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DISEASE-SPECIFIC CANCER CONTROL

CANCER CONTROL 2015 101

for resource-poor settings, including "Apps" for mobile

phones and other devices to facilitate easy result

verification in the field. Validation studies of several noninvasive

and inexpensive blood-based diagnostic models

such as the Aspartate to Platelet Ratio Index (APRI) and Fib4

(25, 34) have also been conducted in the African context.

Accuracy of transient elastography has also been assessed in

African patients (25). Results of these studies will be

paramount for implementation of liver disease assessment

in resource-poor settings.

New diagnostic markers for HCC - genomics,

epigenomics, proteomics and metabonomics

Several groups within the PROLIFICA team have been

investigating genetic, proteomic and metabonomic markers

for HCC diagnosis as current standard diagnostic modalities

such as CT scan and MRI scan are not available throughout

most of Africa. Key urinary metabolytes have been

identified which have excellent discriminative ability for

HCC, even in patients with background liver disease and

cirrhosis (22, 33), offering the exciting potential of a urinary

dipstick test for HCC diagnosis.

Overall benefits of the platform

Importantly, the PROLIFICA platform has resulted in

substantial capacity building in each of the three countries

involved in the study. Local health infrastructure has

benefitted from new technologies, such as FibroscanTM to

assess liver fibrosis using ultra-sound-based transient

elastography a mass spectroscopy system in The Gambia

for local biomarker research and the development of inhouse

laboratory assays, as well as skills transference to

build capacity for improved liver cancer health care in West

Africa.

The data provided by PROLIFICA will be crucial for the

development of local guidelines for the effective

management of HBV and HCC, including screening and

treatment. These data will also be of paramount importance

for the development of WHO HBV treatment guidelines,

which are currently underway.

Local nursing, medical and laboratory staff have

benefitted from training, education and employment

opportunities. Procedures and training in effective and

secure data management and ethical research practices has

also been a central part of the PROLIFICA platform. Local

researchers have availed themselves of specialized

academic mentorship at each of the three sites involved in

the study to obtain higher research degrees and highlyregarded

academic publications. Finally, community

education on HBV infection, mode of transmission and

prevention is also likely to have had a positive impact on

HBV awareness, both at the community and political level.

Above all, the PROLIFICA platform has facilitated the

development of strong relationships for future research

collaborations between major academic centres and a

deeper understanding of the barriers to improved healthcare

delivery in Africa. All centres have equally benefitted

from the experience and knowledge shared between the

investigating teams. These are arguably the greatest

achievements yielded from this project to date.

International collaborative projects between academic

institutions in Africa and the rest of the world are a

fantastic opportunity to share ideas, specialized expertise

and new technologies and foster a united approach to

solving some of the greatest public health challenges in

Africa today. Collaborations also provide a stronger

international voice to raise global awareness of the

importance of liver disease in Africa to governments, the

pharmaceutical industry and the international community.

Conclusion

HBV screening and subsequent treatment that is accessible

and affordable to all is a pressing requirement in SSA and

greater support from the international medical community

is critical to engender support from the pharmaceutical

industry for equitable drug availability. The crucial

importance of viral hepatitis research cannot be overstated

in achieving this goal, particularly research demonstrating

that screening and treatment for HBV not only saves lives,

but is cost-effective. Furthermore, the strong collaborative

relationships formed by international projects like

PROLIFICA between local and international partners

enable a strong, united international voice to campaign for

equitable access to HBV treatment and prevention and

improved lives for people living with HBV infection in

Africa.

Acknowledgements

All authors are grateful to the United Kingdom National

Institute for Health Research (NIHR) Biomedical Facility at

Imperial College London for infrastructure support. Mary M E

Crossey is supported by a Fellowship grant from the Sir Halley

Stewart Foundation (Cambridge, United Kingdom). All authors

are participant workers in the European Union Framework 7funded

"PROLIFICA" (Prevention of Liver Fibrosis and Cancer in

Africa) project in West Africa, which aims to diagnose, treat and

follow-up a cohort of hepatitis B-positive patients in The

Gambia, Senegal and Nigeria (EC FP7, P34114;

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