and local staff in the use of registry matching, with appropriate steps to guard confidentiality, as a powerful epidemiologic tool elucidating ARM patterns in the era of AIDS treatment in Africa. These activities will dramatically improve research capacity in ARM in Africa.
;We are lacking adequate data on nearly every aspect of AIDS malignancies (ARM) in Africa, The successful completion of this program will result in Rwandan investigations to advance knowledge in epidemiologic, clinical and translational questions in ARM, informing our understanding of epidemiology, effect of HAART treatment on ARM manifestations and response to therapy, cancer prevention strategies, cancer pathogenesis, innate immunity, and HPV molecular virology.
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