Every year, cervical cancer is responsible for 275,000 deaths worldwide, of which about 88% occurred in lower and middle income countries where HIV infection is greatest and access to skilled care is poorest. The adult HIV incidence rate in Kenya is 1.21/1000 in 2017. There are 1,500,000 Kenyans living with HIV: 860,000 are women compared to 520,000 men. Cervical cancer is the most common gynecological cancer in this country . The crude incidence of cervical cancer in Kenya is 22.4/100,000 women and the age standardized rate (15-44 y.o.) is 40.1/100,000. Cervical neoplasia/cancer is more prevalent among women living with HIV (WLHIV) . As WLHIV are living longer with increasing access to combination antiretroviral therapy and if we are to optimally improve their health and lives, it is not enough to provide HIV treatment through many programs including PEPFAR programs and watch them die from cervical cancer. The focus of this proposed research training program is the understanding of the pathogenesis of cervical cancer in WLHIV and to optimize the screening, prevention and treatment of HIV related cervical cancer. A multidisciplinary group of Kenyan researchers will be trained to conduct HIV, HPV, cervical cancer related studies with the end goal of decreasing cervical cancer related deaths among WLHIV. The scope of training will be related to priority areas identified by the Kenyan MOH:1) translational research on the interactions between HIV and HPV; 2) improvement of cervical cancer screening programs including low cost technologies ;3) assessment of the best treatment options for cervical precancer/cancer among WLHIV ;4) operational studies on HPV vaccination and 5) assessment of behavioral, social and ethical issues related to HPV infection, cervical precancer/cancer, and HPV vaccination. We propose to train 6 long term trainees in graduate studies (2PhD and 4 Master’s ); 8 medium term trainees (3-6 months) for doctors, nurses, cytotechnologists, data managers, pharmacist, social workers, research assistants, laboratory technicians; and conduct short term symposiums/workshops in these priority areas. The ultimate goal is to develop a cadre of multidisciplinary researches in Western Kenya who will anchor research in this NIH priority area and to increase research capacity on HIV and cervical cancer in Kenya.

The main purpose of this training program is to build research capacity at Moi University, Eldoret, Kenya by providing research training to the next generation of Kenyan investigators dedicated to HIV-related cervical cancer, the most common gynecological cancer in Kenya. Cervical neoplasia/cancer is more prevalent among women living with HIV (WLHIV). As WLHIV are living longer with increasing access to combination antiretroviral therapy, it is imperative that we find a way understand the pathogenesis of cervical cancer in this population and to provide accurate and feasible methods to prevent the development of cervical cancer and treatment in resource-limited settings.