Fred Hutchinson Cancer Center Global Oncology’s annual report for fiscal year 2022 (July 1, 2021-June 30, 2022) provides an overview of research progress and scientific achievements, training initiatives, grants and finances, operations and the Global Oncology community. The report also provides an update on our local response to the COVID-19 pandemic.
As another fiscal year closes, we remain humbled by the evolving COVID-19 pandemic but committed to our work. Our critical cancer and infectious disease research and training efforts are informing and transforming research, care and treatment in limited-resource settings. We acknowledge the enormous toll that the pandemic and other global events have had — and continue to have — on our research and operations, teams, partners, patients, and the world. Despite these challenges, we have been inspired by the progress we have made. Through our collaboration with the Uganda Cancer Institute, and through the commitment of our faculty and staff in Kampala (part of the Hutchinson Centre Research Institute of Uganda, HCRI-U) and our entire Global Oncology program, our research has continued to advance. Most importantly, the overall standard of care delivered to patients at the UCI has been enhanced through our collaborative research.
During FY22, we continued studies on Kaposi sarcoma, breast cancer, and lymphoma, which are among the top five cancers with the highest incidence rates in Uganda.1 We are studying the burden and management of infectious diseases among cancer patients. With our colleagues at the UCI, we continued to prioritize training initiatives, particularly through the East African Adult Hematology Oncology Fellowship Program and National Institutes of Health training grants focused on Ph.D.-level training. We look forward to expanding into new training areas. Further, the year was also a time to reflect and refine our mission and goals. We are committed to the pursuit of cancer and infectious disease research with global impact and to supporting research and clinical capacity in low-resource settings, particularly Uganda. Like many organizations, we experienced change and transitions, yet remain excited about the present and future of Global Oncology and our partnerships. We are eager to explore new opportunities through the UCI’s expansion into new satellite clinics. We also look forward to the opportunities presented by the formation of Fred Hutchinson Cancer Center, which brought together Fred Hutchinson Cancer Research Center and Seattle Cancer Care Alliance into one organization that is a clinically integrated part of UW Medicine and UW Medicine’s cancer program.
“It was wonderful to see firsthand the new ground floor of the UCI-Fred Hutch Cancer Centre, which was spectacular, and more importantly, to see the inspirational work going on inside.”
In April, I had the privilege of returning to Kampala after more than two years. The progress that has been made in our research and training during these extraordinarily trying times has been remarkable.
There continues to be urgency in conducting collaborative cancer research and training with a global lens — and in translating findings into clinical care and action. By 2040, there will be an estimated 27 million new cancer cases globally — with 19.3 million new cases estimated in Africa, Latin America and the Caribbean, and Asia, or roughly 70% of all new cases, and an estimated 12.4 million cancer deaths in the same region.2 The deep inequities in cancer progress between high-income and low- and middle- income countries (LMICs) underscore the importance of this work. The National Cancer Institute’s Center for Global Health recognizes this: The center updated its five-year strategy to renew its commitment to global cancer research and control and focus its research through collaborations on technologies for global cancer control, implementation science, global cancer health disparities, cancer clinical trials in LMICs, and cancer etiology and biology.3
We are determined to advance our mission through challenging times because the call to action is urgent. On behalf of the entire HCRI-U and Global Oncology teams in Kampala and Seattle, thank you for your support and partnership that helps us move science forward and make a greater impact.
Dr. Edus H. Warren, Global Oncology Program Head
Global Oncology has five strategic objectives that guide us in pursuit of our mission.
During this last fiscal year, Global Oncology reflected on and refined our mission, strategic goals and objectives to a) focus on our research and training partnership with the Uganda Cancer Institute and b) explore new opportunities that would enable us to build on our research expertise.
and publications by UCI-Fred Hutch Collaboration trainees (former or current)
Our research is impacting patient care in Uganda while also making valuable discoveries in the field of oncology globally.
