# Innovations in diagnosis for lymphadenopathy across HIV Centers of Excellence in Malawi

> **NIH NIH DP1** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2024 · $544,250

## Abstract

ABSTRACT
In SSA, deaths occur in 5-10% of PLWH during the first year after initiating antiretroviral therapy (ART) and
causes for these early deaths are not well elucidated in most patients. Many patients present with
lymphadenopathy and are empirically treated for tuberculosis (TB), even when TB testing is negative, and
may have undiagnosed lymphoproliferative disorders (LPDs). Access to lymph node biopsy and high-quality
pathologic evaluation are limited and often lead to missed or delayed diagnosis which may contribute to early
preventable deaths after ART initiation. The barriers to pathologic diagnosis of lymphadenopathy in Malawi
have not been extensively studied. LPDs, including lymphomas and multicentric Castleman disease (MCD)
are a common causes of lymphadenopathy in PLWH, but are likely delayed and/or underdiagnosed. In the
KCH Lymphoma Study, we have enrolled all patients with newly diagnosed LPDs since 2013; 123/245 (50%)
PLWH with lymphoma and 19/35 (54%) with MCD are from Lilongwe district which makes up only 10% of the
catchment area. Given this marked overrepresentation of participants from Lilongwe, we hypothesize that
there many undiagnosed LPDs, though a gap exists in understanding the burden of LPDs in this population.
Critically, when diagnosed appropriately, LPDs are treatable and curable in SSA. To overcome barriers to
diagnosis, innovative and rapid diagnostic technologies are urgently needed to improve the speed and
accuracy of LPD diagnoses at the point of care. There a number of methods for EBV and KSHV
measurement including traditional PCR and a point of care device known as TINY. TINY is a loop-mediated
isothermal amplification (LAMP)-based device that allows amplification and quantification of DNA at point-of-
care with operability even in settings where electricity is not available. Our collaborators have shown that
TINY is sensitive and specific for diagnosing Kaposi sarcoma from skin biopsies and can potentially
diagnose Burkitt lymphoma using EBV measurement though its utility at point of care for LPDs has not been
studied. This proposal addresses current gaps in knowledge by 1) assessing multifactorial causes of
diagnostic delay for LPDs in Malawi, 2) comprehensively describing clinical characteristics and diagnoses in
PLWH presenting with lymphadenopathy from HIV clinics, and 3) assessing utility of EBV and KSHV
measurement from FNA and blood for expedited diagnosis using standard PCR as well as TINY. In
summary, this proposal will open a research focus that is distinct from my previous work as it will be my first
time studying diagnostics and implementation science and the first time working in peripheral health centers.
This multidimensional proposal will build towards my long-term goal of improving outcomes for PLWH and
LPDs by providing critical information about prevalence of undiagnosed LPDs, key implementation
challenges toward accurate and timely LPD diagnosis, and innovative diagnostic methods to over...

## Key facts

- **NIH application ID:** 10915169
- **Project number:** 1DP1CA291150-01
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** Matthew Scott Painschab
- **Activity code:** DP1 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $544,250
- **Award type:** 1
- **Project period:** 2024-07-01 → 2029-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10915169

## Citation

> US National Institutes of Health, RePORTER application 10915169, Innovations in diagnosis for lymphadenopathy across HIV Centers of Excellence in Malawi (1DP1CA291150-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10915169. Licensed CC0.

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