Vanderbilt University (VU) and the National AIDS Research Institute (NARI) are engaged in an important research agenda focused on cervical cancer screening for HIV-infected women in India. Through NIH funding, we have successfully developed a clinical research facility and resources, including a colposcopy clinic, HPV laboratory infrastructure and ability to recruit and retain patients for clinical and epidemiological research related to HIV-HPV-cervical cancer. A cohort of three hundred HIV-infected women is being followed-up at research site at the B.J. Medical College and Sassoon General Hospitals (BJMC-SGH) in Pune. Our work has involved describing the prevalence and predictors of cervical intraepithelial neoplasia (CIN) among HIV-infected women, and comparison of screening approaches (Visual Inspection with Acetic Acid [VIA], cervical cytology, and HPV testing) evaluated against a colposcopic-histological """"""""gold standard."""""""" Through a recent joint Indo-US grant, we have expanded our network to include three additional sites in India. Our goal is to develop capacity to conduct cervical cancer prevention research in the context of care provision and secondary prevention for women living with HIV. Through this supplemental grant application, we seek funds for two essential elements of our India program on cervical cancer prevention in HIV-infected women: (1) Enhanced short-term training opportunities in clinical epidemiology, leadership and management and implementation research for trainees from our partner institutions at the field sites in the high-HIV prevalence states of Maharashtra (Pune & Vadu), Karnataka (Belgaum) and Tamil Nadu (Chennai). We request support for a US-based training and a novel 'south-south' training initiative for short-term training in implementation research at our affiliated collaborating site in Lusaka, Zambia. (2) Essential software and equipment for our training and research efforts, including colposcopic image management software, project data management software, and machines to treat advanced cervical lesions with loop electrosurgical excision procedures (LEEP). Hence, the proposed supplement is highly focused on missing elements of our existing HIV-cervical cancer screening program. The efforts proposed herein will advance the research capacity for collaborative studies with our partner Indian institutions with an overarching goal to prevent cervical cancer among HIV-infected women in India. We focus on HIV-infected women to establish effective, high-impact programs that generate the research data to validate their public health importance, but we will strive to work with Indian authorities to expand such programs to all Indian women.
HIV-infected women in India face a significant burden of cervical cancer due to their increasing lifespan and prolonged periods of moderate immunosuppression. This project will develop capacity to conduct research that contributes to a better understanding of cervical cancer prevention methods and strategies for high-risk HIV-infected women in India. ? ? ?
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