In the field of HIV-associated malignancies, East Africa faces three intersecting problems common to resource-limited settings. First, East Africa lacks effective primary and secondary prevention strategies for cervical cancer and Kaposi’s sarcoma (KS), two of the most common cancers not only among HIV-infected persons but in the general population. Survival for both malignancies is poor due to multiple factors including lack of screening, advanced disease stage at presentation, suboptimal diagnostic tests and fragile linkage to care. Second, there is a paucity of local principal investigators to lead research related to HIV- associated cancer. Third, there are no robust research networks to study primary and secondary prevention of HIV-associated cancers in the region. To address this, eight institutions in the U.S. and East Africa will: Aim 1. Create a collaborative network of U.S.-based and East African-based scientists and institutions — the United States-East Africa HIV-Associated Malignancy Research Center (USEAHAMRC) — focused on career development and the performance of research related to prevention, early detection and efficient linkage to care for virus-related cancers; Aim 2. Support the career development of emerging African principal investigators, U.S.-based junior investigators and others in the USEAHAMRC in the performance of HIV and other virus- related cancer research; and Aim 3. Conduct novel research — led by our emerging African principal investigators — related to the prevention, early detection and efficient linkage to care for virus-related cancers. The USEAHAMRC will build on prior work in U54 CA190153 to create a network of scientists from 4 U.S. institutions (UCSF, Duke, Massachusetts General Hospital, and the National Library of Medicine) and 4 African institutions in 3 East African countries (Infectious Diseases Institute in Uganda; Moi University in Kenya; Kenya Medical Research Institute; and Muhimbili University in Tanzania) (Aim 1). We will model our career development activities after NIH-sponsored institutional mentored career development programs (Aim 2). Managed by a Developmental Core, these activities will include professional enrichment to all interested junior scientists at our participating institutions, mentoring of a select group of African and U.S.- based junior scientists to compete for career development awards, and a Pilot Project program to attract new junior scientists. Our African junior investigators will also lead two research projects (Aim 3): Project 1, A Public Health Approach to Cervical Cancer Prevention in East Africa; and Project 2, Rapid Case Ascertainment as a Tool for Epidemiologic Investigation and Efficient Linkage to Care in HIV-infected Patients Diagnosed with Kaposi Sarcoma in East Africa. A Data Management and Biostatistical Analysis Core (DMBAC) will support all of the science. Finally, an Administrative Core will oversee all operations.

The burden of cervical cancer and Kaposi’s sarcoma in sub-Saharan Africa is daunting; both cancers are common with poor survival because the region lacks effective prevention, early detection and treatment. Efforts to improve this are hindered by a shortage of qualified researchers and efficient research networks. We will create a multi-country collaboration amongst scientists in the U.S. and East Africa to conduct relevant research on prevention and early detection of these cancers while also training both East African and U.S. junior scientists.