Project Summary / Abstract
Successful HIV treatment programs in Botswana and elsewhere in southern Africa have led to dramatic
reductions in mortality from tuberculosis, cryptococcosis, and other non-cancer AIDS deaths. However, cancer
deaths have not decreased, and cervical cancer now is the leading cause of death for women living with HIV in
the region. Cervical cancer is preventable with early detection and treatment of precancerous lesions but
challenges of limited access to initial screening, poor performance of initial screening technologies, high
prevalence of cervical precancers, and persistent or relapsed dysplasia following therapy impair the impact of
programs for women living with HIV. Working to develop strategies to these challenges, we will establish the
Botswana CASCADE Clinical Trials Site at BHP that will participate in and contribute to the following high-
impact areas of research: 1) Enhancing cervical precancer screening uptake through patient and context
relevant approaches, including HPV self-sampling, non-clinical screening venues, and screening during
antenatal care; 2) Strategies and novel technologies to improve management of positive HPV initial screening
maximize prevention of invasive cancer while minimizing patient risk and consumption of health system
resources; 3) Improving precancer treatment access, treatment completion, and outcomes; and 4) Optimizing
treatment approaches to cervical precancers including comparative trials of ablation techniques, intervals of
repeat evaluation, and vaccines or other immunologic therapies. The Botswana CASCADE Clinical Trials Site
will contribute to conducting high-quality clinical research studies, provide context-relevant input on
developing trial concepts, understand disparity in access by geography, economic factors, and
language/ethnicity, and continue to develop local research capacity through mentoring and training.