This application is to establish the UNC-Malawi Cancer Consortium (UNC-MCC), to develop capacity and conduct high-impact research focused on HIV-associated cancers. The consortium builds on longstanding collaborations between the University of North Carolina at Chapel Hill.(UNC-CH), Lighthouse Trust, Malawi Ministry of Health, and University of Malawi College of Medicine. These partnerships have resulted in internationally recognized contributions for HIV care and prevention in sub-Saharan Africa. This infrastructure can now be leveraged for HIV-associated malignancies. UNC-MCC is focused on the herpesvirus-associated cancers, Kaposi sarcoma (KS), and lymphoma. Our consortium will be led by three principal investigators with highly complementary expertise (Satish Gopal MD, clinical research; Sam Phiri PhD, implementation science; Blossom Damania PhD, virology). The first of three research projects being undertaken by UNC-MCC is an HIV-cancer record linkage study using the Malawi National Cancer Registry (MNCR). The project is led by three co-PIs, Drs. Charles Dzamalala (MNCR Director), Kennedy Malisita (Director, Antiretroviral Therapy Clinic, Queen Elizabeth Central Hospital), and Andy Olshan (Professor and Chair of the UNC-CH Department of Epidemiology). The project utilizes a unique set of resources within Malawi, including a population-based national cancer registry which is one of only four from sub-Saharan Africa to be included in the current WHO cancer incidence monograph, and HIV cohorts with detailed, longitudinal characterization of large numbers of patients. Combining these resources presents a rare opportunity to understand how cancer risk may be changing in the antiretroviral (ART) therapy, including for herpesvirus-associated cancers. This is still largely unknown in sub-Saharan Africa, and declines in incidence have not yet been observed in Malawi even after ART scale-up began 2004. The study will be conducted using probabilistic matching methods to link large national datasets, with technical assistance from the International Epidemiologic Databases to Evaluate AIDS (IeDEA) network, who have sponsored prior record linkage studies in South Africa. This work is anticipated to result in one of the best epidemiologic resources in the region for HIV-related malignancies research, to better understand current trends, and assist in prioritization of resources within Malawi based on high-quality local data.

The UNC-Malawi Cancer Consortium will address herpesvirus-associated cancers in HIV-infected individuals. The first project will conduct record linkage between the national cancer registry and HIV cohorts, to define cancer risk in the HIV population and how it is changing since antiretroviral treatment became available. This will aid national priority setting, and be informative to sub-Saharan Africa as a whole.