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/艾滋病流行的演变，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和艾滋病生存率正在改善，但艾滋病毒相关恶性肿瘤是南非男女和儿童日益紧迫的公共卫生问题。我们建议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，建立在哥伦比亚大学（CU）公共卫生梅尔曼学院的成就基础上。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方案（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多名学员在《科学》、《自然》和《柳叶刀》等杂志上发表了900多篇论文。前学员现在是全球领导人在研究艾滋病毒发病机制在急性艾滋病毒感染，新的预防技术，和新的方法来治疗艾滋病毒-结核病合并感染。同样，近25年来，我们有一个NCI资助的T32培训补助金，并为7年的R25培训补助金;两者都是在流行病学，生物统计学和环境健康科学和CU的NCI资助的赫伯特欧文综合癌症中心的教师的合作。这两个项目提供了多学科的视角，已经培训了100多名癌症研究人员，他们已经走上了享有盛誉的学术和研究岗位。我们先前的D43补助金产生的数据证实了KS的高发病率和KZN的管理问题，因为共病结核病（TB）负担沉重。每年，我们在KZN大学的合作者看到>150例新的KS患者，在Stellenbosch大学>100例新的NHL病例，在Witwatersrand大学>200例新的宫颈癌病例。在拟议的3年资助中，我们的领先癌症流行病学家，肿瘤学家和实验室科学家团队将专注于这3种癌症，与18名博士前和博士后学员以及南非的同事合作，他们正在提供临床护理，进行试验和收集标本用于研究。学员将在哥伦比亚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特定专业知识;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培训（可能适用于建立急需的基于人群的癌症登记）。我们将在南非举办两个癌症和临床流行病学讲习班。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长期合作和艾滋病毒相关恶性肿瘤研究能力（例如，开发快速、低成本的KS测试）。相关性：该计划是一个重要的培训资源，以加强关键的三个主要的艾滋病毒相关的恶性肿瘤在处理这些疾病的负担在艾滋病毒流行病的震中机构的临床研究的机构基础，并给新一代的科学家一个全球健康的观点。

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.