Strategies to Improve Kaposi's Sarcoma Outcomes in Zimbabwe

描述(由申请人提供)：SICO项目将提供重要的实用信息，说明如何改进艾滋病-KS的治疗，从而改善津巴布韦和其他这种癌症负担较重的非洲国家的抗逆转录病毒治疗结果。该项目将改善与津巴布韦和PEPFAR卫生优先事项有关的医疗实践、研究和知识。 公共卫生相关性：艾滋病相关卡波西肉瘤(AIDS-KS)是一种癌症，是非洲发病率和死亡率的主要原因。为了在非洲实现抗逆转录病毒治疗的最大可能益处，重要的是制定在资源有限的地区可行和可持续的艾滋病-KS治疗战略。NIH/PEPFAR合作实施科学和影响奖的申请将建立改善Kaposi肉瘤结果的战略(SICO)项目。SICO将基于津巴布韦大学健康科学学院(UZCHS)和科罗拉多大学丹佛大学(UCD)教职员工在教育和研究方面强有力和富有成效的合作的长期历史。SICO项目旨在通过更好地及早发现和治疗KS疾病和常见相关症状，改善KS患者的治疗结果。拟议研究的总体目标是开发基于证据的、成本效益高的方法，以改进在资源匮乏的环境中检测和管理艾滋病-KS及其相关症状，并评估这些方法在津巴布韦城乡社区初级保健环境中的实施情况。为了实现这一目标，SIKO将评估一项改进非洲艾滋病-KS治疗的新战略，该战略基于两个原则：1)通过及早开始抗逆转录病毒治疗及早发现AIDS-KS将改善治疗结果，并消除昂贵和潜在毒性化疗的需要。2)在津巴布韦，通过将咨询性专科护理下放到初级保健环境，可以更有效地管理晚期或难治性KS。如果成功，SICO战略将促进津巴布韦艾滋病-KS护理的权力下放，并将成为在资源有限的情况下下放其他常见恶性肿瘤(即宫颈癌)医疗管理的典范。尽管我们的评估将是 鉴于撒哈拉以南非洲艾滋病-KS的高发病率，仅在津巴布韦进行，从SICO获得的知识很可能将适用于其他非洲国家，并将为国际治疗准则提供参考。

DESCRIPTION (provided by applicant): The SIKO Project will provide important practical information about how to improve treatment of AIDS-KS and thereby improve outcomes of antiretroviral treatment in Zimbabwe and other African countries that have a high burden of this cancer. This project will lead to improved medical practice, research and knowledge related to Zimbabwe and PEPFAR health priorities. PUBLIC HEALTH RELEVANCE: AIDS-associated Kaposi' sarcoma (AIDS-KS) is a cancer that is a major cause of morbidity and mortality in Africa. To realize the greatest possible benefits from antiretroviral therapy in Africa, it is important that AIDS-KS treatment strategies be developed that are feasible and sustainable in resource constrained areas. This application for a NIH/PEPFAR Collaboration for Implementation Science and Impact Award will establish the Strategies to Improve Kaposi' Sarcoma Outcomes (SIKO) Project. SIKO will be based on the long history of strong and productive collaborations in education and research between faculty at University of Zimbabwe College of Health Sciences (UZCHS) and the University of Colorado Denver (UCD). The SIKO Project is designed to improve outcomes in KS treatment through better early detection and treatment of KS disease and common related symptoms, in people with AIDS-KS. The overarching goal of the proposed studies is to develop evidence-based, cost-efficient approaches to improve detection and management of AIDS-KS and its related symptoms in low resource environments, and to evaluate the implementation of these approaches in primary care settings in urban and rural communities in Zimbabwe. To accomplish this goal SIKO will evaluate a novel strategy for improving treatment of AIDS-KS in Africa that is based on two principles: 1) Early detection of AIDS-KS with early initiation of antiretroviral therapy will improve treatment outcome and obviate the need for expensive and potentially toxic chemotherapy. 2) Advanced or refractory KS can be more effectively managed in Zimbabwe through decentralization of consultative specialty care to primary care settings. The SIKO strategies, if successful, will facilitate the decentralization of AIDS-KS care in Zimbabwe and will serve as a model for decentralizing medical management of other common malignancies (i.e., cervical cancer) in resource-limited settings. Although our evaluations will be conducted exclusively in Zimbabwe, given the high incidence of AIDS-KS in sub-Saharan Africa, it is likely that the knowledge gained from SIKO will be applicable to other African countries and will inform international treatment guidelines.