Rates of HIV associated malignancies due to cervical cancer and Kaposi's sarcoma have increased dramatically in Uganda as a consequence of the HIV epidemic. Lack of cervical cancer screening results in late presentation of largely untreatable invasive malignancies, and cervical cancer is the most common female malignancy in Uganda. The Rakai Project, a collaboration between the Uganda Virus Research Institute (Ministry of Health), Makerere University, Kampala, and Columbia and Johns Hopkins Universities, has, since 1989, conducted large population- based epidemiologic studies of HIV and STDs in rural Rakai District, southwestern Uganda. These investigations have included studies of human papillomavirus (HPV) based on hybrid capture assay of self- collected vaginal swabs, and have shown high rates of HPV infection and high intensity of HPV shedding in the genital tract in HIV+ compared with HIV- women. The prevention of cervical cancer is a public health priority in Uganda and to meet this national need we propose linked training and research programs as follows: 1) training in cancer epidemiology and surveillance at Johns Hopkins with post-training in- country field experience in cancer surveillance (Kyadondo County Cancer Registry), and population-based HPV screening (Rakai Project Field site); 2) laboratory training in HPV detection by hybrid capture and PCR at JHU with technology transfer to the Rakai Project Laboratory, Entebbe; 3) Postdoctoral training in clinical diagnostic and therapeutic procedures, such as colposcopy, biopsy, and treatment of pre-invasive cervical cancer at Johns Hopkins, with technology transfer and in-country training at Makerere University Kamapala. 4) Linked Advanced Research Training (ART) awards for trainees. 5) An in-country workshop in the third year to present findings to the Ministry of Health and Ugandan scientists to plan cervical cancer prevention on a national scale. The Rakai Project proposes to strengthen competency of key personnel in these areas. This administrative supplement to our existing Fogarty AITRP award seeks to continue and expand the training and in-country research efforts of this collaboration. Specifically, we propose: (2) In-Country Training courses/practicum, one on Cancer Surveillance and Population Screening for Cervical Neoplasia and another on Colposcopy and Clinical Management, and (1) In-Country Workshop in Year 3 to present findings; (3) short-term fellows for the Graduate Summer Institute in Epidemiology and biostatistics; (2) post-doctoral fellows following the Cancer Surveillance and the Colposcopy/Clinical Management tracks; (2) short-term fellows to received advanced laboratory training in HPV detection; (1) degree fellow for a Master's degree in epidemiology and biostatistics with a focus on cancer epidemiology and surveillance and (4) Advanced Research Training awards.
| Sahasrabuddhe, Vikrant V; Vermund, Sten H (2007) The future of HIV prevention: control of sexually transmitted infections and circumcision interventions. Infect Dis Clin North Am 21:241-57, xi |
