The prevalence of HIV remains high in Malawi;the national estimate among adults is approximately 14% but the prevalence among reproductive age women is much higher- approximately 20%. The expanding antiretroviral treatment services provide an opportunity for longer survival of HIV infected individuals. In Malawi, as well as in most sub-Saharan Africa, adequate registries do not exist to document and monitor complications of HIV An important complication is HIV-associated cancers (malignancies) which has been reported to be increasing. However, we do not know the cancer burden, and consequently are not able to assess the impact of the HIV epidemic on the rates of these cancers. The main deficiencies are weak or non-existent surveillance systems and poor classification of diseases, especially cancers (including HIV assoaciated malignancies). Major underlying factors contributing to these limitations are inadequately trained personnel coupled with poor infrastructure. Therefore, building capacity to establish better diagnosis, of the main cancers, surveillance of all cancers and population-based research on cancers in settings such as Malawi where resources are limited is important. In this research training program, we intend to train a diverse group of Malawian scientists and establish a surveillance system that can be expanded in future to become a national program to monitor HIV-associated cancers. We will target multiple priority areas of training to improve diagnostic capabilities;especially data and record management and development of registry (for both data and samples) capabilities. We intend to train physicians, technologists, epidemiologists, basic scientists and others to acquire the needed skills. We will prospective candidates in-country, in the USA and other collaborating institutions in the US and other sites in Africa (South to South Collaboration), The duration of training will be variable including formal/long term (masters in public health and pathology), medium term and short term. The participating program faculty is diverse with experience in multiple disciplines. This training program will be highly integrated with the main programmatic award application and our ongoing HIV research working in Malawi at the Blantvre and Lilongwe research sites.
PUBLIC HEATLH RELEVANCE: HIV prevalence is high in Malawi and the burden of disease is substantial in resource-constrained setting, A major underlying limitation is lack of trained personnel and limited infrastructure. The proposed program will address these deficiencies by training a critical mass of Malawian scientists and supporting local capacity building in the areas of HIV-related cancers: diagnosis, surveillance and establishment of a registry.
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