Although the world continues to grapple with the COVID-19 pandemic and other ongoing challenges, we saw a shift in momentum related to our studies at the UCI-Fred Hutch Cancer Centre, in a large part due to our dedicated team and a decrease in COVID-19 cases in Uganda, particularly in the last two quarters of the fiscal year. Our clinical studies continued relatively smoothly, despite the pandemic. Our study teams cross-trained on all protocols to provide backup support for each study. During this time, we enrolled an increasing number of participants in our studies, particularly in the latter half of the fiscal year.
We have learned from our colleagues in Kampala that patient care quality has been enhanced through participation or enrollment in our studies, for instance, by facilitating timely diagnosis of cancers and comorbidities. In one of our studies on Kaposi sarcoma, participant visits are synchronized with the standard of care visits at the UCI. If participants have challenges with transport to the UCI, this study will support their transport. This was a critical need during COVID-19 pandemic travel restrictions, and it enabled many patients to access chemotherapy visits and other standard of care reviews regularly and in a timely way.
A few of our studies are focused on infections among cancer patients — a critical and growing area of our research portfolio. Findings from a 2022 study in The Lancet indicated that 1.2 million people died from antibiotic-resistant infections in 2019, making it a leading global cause of death.4 A study led by Dr. Margaret Lubwama on bacteremia among lymphoma patients and another study on infections in solid tumor patients, led by Dr. Elizabeth Gulleen, advocated for improved temperature monitoring among study participants at the UCI. The team supporting the bacteremia study monitors febrile episodes in lymphoma patients, and according to Constance Namirembe, HCRI-Uganda clinical research project manager:
“[The study] supports tests for blood culture and sensitivity during a febrile episode; where if an organism is identified and is suspected to be causing the fever, it informs the standard of care in real time regarding the appropriate antibiotics to be given.”
In Gulleen’s study, the temperature monitoring has increased the ability to rapidly diagnose and treat infections among UCI patients receiving chemotherapy. Participants were provided with blood cultures as well as malaria and tuberculosis testing. The study results were given to the clinical teams in real time, which helped improve their ability to prescribe the correct antimicrobials for their patients. The results of this study were presented to UCI faculty and staff at multiple clinical care conferences. According to Gulleen, “We are currently working with the UCI pharmacists and clinicians to develop infection treatment protocols based on our study results with the goal of improving patient management and decreasing infection-related mortality.” In a related study on antimicrobial stewardship, Gulleen and colleagues asked UCI clinicians about their experiences with diagnosis and treating patients with infections. The study team learned about current knowledge regarding antibiotic use and barriers to diagnosis and treating infections in their patients.
“We are using the results to build an antimicrobial stewardship program at the UCI and create educational sessions on infection management for clinicians,” Gulleen said.
Further details about these studies and our other research are below.
4 Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022 Feb 12;399(10325):629-655. doi: 10.1016/S0140-6736(21)02724-0. Epub 2022 Jan 19. PMID: 35065702; PMCID: PMC8841637. Accessed July 19, 2022.
Learn about our research led by Global Oncology faculty, fellows, and collaborators at the UCI and elsewhere.
Principal investigators: Dr. Warren Phipps (Fred Hutch), Dr. Elizabeth Gulleen (Fred Hutch) and Dr. Margaret Lubwama (UCI)
Co-investigators: Dr. Catherine Liu (Fred Hutch), Alfred Komakech (UCI) and Elizabeth Krantz (Fred Hutch)
Infections are one of the most common complications during cancer treatment. Developing programs to enhance antibiotic stewardship, or the rational use of antibiotics, is a critical component of decreasing infection-related morbidity and mortality. In this study, the investigators aim to examine the current knowledge and attitudes of UCI health care providers towards antimicrobial resistance. They also aim to determine the current knowledge and attitudes of UCI health care providers towards antimicrobial stewardship. Finally, the investigators aim to understand perceived barriers to the diagnosis and management of infections in patients at UCI. The study met accrual targets (61 participants) in the second quarter of FY21. While all respondents had heard of the term “antimicrobial resistance,” only 73% had heard of the term “antimicrobial stewardship.” Nurses were less likely than pharmacists or physicians to be familiar with either term. The ability to obtain blood cultures and to regularly measure temperatures were identified as major barriers to diagnosing infections. The results of the study were published in Antimicrobial Stewardship and Hospital Epidemiology, volume 2, issue 1, 2022, e54.
