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From Discovery to Delivery: Benchwork to Global Health: Corey Casper
 

From Discovery to Delivery: Benchwork to Global Health: Corey Casper

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Explores relationships and discrepancies between important research-based medical advancements and subsequent real world implementation. Advancements in the management and potential elimination of ...

Explores relationships and discrepancies between important research-based medical advancements and subsequent real world implementation. Advancements in the management and potential elimination of infectious diseases such as HIV and TB will be addressed, as related to development and implementation of effective diagnostics, vaccines, or treatments.

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    From Discovery to Delivery: Benchwork to Global Health: Corey Casper From Discovery to Delivery: Benchwork to Global Health: Corey Casper Presentation Transcript

    • Clinical Research in Global Health: Lost in Translation? Corey Casper, MD MPH Vaccine and Infectious Disease Institute, Clinical Research and Public Health Sciences Divisions Fred Hutchinson Cancer Research Center Division of Infectious Disease, Department of Medicine University of Washington
    • Translational Research
      • “ It is the responsibility of those of us involved in today's biomedical research enterprise to translate the remarkable scientific innovations we are witnessing into health gains for the nation”
        • Elias A. Zerhouni, M.D. (Former) Director of the National Institutes of Health, NEJM 2005
    • Blueprint for Translational Research Identify Diseases Causing Significant Morbidity / Mortality to a Population (Epidemiology) Conduct Basic or Translational Research to Identify Etiology, Pathogenesis, Biomarkers, and Treatments Conduct Operational Research to Determine Feasibility of Implementing Research Findings Assess Impact of Translational Research on the Health of a Population
    • Cancer Crisis in Africa: WHO Report on African Health 2006
      • Recommendations
        • “ Noncommunicable diseases and injuries constitute a growing public health problem in the African Region”
        • “ Donor agencies and research institutions are neglecting the growing burden of noncommunicable diseases in Africa”
    • 23% of Cancers Worldwide are Due to Chronic Infections
    • Burden of Infection-Associated Cancer is Disproportionately Borne By Resource-Poor Countries
      • Estimated that nearly 23% of cancer worldwide is attributable to chronic infections (Parkin 2006)
        • Responsible for 1.5 million deaths annually
      • Burden disproportionately shouldered by resource-poor nations
        • Similar cancer incidence, but higher attribution to infections
      Cancer Infectious Agent Resource-Rich Resource-Poor Combined Liver Hepatitis B&C 48,000 47,500 95,500 Cervix Human Papillomavirus 83,400 409,400 492,800 Stomach Helicobacter pylori 192,000 400,000 592,000 Kaposi Sarcoma Human Herpesvirus 8 3,800 62,500 66,300 Non-Hodgkin's Lymphoma Epstein Barr Virus 5,600 26,800 32,400 Ano-Genital Human Papillomavirus 22,450 31,430 53,880 Nasopharynx Epstein Barr Virus 65,000 71,600 136,600 Mouth Human Papillomavirus 56,000 8,000 64,000 Hodgkin's Lymphoma Epstein Barr Virus 11,500 17,100 28,600 Bladder Schistosomiasis - 11,000 11,000 Total   487,750 1,085,330 1,573,080
    • From Infection to Cancer Primary Infection Chronic Infection Replication Progression to Cancer Vaccine eliciting neutralizing antibodies Genetic and Environmental Factors Antimicrobial Agents Chemotherapy
    • So where in the world…
    • Cancer in Uganda: A Dire Equation
      • Uganda population: 32 million people
      • + Highest rates of cancer in the world
      • + 2 oncologists
      • + 1 cancer clinic / treatment center
      • + Limited / no chemotherapy, pain medication, diagnostic equipment
      • _______________________________
      • = CANCER CRISIS
    • Cancer and Infectious Disease at The Uganda Cancer Institute
      • The UCI is the only cancer clinic in Uganda with a rich history of cancer research and care
        • Site of the initial description of Burkitt’s lymphoma in 1957
        • First place where combination chemotherapy (now global standard of care) was ever administered worldwide
        • Over 200 scientific publications on cancer
        • Home of a comprehensive, WHO-certified, population-based cancer registry in continuous operation for over 50 years
      • 8 of the 10 most common cancers in Uganda are due to chronic infections
      • Almost 70% of the patients at the UCI are HIV+
      • Cancer and infectious disease go hand-in-hand in Uganda
    • “ Protocol” for Translating Biomedical Research into Meaningful Health Improvements Identify Diseases Causing Significant Morbidity / Mortality to a Population (Epidemiology) Conduct Basic or Translational Research to Identify Etiology, Pathogenesis, Biomarkers, and Treatments Conduct Operational Research to Determine Feasibility of Implementing Research Findings Assess Impact of Translational Research on the Health of a Population Kaposi Sarcoma in Uganda
      • Research Findings:
      • Individuals Vary in their Degree of HHV-8 Replication
      • HHV-8 Replication May Predict KS Development
      • Inhibiting HHV-8 Replication May Prevent Development of KS and Augment its Treatment
      • HIV / HHV Interactions
      • Refining HHV-8 Testing to More Efficiently Characterize Replication
      • Integrate Care of Cancer into PEPFAR
      • Expand Ugandan capacity in care, diagnosis, treatment of Infection-Associated Caner
      Monitor Kampala Cancer Registry
    • “ Protocol” for Developing a Career in Clinical Global Health Research
      • Obtain a broad-based education to provide the foundation for your future work
        • Problems in resource-poor regions tend to be complex and multi-dimensional – difficult to know exactly which skills you will need at any given time
      • Spend time abroad
        • Global health research requires cultural sensitivity and personal sacrifice – only a “decent” amount of time overseas can adequately expose trainees
      • Focus on Problem over Place
      • Build strong partnerships
        • Take time to understand the needs of the population where you work, find the optimal local partners, and develop a research program which is bi-directionally meaningful