Building Implementation Science Research Capacity to advance cancer prevention and care in Uganda and Zambia

Project Summary/Abstract This application is being submitted in response to the Notice of Special Interest (NOSI) identified as “NOT-CA- 24-039: Administrative Supplement for NCI Center for Global Health Research Programs''. While AIDS-related morbidity and mortality among people living with HIV (PLWH) have decreased substantially with the

introduction of combination antiviral therapy, the now aging PLWH population is at an increased risk of other comorbidities, including cancer. This has been especially true of AIDS-defining malignancies, though more recently the risk of developing several non-AIDS-defining cancers (NADCs), including Hodgkin lymphoma and

cancers of the mouth, throat, liver, lung, and anus, has also increased among PLWH. This elevated risk is partially attributed to known behavioral risk factors among PLWH such as poor diet, low physical activity, and higher use of tobacco, alcohol, and other substances. The intersection of HIV and cancer presents a significant

challenge in sub-Saharan Africa (SSA) where an estimated 75% of HIV deaths occur and cancer treatment capacity is limited. There is an urgent need for early primary interventions to prevent cancer among PLWH. Widely effective interventions have included clinician education and training and targeted behavioral

interventions that prevent and reduce the use of tobacco, alcohol, and other substances. However, there is a lack of implementation research to properly adopt, integrate, sustain, and scale up these evidence-based cancer interventions for PLWH within the health systems of SSA. We approach this gap by leveraging the

capacity and resources of two NIH-funded cancer research consortiums in Uganda, Quit4Life+ (5U01CA261624-03) and the Building independent research capacity in HIV-associated malignancies (HIVAM) (D43TW009759). Together, we aim to build cancer-related implementation science research capacity to strengthen cancer prevention programming, treatment access, and care infrastructure for PLWH populations

throughout the region. Guided by the WHO health systems building blocks and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) evaluation framework, the study includes 3 phases: 1) Preparation and delivery of cancer-related implementation science research training sessions; 2) Adaptation

and testing of a health systems and service delivery assessment tool to evaluate implementation barriers impacting Quit4Life+’s behavioral support interventions within the Ugandan and Zambian healthcare systems; and 3) Evaluation of the assessment tool process and outcomes to inform future programs aimed at

strengthening sustainable models of cancer control for PLWH in LMICs. Study results will be widely disseminated to healthcare providers, policymakers, and public health practitioners. Primary study partners include the Center for Tobacco Control in Africa at the Makerere University School of Public Health, the

Uganda Cancer Institute, Fred Hutchinson Cancer Research Center in Kampala and the Keck School of Medicine of USC.