Uganda-UCSF Research Training in HIV-Associated Malignancies

描述（由申请人提供）：在撒哈拉以南非洲地区，HIV流行病与卡波西肉瘤相关疱疹病毒（KSHV）感染的地方性之间的灾难性交叉导致卡波西肉瘤（KS）成为成人中最常见的恶性肿瘤，并成为该地区许多地区儿童的重要威胁。我们在乌干达开展的R 01 CA 119903研究以及其他研究结果表明，在非洲预防KS发病率和死亡率的最大障碍是诊断延迟。因此，我们假设，在非洲对癌症产生最大公共卫生影响的最快途径是在最早阶段检测KS，此时单独抗逆转录病毒治疗（ART）最有效。虽然在非洲早期诊断KS是有吸引力的，但在许多层面上都存在挑战-所有这些都可以通过培训来补救。因此，该培训补助金的总体目标是建立一个多学科研究团队，以促进和调查乌干达的早期KS诊断，并在ART时代对KS的流行病学，临床过程和治疗进行研究。我们的具体目标是：（1）在乌干达培训数百名社区卫生工作者和传统治疗师，以促进社区对KS的早期识别和早期向卫生保健提供者报告;（2）指导乌干达数百名卫生保健提供者对早期KS进行临床识别，并进行简单的床边皮肤穿刺活检，以病理学确认KS;（3）在皮肤病理学领域对四名乌干达病理学家进行培训，并为他们配备适当的试剂，以便对KS进行特异和敏感的组织病理学诊断;（4）对五名乌干达新科学家进行临床研究方法方面的全面培训，使他们成为独立的主要研究人员，研究KS的各个方面; 5）培养一支由三名乌干达临床研究协调员组成的骨干队伍，以便在ART时代调查KS的多学科研究团队中发挥重要的支持作用。在这个为期三年的培训计划结束时，我们将组建一个由医疗保健专业人员和研究人员组成的多学科团队，该团队能够a）研究鼓励早期诊断KS的最佳方法; B）了解哪些患者在ART时代仍然发展KS; c）记录早期KS诊断对生存率的影响;以及d）进行临床试验以优化早期诊断KS的治疗。一旦建立，我们的早期KS检测方法也可以用作其他癌症的模型。相关性：卡波西肉瘤（KS）是非洲最常见的癌症类型，现在非洲有了艾滋病毒的抗逆转录病毒疗法，有希望减轻KS造成的痛苦。然而，只有在早期阶段诊断出KS才能实现这一目标。因此，该项目的目标是培训一批乌干达卫生保健专业人员和研究人员，以促进KS的早期诊断并研究其影响。一旦建立，我们的早期KS检测方法也可以用作其他癌症的模型。

DESCRIPTION (provided by applicant): In sub-Saharan Africa, the catastrophic intersection between the HIV epidemic and the endemic nature of Kaposi's sarcoma-associated herpesvirus (KSHV) infection has resulted in Kaposi's sarcoma (KS) becoming the most common malignancy amongst adults ~ and an important threat in children - in many parts of the region. Our work in Uganda in the context of R01 CA119903, as well as the findings of others, has shown us that the single largest obstacle to prevention of KS morbidity and mortality in Africa is late diagnosis. We therefore hypothesize that the fastest route to the greatest public health impact on cancer in Africa is by detection of KS in its earliest stages, at a time when antiretroviral therapy (ART) alone is most effective. While early KS diagnosis in Africa is attractive, there are challenges at many levels - all of which can be remedied with training. Therefore, the overarching aim of this training grant is to build a multidisciplinary research team poised to promote and investigate early KS diagnosis in Uganda and to perform research on the epidemiology, clinical course, and treatment of KS in the ART era. Our specific aims are to: 1) Train several hundred community health workers and traditional healers in Uganda in the promotion of early recognition of KS in the community and of early presentation to health care providers; 2) Instruct several hundred health care providers in Uganda in the clinical recognition of early KS and in the conduct of simple bedside skin punch biopsies for the pathologic confirmation of KS; 3) Educate four Ugandan pathologists in the field of dermatopathology and arm them with suitable reagents for the specific and sensitive histopathologic diagnosis of KS; 4) Comprehensively train five emerging Ugandan scientists in the methods of clinical research to transform them into independent principal investigators to study a variety of aspects of KS; and 5) Develop a cadre of three Ugandan ciinicai research coordinators in order to play a vital support role on multidisciplinary research teams that investigate KS in the ART era. At the conclusion of this three year training program, we will have assembled a multidisciplinary team of health care professionals and researchers which is able to a) study the optimal approach to encourage early diagnosis of KS; b) understand which patients still develop KS in the ART era; c) document the impact of early KS diagnosis on survival; and d) conduct clinical trials to optimize the treatment of early diagnosed KS. Once established, our approach to early KS detection can be used as a model for other cancers as well. RELEVANCE: Kaposi's sarcoma (KS) is the most common type of cancer in Africa, and now that antiretroviral therapy for HIV is available in Africa, there is hope that the suffering caused by KS can be alleviated. Yet, this can only be achieved if KS is diagnosed at early stages. Therefore, this project's goal is to train an array of Ugandan health care professionals and researchers in order to promote early diagnosis of KS and to study its impact. Once established, our approach to early KS detection can be used as a model for other cancers as well.