# Improving the Care Cascade for HIV-associated Kaposi's Sarcoma in sub-Saharan Africa

> **NIH NIH K23** · MASSACHUSETTS GENERAL HOSPITAL · 2022 · $199,800

## Abstract

PROJECT SUMMARY
Resource-poor settings bear the greatest burden of HIV-associated malignancies, with high background
prevalence of HIV and oncogenic viruses. HIV-associated Kaposi’s sarcoma (KS) is one of the most common
HIV-associated malignancies in sub-Saharan Africa. Incidence has decreased with more widespread use of
antiretroviral therapy (ART), but remains higher than prostate cancer in the United States. Survival after a
diagnosis with HIV-associated KS in sub-Saharan Africa, even in the ART era, remains poor, with almost half
of patients dead by two years. One reason for poor outcomes is that by the time patients seek care for their
skin lesions, the disease has progressed to an advanced stage. Even after diagnosis, a substantial number of
patients have delays in starting appropriate treatment. My own work has shown that 17-29% of KS patients do
not receive timely initiation of ART and that nearly half of those with indications for chemotherapy never
receive it. In order ultimately to improve survival, we first need to better understand the gaps in KS care. The
KS care cascade includes a series time intervals separated by discrete events: noting symptoms, presenting to
healthcare, receiving a diagnosis, and finally starting and completing treatment. Identifying personal and health
system barriers at each step of the cascade is critical to designing and implementing interventions that improve
outcomes for this vulnerable population. I am a PhD-trained epidemiologist and board certified dermatologist,
with a career goal of becoming an independent investigator in the global health epidemiology of HIV-
associated malignancies and associated skin conditions, and implementation of interventions to improve the
treatment of these conditions in resource-poor settings. I will draw upon the methodological training of the K23
award and leverage the existing research infrastructure of my co-mentors and collaborators in a large NIH-
sponsored cohort of HIV patients from the International Epidemiology Databases to Evaluate AIDS (IeDEA) in
western Kenya to accomplish the following specific aims: (1) Evaluate the determinants of advanced disease
stage at KS diagnosis and associated attributable risk, as well as the distribution and determinants of time
intervals leading up to diagnosis, (2) Among patients newly diagnosed with KS, evaluate the timing and
determinants of ART initiation and, where indicated, chemotherapy initiation and adherence after a diagnosis
of KS and (3) Develop and pilot test a multi-level intervention including both patient and healthcare provider-
centered components to promote prompt, appropriate treatment for KS. Building on my quantitative
background in HIV epidemiology, this award will provide training in qualitative methods, behavioral theory
based in intervention design, and implementation science. This combination, along with mentorship from a
multidisciplinary team of experts in global health, HIV epidemiology, oncology, gl...

## Key facts

- **NIH application ID:** 10433922
- **Project number:** 5K23AI136579-05
- **Recipient organization:** MASSACHUSETTS GENERAL HOSPITAL
- **Principal Investigator:** Esther E Freeman
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $199,800
- **Award type:** 5
- **Project period:** 2018-07-19 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10433922

## Citation

> US National Institutes of Health, RePORTER application 10433922, Improving the Care Cascade for HIV-associated Kaposi's Sarcoma in sub-Saharan Africa (5K23AI136579-05). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10433922. Licensed CC0.

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