East Africa

Africa is facing an unprecedented growth in cancer burden. By 2030, 1.27 million new cancer cases per year are expected, with 0.97 million expected deaths. While there is no population-based cancer registry in Tanzania to provide reliable data on the country’s cancer burden, Tanzania estimates that it will see approximately 44,000 new cancer patients per year. Currently, demands for cancer care at the national referral center, Ocean Road Cancer Institute (ORCI), far exceed available services, and the number of new cases is steadily increasing, doubling between 2006 and 2013 alone.

UCSF’s partnership with Tanzania’s Muhimbili University of Health and Allied Sciences (MUHAS) began in 2005, with funding from the Bill & Melinda Gates Foundation, to support cultivation of a strong national health workforce in East Africa. During the following years, this partnership between UCSF and MUHAS expanded to include additional collaborative activities in the areas of emergency medicine, surgery, orthopaedics, and oncology. In the area of cancer research, Dr. Katherine Van Loon, Global Cancer Program Director, began working with Dr. Elia Mmbaga of MUHAS in 2011 to examine esophageal cancer in Tanzania, and their partnership has since expanded to include biostatistical, epidemiologic, genetic, genomic, virologic, and laboratory studies. In 2017, they cohosted a meeting of UCSF and MUHAS stakeholders in Dar es Salaam to formally launch the MUHAS-ORCI-UCSF Cancer Collaboration across multiple cancer disciplines. During this meeting, a collaborative needs assessment identified priorities for the collaboration across a variety of specialties, including pathology, radiology, oncology, nursing, and surgery, and participating Tanzanian faculty highlighted the critical need for cancer research training and mentorship. The MUHAS-ORCI-UCSF Cancer Collaboration has since initiated partnerships and projects across all of these specialties, and the teams are focusing significant effort on cancer research education and mentorship for trainees. 

The MUHAS-ORCI-UCSF Cancer Collaboration employs a full-time Tanzanian program manager and three full-time Tanzanian research coordinators to support all Collaboration projects and activities in Tanzania. 

Current Projects: 

Patient Navigator Education and Training Strategies to Support Cancer Survivors in Tanzania

UCSF Investigator: Katherine Van Loon, MD, MPH

Tanzania Investigator: Mamsau Ngoma, MD, MMed

Cervical cancer is the leading cause of cancer mortality among women in Sub-Saharan Africa. In Tanzania, like many low-resource countries, cervical cancer patients experience extensive barriers in receiving care such as limited number of cancer centers, high cost of travel to cancer centers, and myths associated with cancer diagnosis and treatment. Use of cancer survivors as advocates in communities and patient navigators in clinics has been shown as one way to address gaps in access to information and person-centered care. We hypothesize that by empowering and training cervical cancer survivors to become patient navigators and agents of change, we can improve treatment adherence and treatment completion rates for cervical cancer patients in Tanzania.

United States-East Africa HIV-Associated Malignancy Research Center (USEAHAMRC) for Career Development and the Prevention, Early Detection and Efficient Linkage to Care for Virus-related Cancers 

UCSF Investigator: Jeffrey Martin, MD

Tanzania Investigator: Elia Mmbaga, MD, PhD, Muhimbili University of Health and Allied Sciences (MUHAS)

Makere Investigator: Andrew Kambugu, MD

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.

Cancer Research Training Program in Tanzania

UCSF Investigator: Katherine Van Loon, MD, MPH

Tanzania Investigator: Elia Mmbaga, MD, PhD, Muhimbili University of Health and Allied Sciences (MUHAS)

The Cancer Research Training Program in Tanzania will be implemented at MUHAS in Dar es Salaam and leverages a longstanding relationship between MUHAS and UCSF. Dr. Elia Mmbaga, Associate Professor in the Department of Epidemiology and Biostatistics emphasizes, “This D43 could not have come at a better time than now when the newly established [non-communicable diseases] program at the Ministry of Health needs evidence to inform cancer control policies in Tanzania." This program will leverage existing training programs at MUHAS and will also build further institutional support by expanding the training activities and strengthening the pool of mentors at MUHAS. Read more. 


Determinants of Esophageal Cancer in Tanzania

UCSF Investigator: Katherine Van Loon, MD, MPH

Tanzania Investigator: Elia Mmbaga, MD, PhD, Muhimbili University of Health and Allied Sciences (MUHAS)

Eastern Africa faces a disproportionately high age-standardized rate of esophageal cancer. Together, Dr. Katherine Van Loon from UCSF and Dr. Elia Mmbaga from Muhimbili University of Health and Allied Sciences (MUHAS) lead a multi-disciplinary team of researchers from MUHAS, Muhimbili National Hospital (MNH), and Ocean Road Cancer Institute (ORCI) in Dar es Salaam focused on understanding the clinical burden and etiology of this high-incidence disease in Tanzania.