Principal Investigators: Dr. Warren Phipps (Fred Hutch), Dr. Elizabeth Gulleen (Fred Hutch), Dr. Abrahams Omoding (UCI) and Dr. Christopher Moore (University of Virginia)
Co-Investigators: Dr. Scott Heysel (University of Virginia), Dr. Michael Keng (University of Virginia) and Elizabeth Krantz (Fred Hutch)
Infection is a leading cause of morbidity and mortality among patients receiving chemotherapy for cancer treatment. Little is known about the microbiological causes of fever or associated outcomes among patients with solid tumors receiving chemotherapy in sub-Saharan Africa. Understanding the microbiological causes of fever could improve antibiotic selection and infection-related outcomes. The primary study objective is to determine the most common microbiologic causes of fever among hospitalized patients who are receiving chemotherapy for the treatment of solid tumors in Uganda. Secondary objectives include a) to determine predictors of in-hospital and 30-day mortality and b) to describe the antibiotic management of patients who develop fever while receiving chemotherapy for the treatment of solid tumors.
The study met its accrual target (100 participants) in FY22 Q4. Preliminary analysis of the first 80 febrile events shows that 25% of participants had at least one microbiologic source of infection. Among these, 10% of participants with fever experienced a bacterial bloodstream infection. The most common causes of bacterial bloodstream infections were Escherichia coli and Klebsiella spp. For participants who underwent urinary lipoarabinomannan testing for tuberculosis, 17% were positive. This did not differ by HIV status. Thirty-day mortality was 23%. The results of this study were presented as an oral presentation at the European Congress of Clinical Microbiology in April 2022.
Principal investigators: Dr. Amanda Phipps (Fred Hutch) and Dr. Victoria Walusansa (UCI)
Co-investigators: Dr. Scott Adams (VA Puget Sound Health Care System), Dr. Tom Uldrick (Regeneron; affiliate professor, Fred Hutch) and Dr. Robert Lukande (Makerere University)
The primary objective of this study was to estimate the prevalence of BRAF and KRAS mutations, CpG island methylator phenotype (CIMP) and microsatellite instability (MSI) in colorectal tumors in the Kampala Cancer Registry (KCR). The secondary objectives were to: describe the demographic and clinical characteristics of colorectal cancer cases in the KCR; evaluate associations of demographic and clinical characteristics with the prevalence of BRAF and KRAS mutation, CIMP and MSI in colorectal cancer cases in the KCR; and evaluate associations of survival time with tumor molecular phenotypes (BRAF, KRAS, CIMP, MSI) and other participant information. Unfortunately, high levels of degradation in DNA specimens, likely due to initial tumor processing and storage conditions, compromised the researchers’ ability to identify BRAF and KRAS mutations and prompted us to forgo CIMP analyses. Greater success was observed in MSI analyses, where the team found 35% of tumors to exhibit MSI-high status (compared to 10%-20% typically observed in U.S. settings). Tumors exhibiting MSI-high status did not differ significantly from other tumors in tumor site or patient age at diagnosis. Despite technical challenges, our results have demonstrated a provocatively higher proportion of MSI-high status tumors among Ugandans with CRC, compared to U.S. cohorts.
Principal Investigators: Dr. Joyce Kambugu (UCI) and Dr. Soheil Meshinchi (Fred Hutch)
Co-Investigators: Dr. Clement D. Okello (UCI), Dr. Fadhil Geriga (UCI), Dr. Henry Ddungu (UCI), Dr. Jackson Orem (UCI), Dr. Katherine Tarlock (Seattle Childrens), Dr. Cecilia Yeung (Fred Hutch) and Andrea Towlerton (Fred Hutch)
Investigators conducted a retrospective study of all patients with acute leukemias, therapies, and outcomes to understand the number of patients treated for acute lymphocytic leukemia and acute myeloid leukemia (AML) at the UCI over a five-year period. They also aimed to document relapse and survival rates. The retrospective review was completed in December 2021. The study of 186 patients with AML treated at the UCI with standard induction regimens over a 5-year period demonstrates a complete remission rate of 46.2% and an overall 30-day induction treatment-related mortality rate of 31.5%, which suggests the need for interventions to reduce treatment-related mortality and improve the outcome for patients with AMC in low- and middle-income countries. This study is funded by the Global Oncology Pilot Grants Initiative 2019.
