Columbia-South Africa Training Program for Research on HIV-associated Malignanci

描述（由申请人提供）：在撒哈拉以南非洲，随着艾滋病毒/艾滋病流行的发展，卡波西肉瘤（KS）和非霍奇金淋巴瘤（NHL）的发病率和死亡率急剧上升。在发达国家，宫颈癌也与艾滋病毒有关，但撒哈拉以南非洲地区甚至在艾滋病毒/艾滋病流行之前就已经是世界上宫颈癌发病率最高的地区之一。抗逆转录病毒治疗的可及性和艾滋病患者的生存率正在改善，但与艾滋病毒相关的恶性肿瘤对南非的男性、女性和儿童来说是一个日益紧迫的公共卫生问题。我们建议在哥伦比亚大学 (CU) 梅尔曼公共卫生学院取得的成就的基础上，通过与南非机构的培训合作，加强 KS、NHL 和宫颈癌的研究能力。自 1994 年以来，位于夸祖鲁纳塔尔大学 (KZN) 的南部非洲福格蒂艾滋病国际培训和研究计划 (CU-SA AITRP) 在创建科学基础设施以应对全球艾滋病毒流行中心南非的艾滋病毒挑战方面发挥了至关重要的作用。 CU-SA AITRP 的 300 多名学员已在《科学》、《自然》和《柳叶刀》等期刊上发表了 900 多篇论文。前学员现在是急性艾滋病毒感染发病机制、新预防技术和治疗艾滋病毒-结核病合并感染新方法研究的全球领导者。同样，近 25 年来，我们一直拥有 NCI 资助的 T32 培训补助金，并拥有 7 年的 R25 培训补助金；两者都是流行病学、生物统计学和环境健康科学领域的教师以及科罗拉多大学 NCI 资助的赫伯特·欧文综合癌症中心的合作成果。这两个项目从多学科角度培养了 100 多名癌症研究人员，他们后来都担任了著名的学术和研究职务。我们之前的 D43 拨款生成的数据证实了 KS 的高发病率以及考虑到并发结核病 (TB) 的沉重负担，在 KZN 管理它的问题。每年，我们在 KZN 大学的合作者都会看到超过 150 名新的 KS 患者，在斯泰伦博斯大学的合作者会看到超过 100 名新的 NHL 病例，在威特沃特斯兰德大学的合作者会看到超过 200 名新的宫颈癌病例。在拟议的 3 年资助中，我们由领先的癌症流行病学家、肿瘤学家和实验室科学家组成的团队将重点研究这 3 种癌症，与 18 名博士前和博士后实习生以及南非提供临床护理、进行试验和收集研究样本的同事合作。学员将在科罗拉多大学和南非的合作大学学习课程。有些人将获得所需实验室技术的具体专业知识；其他人将接受以患者为导向的临床研究或以公共卫生为导向的流行病学方面的培训（可能适用于建立急需的基于人群的癌症登记处）。我们将在南非举办两场癌症和临床流行病学研讨会。所有学员都将接受指导，所有参与者都将致力于在资源有限的环境中建立与艾滋病毒相关的恶性肿瘤的长期合作和研究能力（例如，开发快速、低成本的 KS 测试）。相关性：该计划是一项重要的培训资源，旨在加强机构基础，以便在处理艾滋病毒大流行中心地区的三种主要艾滋病毒相关恶性肿瘤的关键性实验室到临床研究基础上，并为新一代科学家提供全球健康视角。

DESCRIPTION (provided by applicant): In sub-Saharan Africa, Kaposi sarcoma (KS) and non-Hodgkin lymphoma (NHL) incidence and mortality rates have risen dramatically as the HIV/AIDS epidemic has evolved. In the developed world, cervical cancer is also HIV-related, but sub-Saharan Africa had among the world's highest cervical cancer rates even before the HIV/AIDS epidemic. Access to anti-retroviral therapy and survival with AIDS are improving, but HIV- related malignancies are an increasingly urgent public health problem for men, women, and children in South Africa. We propose to strengthen research capacity in KS, NHL, and cervical cancer through a training collaboration with institutions in South Africa, building on the achievements of the Mailman School of Public Health of Columbia University (CU). Since 1994, our Southern Africa Fogarty AIDS International Training and Research Program (CU-SA AITRP) based at the University of KwaZulu-Natal (KZN) has played a vital role in creating science infrastructure to meet the challenges of HIV in South Africa, the epicenter of the global HIV pandemic. The CU-SA AITRP's >300 trainees have published >900 papers, in such journals as Science, Nature and the Lancet. Ex-trainees are now global leaders in research on HIV pathogenesis in acute HIV infection, new prevention technologies, and new approaches to treating HIV-TB co-infection. Similarly, for nearly 25 years, we have had an NCI-funded T32 training grant, and for 7 years an R25 training grant; both are collaborations of faculty in Epidemiology, Biostatistics, and Environmental Health Sciences and CU's NCI- funded Herbert Irving Comprehensive Cancer Center. Providing a multidisciplinary perspective, the two programs have trained more than 100 cancer researchers who have gone on to prestigious academic and research positions. Our prior D43 grant generated data confirming the high rates of KS and the problem of managing it in KZN given the heavy burden of co-morbid tuberculosis (TB). Each year, our collaborators at the University of KZN see >150 new patients with KS, those at Stellenbosch University >100 new cases of NHL, and those at the University of Witwatersrand >200 new cases of cervical cancer. In the proposed 3- year grant, our team of leading cancer epidemiologists, oncologists, and laboratory scientists will focus on those 3 cancers, working with 18 pre- and postdoctoral trainees and with colleagues in South Africa who are providing clinical care, conducting trials, and collecting specimens for study. Trainees will take courses at CU and the collaborating universities in South Africa. Some will acquire specific expertise in needed laboratory techniques; others will be trained in patient-oriented clinical research or public-health oriented epidemiology (potentially applicable to building a much-needed population-based cancer registry). We will conduct two workshops in cancer and clinical epidemiology in South Africa. All trainees will receive mentoring, and all participants will be committed to building long-term collaborations and research capacity on HIV-related malignancies in resource-limited settings (e.g., development of a quick, low-cost KS test). RELEVANCE: This program is a critical training resource to strengthen the institutional base for pivotal bench-to-bedside research on the three major HIV-related malignancies at institutions dealing with the burden of those diseases in the epicenter of the-HIV pandemic and to give the rising generation of scientists a global health perspective.