Evaluation of the GeneXpert Breast Cancer STRAT4 Assay for Point of Care Analysis of Breast Cancer Biomarker Status from Fine Needle Aspiration Biopsies in Tanzania (GX-BCB)

UCSF Investigator: Dianna Ng, MD

Tanzania Investigator: Edda Vuhahula, DDS, PhD, MUHAS

Breast cancer hormone receptor status is critical in determining patient prognosis and treatment. However, identification of breast cancer biomarkers in Tanzania is currently limited by reagent shortages, lack of trained staff, and long processing times. This project aims to validate the GeneXpert Breast Cancer STRAT4 assay as a tool for the evaluation of breast cancer biomarkers from fine needle aspiration specimens obtained from patients in Tanzania through assessing rates of misclassification and describing the impact of a rapid biomarker assay for determination of hormone receptor status on breast cancer care in a low-resource setting.



Improving shared decision-making about palliative cancer therapy in Tanzania

UCSF Investigator: Rebecca DeBoer, MD, MA

At Ocean Road Cancer Institute (ORCI) in Dar es Salaam, Tanzania, physicians and nurses have identified decisions about palliative cancer therapy as among the most difficult clinical and ethical challenges they face on a day-to-day basis. The goal of this project is to explore this challenge and develop a context-appropriate decision tool to support oncology providers who treat cancer patients in low-resource settings.



Management of esophageal cancer in East Africa: a prospective cohort study of treatment strategies and supportive care

UCSF Investigator: Geoffrey Buckle, MD, MPH

Despite emerging research on esophageal cancer in East Africa, limited data exists on optimal management strategies for advanced disease in this resource-limited setting. This prospective observational cohort study is at thee sites within the African Esophageal Cancer Consortium (AfrECC), including Ocean Road Cancer Institute (ORCI) and Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania and Tenwek Hospital in Bomet, Kenya. The project aims to describe the types of treatments administered for all patients diagnosed with esophageal cancer, evaluate the effect of different esophageal cancer treatment modalities on patients’ quality of life during and after completion of treatment, and measure the effect of different treatment modalities on overall survival at six months.


African Esophageal Cancer Consortium (AfrECC)

UCSF Investigators: Katherine Van Loon, MD, MPH, and Geoffrey Buckle, MD, MPH

Esophageal cancer is the sixth most common cause of worldwide cancer death, with very high incidence of esophageal squamous cell carcinoma (ESCC) occurring throughout the eastern corridor of Africa, from Ethiopia to South Africa. During the past several years, several groups have initiated studies of ESCC at sites in sub-Saharan Africa. In 2017, these groups recently joined together to form the African Esophageal Cancer Consortium (AfrECC) to share expertise, infrastructure, and resources. MUHAS, ORCI, and UCSF lead AfrECC activities in Tanzania.



Characteristics, Treatment Modalities and Survival of Colorectal Cnacer Cases Presenting at Muhimbili National Hospital and Ocean Road Cancer Institute in Tanzania. 

UCSF Investigators: Katherine Van Loon, MD, MPH, and Geoffrey Buckle, MD, MPH

Tanzania Investigator: Beatrice Mushi, MD, MPH 

Colorectal cancer (CRC) is the third most commonly diagnosed malignancy and the fourth leading cause of cancer death in the world, accounting for approximately 1.4 million new cases and almost 700,000 deaths in 2012. Enormous disparities in colorectal cancer exist globally, including access to screening, early diagnosis and treatment services. The 5-year survival rate for people with colorectal cnacer stands at 65% in the US. The characteristics and survival rate of CRC in Tanzania, where the majority of cases present at an advanced stage, have not been previously studied. 

Efforts to improve and reduce CRC burden begins with knowledge of the disease and precise estimation of its magnitude and survival rate. This study will ensure information is captured in its entirety, leading to results that will reflect the true picture of the magnitude, characteristics, treatment modalities and survival of CRC in Tanzania. 

Understanding the Burden of Human Papilloma Virus-Associated Oropharyngeal Head and Neck Cancer in Tanzania

UCSF Investigator: Mary Jue Xu

Tanzania Investigator: Aslam Nkya

Worldwide, head and neck cancers are the 7th most common malignancy accounting for 20,000 deaths yearly. Among head and neck cancers, head and neck squamous cell carcinoma (HNSCC) accounts of 90% of head and neck cancer. HNSCC have been traditionally associated with tobacco and alcohol abuse, however is a rising prevalence of HNSCC associated with human papilloma virus (HPV) in Western countries. While epidemiologic studies of the prevalence of HIV and HPV in HNSCC patients have been well described in Western populations, the majority of the existing burden of HIV-associated malignancies continues to be in low and middle-income countries (LMICs). Although the use of highly active anti-retroviral therapy (HAART) in HIV-infected populations has decreased incidences of cancers such as cervical cancer, lymphomas, and Kaposi sarcoma, there have been little data to support its impact on the incidences and risk reduction in HPV-related HNSCC. This study will assess the overall rates and subtypes of high-risk human papilloma virus oropharyngeal squamous cell carcinomas in Tanzania. This study will also identify the risk for HPV infection among head and neck squamous cell carcinomas in relation to HIV-status, tobacco use, alcohol use, sexual practices, and oral health in Tanzania.

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