The incidence of cancer among persons with HIV infection has increased annually since the widespread availability of antiretroviral therapy. Cancer is now a leading cause of death among HIV-positive persons, as survival after a diagnosis of an HIV-associated malignancy (HIVAM) is poorer compared with HIV-negative cancers across the world. In regions with a high prevalence of both HIV and viral oncogens, AIDS-defining malignancies such as Kaposi Sarcoma, non-Hodgkin lymphoma and cervical cancer present some of the largest threats to the health of HIV-infected individuals;non-AIDS defining cancers such at hepatocellular carcinoma, lung cancer and anal cancer now comprise >50% of HIVAM. New strategies are needed for cancer prevention and treatment among persons living with HIV in resource-limited settings. Since 2004, the Fred Hutchinson Cancer Research Center (FHCRC) has collaborated with the Uganda Cancer Institute (UCI) in Kampala, Uganda, to conduct research in HIVAM and develop new strategies for cancer treatment and prevention. Through several well-established training grants and strong relationships with our academic partners, the University of Washington (UW) and Makerere University (MU), we have trained >250 individuals in HIVAM research and care at all levels. Key informant interviews with academic, governmental and clinical leaders in Uganda find that a few gaps in the capacity to conduct HIVAM research persist. We propose to increase the capacity for independent research in HIVAM in Uganda through three Specific Aims: 1) Increase the number of Ugandan research scientists in HIVAM through the conferral of doctoral degrees with an established hybrid program between UW and MU;2) Build the capacity for independent scientific research in HIVAM through a structured program of mentoring and career development;3) Maintain capacity to implement HIVAM research in Uganda through ongoing short-term trainings in areas fundamental to research operations. The training activities will be overseen by an experienced and outstanding committee representing leaders in HIV and oncology research from the US and all Deans from three medical schools distributed across the country of Uganda, and will be rigorously measured and evaluated. By the completion of the five-year award period, >130 individuals will be trained in HIVAM research in Uganda, allowing for the conduct of a wide variety of research projects in HIVAM.
Cancer has become a leading cause of death and disability among HIV infected persons worldwide, with the number of cases increasing annually in the years since the widespread availability of antiretroviral therapy. This project builds on a successful, long-standing, collaboration in Kampala between the Uganda Cancer Institute and the Fred Hutchinson Cancer Research Center;an alliance that is actively supported by key stakeholders from medical schools, government and care providers across Uganda. We will train >130 individuals who, as the thought leaders of the future in Uganda and their research managers and staff, will pursue high-impact scientific research to inform the prevention and treatment of cancer in HIV-infected persons worldwide.