Uganda-UCSF Research Training in HIV-Associated Malignancies

描述（由申请人提供）：在撒哈拉以南非洲，艾滋病毒流行和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）成为该地区许多地区成人中最常见的恶性肿瘤，也是儿童的重要威胁。我们在乌干达开展的R01 CA119903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晚期诊断。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早期阶段检测KS，此时仅抗逆转录病毒治疗（ART）最有效。虽然非洲的早期KS诊断很有吸引力，但在许多层面上都存在挑战——所有这些都可以通过培训加以补救。因此，这项培训赠款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，促进社区对KS的早期认识，并尽早向卫生保健提供者介绍；2)指导乌干达数百名卫生保健提供者临床识别早期KS，并进行简单的床边皮肤穿刺活检以病理确认KS；3)对4名乌干达病理学家进行皮肤病理学方面的培训，并为他们配备合适的试剂，用于KS的特异性和敏感性的组织病理学诊断；4)全面培训5名乌干达新兴科学家的临床研究方法，使他们成为独立的首席研究员，研究KS的各个方面；5)发展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时代研究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，我们将组建一支由卫生保健专业人员和研究人员组成的多学科团队，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时代仍会发生KS；c)记录早期KS诊断对生存的影响；d)开展临床试验，优化早期诊断KS的治疗方法。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，现在非洲有了针对HIV的抗逆转录病毒治疗，KS引起的痛苦有希望得到缓解。然而，只有在早期诊断出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保健专业人员和研究人员，以促进对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.