Despite the availability of a screening test and a range of treatment options. Cervical cancer remains the single most important cause of malignancy- associated death for Thai women. Thailand also has one of the highest population prevalences of HIV in Asia, with disproportionately high rates among women and men in northern Thailand. As many as 1 in 50 women of child-bearing age in northern Thailand are HIV epidemic and a long- standing chronic endemic of HPV infection and cervical carcinoma. Evidence demonstrating that women with HIV infection are at an increased risk of cervical carcinoma, highlights the critical challenge facing northern Thailand with the intersection of these two diseases. Prevention, detection And early treatment of cervical carcinoma in Thailand are already public health priorities, although pap smears remain under-utilized, are far from routine. Thus, there is an urgent need for the latest technology and information for diagnosis, treatment and prevention of cervical carcinoma in the setting of the heterosexual epidemic of HIV and HPV in the northern Thailand. This Fogarty Training Supplement has four specific aims: To train Thai scientists in the etiology, epidemiology, natural history, surveillance, screening, diagnosis, and secondary prevention and treatment of cervical carcinoma. To train investigators from Thailand to evaluate the effects of HIV on HPV acquisition, persistence and risk for cervical carcinoma in Thai women. To upgrade programmatic approaches in Thailand for prevention of cervical cancer, including the sensitivity, specificity and predictive value of screening methods and options for treatment of early lesions. To investigate the use of visual inspection with acetic acid combined with cryotherapy for early detection and treatment of cervical lesions at district level health facilities. This administrative supplement to our existing Forgarty AITRP award seeks to continue and expand the training and in-country research efforts of this collaboration. Specifically, we propose the following training activities: Year I - One in-country workshop plus 4 short course trainees (Epidemiology, HPV laboratory diagnosis, Cytopathological diagnosis of cervical neoplasia and clinical diagnosis and management of cervical carcinoma) Year II One in- country workshop plus 4 short course trainees (Epidemiology, HPV laboratory diagnosis, Cytopathological diagnosis of cervical neoplasia and clinical diagnosis and management of cervical carcinoma) Year III One in-country workshop plus 3 Advanced Research Training Awards.
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