Principal Investigators: Dr. Alice Berger (Fred Hutch) and Dr. Nixon Niyonzima (UCI)
Co-Investigators: Dr. Gavin Ha (Fred Hutch), Dr. Manoj Menon (Fred Hutch), Dr. Alex Bakenga (UCI) and Dr. Sitapriya Moorthi (Fred Hutch)
The study team aims to understand if a liquid biopsy be used for diagnosis and biomarker profiling in Ugandan lung cancer patients. Specifically, they seek to compare circulating tumor DNA (ctDNA) sequencing to standard histopathologic diagnoses of lung cancer in patients with advanced-stage lung cancer at UCI. They will determine the prevalence of detectable ctDNA in 35 patients with confirmed lung cancer, prior to therapy. Further, the team will describe the tumor-specific molecular alterations present in lung cancer specimens and ctDNA in advanced-stage lung cancer patients at UCI. They will detect common cancer-associated mutations with a lung cancer next-generation sequencing panel and describe the frequency of EGFR mutations and other targetable mutations for the first time in the Ugandan population. The study received final regulatory approvals in late in FY22 with a plan to activate in early FY23. It is funded by the Global Oncology Pilot Grants Initiative 2019.
Principal Investigators: Dr. Joyce Kambugu (UCI) and Dr. Soheil Meshinchi (Fred Hutch)
Co-Investigators: Dr. Clement D. Okello (UCI), Dr. Fadhil Geriga (UCI), Dr. Henry Ddungu (UCI), Dr. Jackson Orem (UCI), Dr. Katherine Tarlock (Seattle Childrens), Dr. Cecilia Yeung (Fred Hutch) and Andrea Towlerton (Fred Hutch)
This is a prospective study of all patients enrolled with acute leukemias at the UCI, including each patient’s diagnosis, therapy, response to therapy, treatment toxicity and the outcome. The study team is developing infrastructure for clinical sequencing and a plan at the UCI for the rapid transition into clinical implementation upon assay validation.
Principal Investigators: Dr. Manoj Menon (Fred Hutch) and Dr. Nixon Niyonzima (UCI)
Co-Investigators: Dr. Scott Adams (VA Puget Sound Health Care System), Andrea Towlerton (Fred Hutch) and Dr. Molly Tokaz (Fred Hutch)
With funding from the Susan G. Komen Foundation, the study team aims to evaluate the liquid biopsy as an effective tool in the diagnosis and monitoring of women with metastatic breast cancer. The ability to accurately diagnose and monitor response to therapy (minimally invasive) could be critical in a limited-resource setting. If successful, the team anticipates that patients will be diagnosed and treated earlier, thereby reducing the health disparities between women with breast cancer in Uganda and in the U.S.
Principal Investigators: Dr. Warren Phipps (Fred Hutch), Dr. Elizabeth Gulleen (Fred Hutch) and Dr. Jackson Orem (UCI)
Co-Investigators: Dr. Johnblack Kabukye (UCI) and Dr. Catherine Liu (Fred Hutch)
Between 50%-80% of patients receiving chemotherapy for cancer treatment experience an episode of neutropenic fever (NF) during treatment. Studies show that time from fever onset to administration of guideline-recommended antibiotics is an important predictor of mortality. A recent study from UCI showed that, for patients with hematologic malignancy who developed NF, it took a median of three days for guideline-recommended antibiotics to be prescribed. In this mixed-methods study, the team’s aims are as follows: 1) understand the current process of antibiotic initiation for patients with cancer at NF at the UCI; 2) identify factors that influence timely initiation of guideline-recommended antibiotics that can be addressed using targeted implementation strategies; 3) identify the unique barriers to diagnosing infections and initiating guideline-recommended antibiotics for patients with NF who are HIV seropositive. Using the results of this study, the team will then collaborate with UCI staff to design implementation studies to overcome the barriers. They will then prospectively test these strategies to determine whether they improve the time –to guideline-recommended antibiotics and decrease infection-related mortality.
