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/艾滋病的流行，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，但撒哈拉以南非洲甚至在艾滋病毒/艾滋病流行之前就已是世界上宫颈癌发病率最高的地区之一。获得抗逆转录病毒治疗的机会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是南非男性、女性和儿童日益紧迫的公共卫生问题。我们建议在哥伦比亚大学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，加强在KS、NHL和宫颈癌方面的研究能力。自1994年以来，我们设在夸祖鲁-纳塔尔大学（KZN）的南部非洲福格蒂艾滋病国际培训和研究项目（CU-SA AITRP）在创建科学基础设施方面发挥了至关重要的作用，以应对全球艾滋病毒大流行中心南非的艾滋病毒挑战。CU-SA AITRP的近300名学员在《科学》、《自然》和《柳叶刀》等杂志上发表了近900篇论文。在急性HIV感染的HIV发病机制、新的预防技术和治疗HIV- tb合并感染的新方法的研究方面，前学员现在处于全球领先地位。同样，近25年来，我们一直有nci资助的T32培训补助金，还有7年的R25培训补助金；这两项研究都是由流行病学、生物统计学、环境健康科学和科罗拉多大学NCI资助的赫伯特·欧文综合癌症中心的教师合作进行的。这两个项目提供了多学科的视角，培养了100多名癌症研究人员，这些研究人员已经走上了著名的学术和研究岗位。我们之前的D43拨款产生的数据证实，鉴于合并结核病（TB）的沉重负担，KZN的KS率很高，管理它的问题。每年，我们在KZN大学的合作者诊治150例新的KS患者，在Stellenbosch大学的合作者诊治100例新的NHL患者，在Witwatersrand大学的合作者诊治200例新的宫颈癌患者。在提议的3年拨款中，我们的主要癌症流行病学家、肿瘤学家和实验室科学家团队将重点研究这3种癌症，与18名博士前和博士后实习生以及在南非提供临床护理、进行试验和收集研究标本的同事合作。学员将在科罗拉多大学和南非的合作大学学习课程。一些人将获得所需实验室技术的专门知识；其他人将接受面向病人的临床研究或面向公共卫生的流行病学方面的培训（可能适用于建立一个急需的以人口为基础的癌症登记处）。我们将在南非举办两次关于癌症和临床流行病学的讲习班。所有学员将接受指导，所有参与者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，开发一种快速、低成本的KS检测方法）。相关性：该项目是一个重要的培训资源，旨在加强在艾滋病毒大流行中心处理这些疾病负担的机构中对三种主要艾滋病毒相关恶性肿瘤进行关键性的从实验室到床边研究的机构基础，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.