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Strengthening Capacity for Research for HIV-Associated Malignancies in Africa and Other Low- and Middle-Income Countries (LMICs)

Building capacity and sharing success stories in HIV-associated malignancy research in Sub-Saharan Africa the 2017 U54 Consortia Annual Meeting.

The brunt of the HIV epidemic is borne by LMICs, with sub-Saharan Africa being the epicenter of the epidemic. As people living with HIV are aging, LMICs are also facing a concomitant rise in the incidence of malignancies.

NCI and the Fogarty International Center (FIC) have partnered in several efforts for developing research capacity in LMICs on HIV-associated cancers. In 2013, NCI and FIC developed a RFA (RFA-CA-13-010) that solicited applications to support research projects that would be conducted jointly between United States (U.S.) and sub-Saharan African investigators. The eight funded applications support inter-disciplinary research on HIV-associated malignancies in sub-Saharan Africa conducted by collaborative consortia between African institutions and institutions in the U.S. The sub-Saharan African Collaborative HIV and Cancer Consortia is composed of partnerships between U.S. investigators and African investigators from five different African countries (Malawi, Uganda (3 applications), Botswana, Tanzania, Kenya and Rwanda). The goal of the sub-Saharan African Collaborative HIV and Cancer Consortia is to build research capacity at the African institutions that will allow them to become independent and competitive research centers.

To continue and expand NCI’s and FIC’s efforts to develop research capacity in Low and Middle Income Countries (LMICs), in 2016 NCI in collaboration with FIC developed a complementary RFA (CA-16-018) soliciting applications that proposed inter-disciplinary HIV-associated malignancy research projects that would be conducted in partnerships between U.S. & LMIC investigators. African countries that were not participating in the sub-Saharan African Collaborative HIV and Cancer Consortia were eligible. The newly funded consortia include two in Africa (Zambia and Nigeria) and one in Argentina. Inter-consortia collaborations will be encouraged.

Each consortium is also developing future scientific leadership among the LMIC investigators through career development activities, training, and mentoring.

The consortia started in 2014 are:

Addressing Herpesvirus-Associated Cancers through the UNC-Malawi Cancer Consortium
Partners are: University of North Carolina at Chapel Hill, Lighthouse Trust, Malawi Ministry of Health, and the University of Malawi College Of Medicine. The consortium is focused on understanding the impact of antiretroviral therapy (ART) on AIDS-defining cancers and ways to improve outcomes of patients suffering from Kaposi’s sarcoma and lymphoma. The consortium will focus on understanding the impact of antiretroviral therapy (ART) on AIDS-defining cancers and ways to improve outcomes of patients suffering from Kaposi’s sarcoma and lymphoma.

HIV and Hepatocellular Carcinoma in Uganda: The H2U Consortium
Partners are: Johns Hopkins University, Makerere University, Mulago Hospital and the Institute for Infectious Diseases in Kampala, Uganda. The H2U Consortium is addressing the epidemiology and etiology of HIV-associated Hepatocellular carcinoma (HCC) and what is the role of screening for HCC among HIV-infected people.

Botswana-UPENN Research Consortium of HPV-related Cervical Cancer in HIV Patients
Partners are: University of Pennsylvania and the University of Botswana. The consortium addresses clinical questions regarding the pathogenesis and epidemiology of HIV-HPV co-infection and cervical cancer by studying three cohorts of women that span the entire natural history of HPV/HIV infection and cervical cancer.

Cancer Research International Training and Intervention Consortium (CRITIC)
Partners are: University of Nebraska-Lincoln, the University of Nebraska Medical Center and the Ocean Road Cancer Institute in Tanzania. This consortium conducts long-term molecular cancer epidemiology training and sort-term technical training and workshops. A molecular virology research laboratory has been developed to support projects on the distribution of HPV genotypes and the characterization of Kaposi’s sarcoma-associated herpesvirus in endemic and HIV-positive epidemic Kaposi’s sarcoma.

Uganda-UCSF Consortium on Prevention and Early Detection of HIV-Associated Cancer
Partners are: University of California San Francisco and Infectious Diseases Institute in Uganda. The consortium focuses on the two most common cancers in Uganda, Kaposi’s sarcoma (KS) and cervical cancer. The consortium is building capacity for research on HIV-associated cancers in Uganda through mentoring, pilot projects and K-like awards and explore strategies for increasing community and provider awareness and diagnosis of KS and cervical cancers.

AMPATH-Oncology Institute: HPV and Cervical Cancer in Kenyan Women with HIV/AIDS
Partners are: Indiana University, AMPATH (Academic Model Providing Access to Healthcare), Moi University and KEMRI (Kenya Medical Research Institute). The consortium is focused on the natural history of oncogenic HPV infections in HIV-infected Kenyan women, identification of modifiable and non-modifiable factors that are associated with progression of oncogenic HPV infection to clinical disease, and determine the best management algorithms for cervical cancer prevention in HIV-positive women.

Biologic Determinants of the Natural History of AIDS-Defining Cancers in Uganda
Partners are: Fred Hutchinson Cancer Research Center and the Uganda Cancer Institute. The consortium will focus on the natural history of three AIDS-defining Cancers (ADCs) including KSHV-associated Kaposi’s sarcoma, EBV-associated non-Hodgkin Lymphoma, and HPV-associated invasive cervical cancer in Uganda. They are defining the viral genetic determinants that influence the natural history of ADCs, building up the research capacity of the next generation of scientists that can conduct long-term investigations addressing the control and management of ADCs in Uganda.

HIV/HPV Cancer Prevention, Treatment & Pathogenesis: Rwanda/Einstein Consortium
Partners are: Albert Einstein College of Medicine, University of Rwanda, the Rwanda Military Hospital and the NGO Regional Alliance for Sustainable Development Rwanda. This consortium is focusing on HPV-related cancers. They are assessing optimal methods to screen and prevent cervical cancer in HIV-positive women and determining the prevalence of anal and penile HPV infection, and screening for anal and penile squamous intraepithelial lesions in Rwandan men who have sex with men.

The consortia started in 2017 are:

The Zambia AIDS Malignancies Diagnosis and Pathogenesis Program (ZAMDAPP)
Partners are: University of Nebraska-Lincoln and the University Teaching Hospital-Lusaka. This consortium is developing research infrastructure at Zambia’s Cancer Diseases Hospital (CDH) and University Teaching Hospital (UTH) focused on conducting HIV-associated malignancy research.  The group is studying the epidemiology of Kaposi's sarcoma (KS) and its causative agent, KS-associated herpesvirus, developing new tools for the pathological diagnosis of ocular surface squamous neoplasia (OSSN) and identifying the role of HPV in OSSN.

Epigenomic Biomarkers of HIV-Associated Cancers in Nigeria
Partners are:  Northwestern University, the University of Jos and the University of Lagos. This consortium is conducting research to identify DNA methylation patterns in hepatocellular carcinoma and cervical cancer that can be used in histopathological grading and other prognostic features that could lead to earlier stage diagnosis and patient stratification for better treatment options.

UM CFAR SCCC/Argentina Consortium for research and training in Virally Induced AIDS Malignancies
Partners are:  University of Miami School of Medicine, the University of Buenos Aires, Fundacion Huesped, and the National University of La Plata. This consortium is evaluating the prevalence and incidence of Kaposi sarcoma (KS) and anal carcinoma in men who have sex with men and transgender women (most affected population in Argentina) and identifying biomarkers for the diagnosis, prevention, and treatment of these virally associated cancers.  They will elucidate oncogenic signaling networks, cellular and molecular mechanisms involved in the development of these two cancers.

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