Institute of Human Virology (IHV) researchers at the University of Maryland School of Medicine (UMSOM) have received two five-year awards from the National Institutes of Health's National Cancer Institute (NCI) for a total of $7.5 million. One award aims to reduce the incidence of lung cancer and other cancers associated with using tobacco in Botswana. The other is focusing on improving screening and treatment of anal precancer in Nigeria. Both grants will make use of existing HIV treatment and prevention infrastructure in low- and middle-income countries to reach people living with HIV who are most at risk for these particular types of cancers.
With the cancer burden rising in persons living with HIV in sub-Saharan Africa and most cancer research heavily skewed toward high-income countries, advancing global cancer research designed to focus on prevention and treatment in these regions is crucial. These studies will contribute to cancer control globally for persons living longer with HIV."
Robert C. Gallo, MD, the Homer & Martha Gudelsky Distinguished Professor in Medicine, Co-Founder and Director of the UMSOM's IHV, and Co-Founder and Chair of the Scientific Leadership Board of the Global Virus Network (GVN)
Botswana lung cancer study
The Botswana Smoking Abstinence Reinforcement Trial, named BSMART, will screen patients for smoking across the network of HIV treatment facilities; it will offer a brief intervention using the "5 A's: Ask, Advise, Assess, Assist, and Arrange" for treatment with medication to help patients quit smoking. Quitting smoking is the most effective way to prevent cancers that can accompany tobacco use.
"Smokers with HIV are at a substantially elevated risk of several tobacco-related cancers," said Principal Investigator of the BSMART study Man Charurat, PhD, MHS, Professor of Medicine, Director of the Center for International Health, Education, and Biosecurity (Ciheb) at UMSOM's IHV, and Division Director for Global Health Sciences at UMSOM's Department of Epidemiology and Public Health. "The BSMART study will use implementation science to enact a comprehensive public health strategy incorporated into a real-world care system, in which patients before now have been frustratingly left behind."
Botswana has the highest prevalence of HIV and tobacco use in sub-Saharan Africa. Lung cancer is the most common cancer not caused by AIDS among people living with HIV and accounts for 20 percent of the cancer burden. The BSMART study in Botswana will be poised to assist the Government of Botswana's national goals in smoking cessation for its citizens.
Nigeria anal cancer study
The IMPACT study, short for Integrated Model for the Prevention of Anal Cancer using screen and Treat for HSIL (high-grade intraepithelial lesions, also known as precancer), will screen and treat precancer to prevent anal cancer in sexual and gender minorities, including men who have sex with other men and people who are transgender. The study will be performed at the TRUST Clinic in Nigeria, which was established by IHV in 2012.
Human papillomavirus (HPV), the virus that causes anal cancer, is spread through anal sex. Because people with HIV can have suppressed immune systems, those who also have HPV can experience persistent, higher risk infections that are more likely to develop into precancer with potential progression to cancer. Following the success of cervical cancer prevention strategies, health care providers recently learned that they could treat precancer to prevent anal cancer. The IMPACT study aims to transfer knowledge immediately from research to practice in a low-to-middle income setting.
"Since it is very difficult to identify as a man who has sex with other men in Nigeria because of the fear of being imprisoned and being ostracized by the community, HPV-associated disease is typically extensive before it is identified," said IMPACT study Principal Investigator Rebecca Nowak, PhD, Assistant Professor of Epidemiology and Public Health at UMSOM's IHV. "The TRUST Clinic is a 'safe' place for us to reach these most vulnerable individuals, where we hope to identify and treat damage from HPV early to prevent progression to anal cancer."
The sexual and gender minorities living with HIV bear the greatest burden of anal cancer with an 80-fold higher risk compared to the general population. Despite the high prevalence of HIV in the Sub-Saharan African region, anal cancer screening and treatment is unavailable. Thus, the IMPACT study will provide care to people living with HIV who face the highest risk of anal cancer in Nigeria.
"To help address the cancer challenges across sub-Sahara African countries, Ciheb aims to accelerate integrating evidence-based cancer control interventions that bring together prevention, early detection and diagnosis, and treatment, all while strengthening research capacity and infrastructure in these regions," said Dr. Charurat.
Mark T. Gladwin, MD, Vice President for Medical Affairs at University of Maryland, Baltimore and the John Z. and Akiko K. Bowers Distinguished Professor and Dean of UMSOM, said, "Sub-Saharan African countries face a double burden of disease. Cancer rates have been rising rapidly alongside continued morbidity and mortality from infectious diseases, like HIV. It is estimated that 75 percent of all cancer deaths will occur in lower to middle income countries by 2030. Hence, studies like BSMART and IMPACT, which are designed to bring evidence-based interventions, are urgent."