Principal Investigators: Dr. Innocent Mutyaba (UCI) and Dr. Warren Phipps (Fred Hutch)
Kaposi sarcoma patients initiated on antiretroviral therapy (ART) have a life-threatening clinical worsening called KS immune reconstitution inflammatory syndrome (KS-IRIS). The scientists have shown that KS-IRIS is common in adults with late-stage KS in spite of concurrent ART and cancer chemotherapy. The team seeks to extend this work by evaluating predictors of KS-IRIS in a complementary cohort of KS patients initiating ART therapy curated by the AIDS and Cancer Specimen Repository. The study aims are 1) to identify baseline predictors of incident KS-IRIS among adults with early-stage KS initiating ART and 2) to determine if select clinical parameters, plasma cytokines and KSHV burden measured at the time of KS-IRIS symptom onset could serve as biomarkers of prevalent KS-IRIS.
Principal Investigators: Dr. Warren Phipps (Fred Hutch), Dr. Elizabeth Gulleen (Fred Hutch) and Dr. Margaret Lubwama (Makerere University)
Co-Investigators: Dr. Catherine Liu (Fred Hutch)
Multidrug-resistant Gram-negative bacteria, including extended-spectrum beta-lactamases (ESBLs) and carbapenem-resistant Enterobacterales (CRE), are an increasing cause of bacterial bloodstream infection for patients receiving cancer treatment in sub-Saharan Africa (SSA). Bloodstream infections with these organisms are associated with high morbidity and mortality. Studies show that gastrointestinal colonization with ESBL or CRE increases the risk of developing bloodstream infections. In SSA, up to 35% of those with cancer are also co-infected with HIV. However, the association between HIV status and gastrointestinal colonization with multidrug-resistant bacteria is yet unknown. The team’s primary goal is to understand the association between HIV status and gastrointestinal colonization with multi-drug resistant organisms (MDROs) among patients who are receiving chemotherapy for treatment of cancer in Uganda. The secondary goals are to a) assess the factors associated with MDRO colonization within the first 30 days of initiating chemotherapy and b) investigate whether colonization with an MDRO is associated with an increased risk of developing a bacterial bloodstream infection with that organism. The team will use the results of this study to develop tailored antibiotic infection prevention and treatment protocols for patients with HIV with the goal of improving cancer treatment outcomes and decreasing infection-related mortality.
Principal Investigators: Dr. Manoj Menon (Hutch) and Dr. Nixon Niyonzima (UCI)
Co-Investigators: Dr. Jamie Guenthoer (Hutch) and Dr. Eric Konnick (UW)
Breast cancer remains the most common non-AIDS-defining cancer among women living with HIV and is characterized by aggressive disease and poor outcomes. Immune cells in the tumor microenvironment (TME) have an essential role in tumor development, progression and response to therapy. The study team will investigate the extent and nature of HIV-associated immune dysfunction in tumor tissues and blood biospecimens from both HIV-positive and HIV-negative Ugandan women with breast cancer. Given the burdens of HIV and breast cancer in sub-Saharan Africa, clarity regarding the effect of HIV and associated immune dysfunction in the TME and blood are required to understand factors associated with cancer development and progression in this population.
Okello M, Nuwagaba J, Ddungu H*, Okuku FM. Cytoreductive surgery for giant locally advanced intra-abdominal tumors in Uganda. J Surg Case Rep. 2022 May 24;2022(5):rjac178. doi: 10.1093/jscr/rjac178. PMID: 35620232; PMCID: PMC9129259.
Ainembabazi P, Abila DB, Manyangwa G, Anguzu G, Musaazi J, Mutyaba I*, Osingada CP, Mwaka AD. Perceived risk and risk reduction behaviours of female first-degree relatives of breast cancer patients attending care at Uganda cancer institute. Psychooncology. 2022 May 18. doi: 10.1002/pon.5963. Epub ahead of print. PMID: 35584282.
