Ten years ago in Uganda the health are infrastructure was in a state of collapse after years of civil strife. About that time, the country recognized that it was in the throes of a devastating epidemic caused by human immunodeficiency virus type-1 (HIV-1). The priorities were to rebuild the infrastructure for public health to deal with the HIV epidemic. After a decade of public education and targeted intervention programs, there are reports of declining seroprevalence of HIV-1 in sentinel populations. But the HIV-1 epidemic is far from controlled in Uganda, or other nations of East Africa. In Uganda today, for example, over 1 million people are infected. One problem of increasing concern is the management and treatment of HIV-related malignancies. In the early stages of the epidemic, Kaposi sarcoma was the first malignancy to emerge in this part of the world where KS is endemic. Over the course of the epidemic, other HIV- related malignancies have emerged including Non-Hodgkin lymphoma and cervical carcinoma. Within the context of the parent AITRP at CWRU, we propose to develop a training program to build the capacity to deal with the evolving complications of the HIV-I epidemic in East Africa. The specific objectives of this proposal are: I) Train and educate Ugandan and Kenyan scientists and health care providers in the area of HIV-associated malignancies; 2) Develop and promote scientific leadership and clinical expertise in this area; 3) Advance knowledge in epidemiology, molecular pathogenesis and treatment of HIV-associated malignancies; 4) Stimulate scientific collaboration between investigators in African and the United States; 5) Enhance links with other MH-sponsored programs at CWRU, such as the Center for AIDS Research and the AIDS Clinical Trials Unit and the AIDS Malignancy Consortium. These objectives will be met through a coherent, multi-disciplinary program of education and training in long-term, non-degree experiences that are based both in the US and in East Africa. To build the capacity for research, especially clinical trials, in HIV-associated malignancies, the program will target the training of health-care professionals in the clinical aspects of HIV-associated malignancies and develop research expertise among qualified individuals.
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