In sub-Saharan Africa, Kaposi sarcoma (KS) and non-Hodgkin lymphoma (NHL) incidence and mortality rates have risen dramatically as the HIV/AIDS epidemic has evolved. In the developed world, cervical cancer is also HIV-related, but sub-Saharan Africa had among the world's highest cervical cancer rates even before the HIV/AIDS epidemic. Access to anti-retroviral therapy and survival with AIDS are improving, but HIV- related malignancies are an increasingly urgent public health problem for men, women, and children in South Africa. We propose to strengthen research capacity in KS, NHL, and cervical cancer through a training collaboration with institutions in South Africa, building on the achievements of the Mailman School of Public Health of Columbia University (CU). Since 1994, our Southern Africa Fogarty AIDS International Training and Research Program (CU-SA AITRP) based at the University of KwaZulu-Natal (KZN) has played a vital role in creating science infrastructure to meet the challenges of HIV in South Africa, the epicenter of the global HIV pandemic. The CU-SA AITRP's >300 trainees have published >900 papers, in such journals as Science, Nature and the Lancet. Ex-trainees are now global leaders in research on HIV pathogenesis in acute HIV infection, new prevention technologies, and new approaches to treating HIV-TB co-infection. Similarly, for nearly 25 years, we have had an NCI-funded T32 training grant, and for 7 years an R25 training grant;both are collaborations of faculty in Epidemiology, Biostatistics, and Environmental Health Sciences and CU's NCI- funded Herbert Irving Comprehensive Cancer Center. Providing a multidisciplinary perspective, the two programs have trained more than 100 cancer researchers who have gone on to prestigious academic and research positions. Our prior D43 grant generated data confirming the high rates of KS and the problem of managing it in KZN given the heavy burden of co-morbid tuberculosis (TB). Each year, our collaborators at the University of KZN see >150 new patients with KS, those at Stellenbosch University >100 new cases of NHL, and those at the University of Witwatersrand >200 new cases of cervical cancer. In the proposed 3- year grant, our team of leading cancer epidemiologists, oncologists, and laboratory scientists will focus on those 3 cancers, working with 18 pre- and postdoctoral trainees and with colleagues in South Africa who are providing clinical care, conducting trials, and collecting specimens for study. Trainees will take courses at CU and the collaborating universities in South Africa. Some will acquire specific expertise in needed laboratory techniques;others will be trained in patient-oriented clinical research or public-health oriented epidemiology (potentially applicable to building a much-needed population-based cancer registry). We will conduct two workshops in cancer and clinical epidemiology in South Africa. All trainees will receive mentoring, and all participants will be committed to building long-term collaborations and research capacity on HIV-related malignancies in resource-limited settings (e.g., development of a quick, low-cost KS test).
This program is a critical training resource to strengthen the institutional base for pivotal bench-to-bedside research on the three major HIV-related malignancies at institutions dealing with the burden of those diseases in the epicenter of the-HIV pandemic and to give the rising generation of scientists a global health perspective.