Towlerton AMH, Ravishankar S, Coffey DG, Puronen CE, Warren EH. Serial Analysis of the T-Cell Receptor β-Chain Repertoire in People Living With HIV Reveals Incomplete Recovery After Long-Term Antiretroviral Therapy. Front Immunol. 2022 May 2;13:879190. doi: 10.3389/fimmu.2022.879190. PMID: 35585986; PMCID: PMC9108698.
Nakisige C, Adams SV^, Namirembe C, Okoche L, Ferrenberg J, Towlerton A, Larsen A, Orem J, Casper C^, Frenkel L, Uldrick TS^. Multiple High-Risk HPV Types Contribute to Cervical Dysplasia in Ugandan Women Living with HIV on Antiretroviral Therapy. J Acquir Immune Defic Syndr. 2022 Feb 21. doi: 10.1097/QAI.0000000000002941. Epub ahead of print. PMID: 35195571.
Radich JP, Briercheck E, Chiu DT, Menon MP, Sala Torra O, Yeung CCS, Warren EH. Precision Medicine in Low- and Middle-Income Countries. Annu Rev Pathol. 2022 Jan 24;17:387-402. doi: 10.1146/annurev-pathol-042320-034052. PMID: 35073168.
Okello CD, Niyonzima N, Ferraresso M, Kadhumbula S, Ddungu H*, Tarlock K, Balagadde-Kambugu J, Omoding A*, Ngendahayo L, Karagu A, Mwaiselage J, Harlan JM, Uldrick TS^, Turner SD, Orem J. Haematological malignancies in sub-Saharan Africa: east Africa as an example for improving care. Lancet Haematol. 2021 Oct;8(10):e756-e769. doi: 10.1016/S2352-3026(21)00198-8. Epub 2021 Sep 2. PMID: 34481552.
Kirenga B, Byakika-Kibwika P, Muttamba W, Kayongo A, Loryndah NO, Mugenyi L, Kiwanuka N, Lusiba J, Atukunda A, Mugume R, Ssali F, Ddungu H*, Katagira W, Sekibira R, Kityo C, Kyeyune D, Acana S, Aanyu-Tukamuhebwa H, Kabweru W, Nakwagala F, Bagaya BS, Kimuli I, Nantanda R, Buregyeya E, Byarugaba B, Olaro C, Mwebesa H, Joloba ML, Siddharthan T, Bazeyo W. Efficacy of convalescent plasma for treatment of COVID-19 in Uganda. BMJ Open Respir Res. 2021 Aug;8(1):e001017. doi: 10.1136/bmjresp-2021-001017. PMID: 34376401; PMCID: PMC8354811.
Gulleen EA, Adams SV^, Chang BH, Falk L, Hazard R, Kabukye J, Scala J, Liu C, Phipps W, Abrahams O, Moore CC. Factors and Outcomes Related to the Use of Guideline-Recommended Antibiotics in Patients With Neutropenic Fever at the Uganda Cancer Institute. Open Forum Infect Dis. 2021 Jun 10;8(7):ofab307. doi: 10.1093/ofid/ofab307. PMID: 34262989; PMCID: PMC8275883.
Bold = Fred Hutch Global Oncology faculty
Underline = UCI collaborators
* = Current UCI-Fred Hutch Collaboration Trainee
Italics = U.S. research fellow
^ = Former Fred Hutch Global Oncology faculty and/or staff scientist
Training the next generation of physician scientists continues to be an emphasis of our collaborative work in Uganda
Dr. Fadhil Geriga
Associate Director of Pediatric Oncology, UCI
Dr. Priscilla Namaganda
Junior Investigator and Fellow, Adult Hematology Oncology Fellowship Program
Dr. Solomon Kibudde
Radiation Oncologist, UCI
The NIH D43 training program activities are managed by our HCRI-Ug training project manage Olive Birungi, who joined the Global Oncology program in FY22, and led by Dr. Warren Phipps, medical director, UCI-Fred Hutch Collaboration. Interested in staying up-to-date about our training activities? Please email Olive Birungi if you would like to receive our monthly Training Program newsletter.
“I have been in this program for close to two years and will be finishing the fellowship in three months and can attest to the foundations and tireless efforts in leading and guiding us to improve the quality of care to cancer patients in Uganda and East Africa. The program is inspirational, engaging and hands-on with a diverse range of patients with different cancers. We see a different future for cancer care in Uganda because of the knowledge and experience we have acquired through the fellowship.”
— Naghib Bogere, Medical Oncology Track, Fall 2020 Cohort
In FY22, the UCI and the Palliative Care Association of Uganda hosted the third annual conference from Sept. 23-24, 2021, with presentations by trainees including Dr. Innocent Mutyaba, Dr. Henry Ddungu, Dr. Geriga Fadhil and Dr. Noleb Mugisha. Dr. Victoria Walusansa, UCI deputy director, was also a panelist.
At IDWeek 2021 — a joint annual meeting of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, the Pediatric Infectious Diseases Society and the Society of Infectious Diseases Pharmacists — two fellows, Dr. Margaret Lubwama and Dr. Elizabeth Gulleen, presented abstracts. Their abstracts were titled, “Multidrug-Resistant Polymicrobial Gram-Negative Bacteremia in Hematologic Cancer Patients With Febrile Neutropenia at the Uganda Cancer Institute” and “Knowledge and Perceptions of Antimicrobial Resistance and Antimicrobial Stewardship Among Staff Providing Cancer Care at the Uganda Cancer Institute,” respectively. This conference was held virtually in late September and early October 2021.
Currently there are five Ugandan trainees/fellows as a principal investigator on one of our current or upcoming studies under institutional review board review. They include:
Integrating Cervical Cancer Screening in HIV Clinics and Assessing the Effect of Using a Modified Referral Protocol on Access to Cancer Services Among HIV-Positive Women in Uganda
Identifying Predictors of Kaposi Sarcoma Immune Reconstitution Inflammatory Syndrome
Treatment Response and Treatment-Related Mortality in Pediatric Patients With Acute Myeloid Leukemia at the Uganda Cancer Institute
More than 200 tumor boards were held by the UCI-Fred Hutch Collaboration, in collaboration with other invited clinicians and experts. Below is a snapshot of the eight different tumor board topics and the number of sessions held over the year.
(Note: these figures include Q2-Q4.)
The UCI-Fred Hutch Collaboration laboratory recently acquired the new Cepheid XPRESS, COV-2/FLU/RSV PLUS cartridges for testing for SARS-CoV-2, influenza and respiratory syncytial virus. The team will begin providing this service in late summer 2022. Despite the ongoing pandemic, the laboratory at the UCI-Fred Hutch Cancer Centre continued to operate successfully under the leadership of Andrea Towlerton, laboratory director, HCRI-Uganda. The lab has processed greater than 11,000 biospecimens during the fiscal year — for several active studies, SARS-CoV-2 testing, and supporting clinical care at the UCI through tumor boards and fellowship training support.
The HCRI-U laboratory team continues SARS-CoV-2 testing as part of the Ugandan Ministry of Health’s National Testing Program and operates at a <12-hour turnaround time for results. The seven-person lab team has performed nearly 4,000 tests since the program started in late 2020. Towlerton secured another donation of 2,500 tests and regents from the Beijing Genomics Institute in March 2022. The laboratory has also passed, at 100%, the OneWorld Accuracy EQA proficiency testing for SARS-CoV-2 testing.
In response to guidelines provided by the Uganda National Council for Science and Technology, we developed a risk management plan (RMP) in 2020 to ensure the safety of research participants and research teams during the ongoing COVID-19 pandemic as research activities supported by the UCI-Fred Hutch Collaboration and HCRI-Uganda resumed. The goal is to minimize transmission among research participants and staff and identify suspicious cases of COVID-19 to facilitate referral to Uganda Ministry of Health testing centers.
In May 2022, HCRI-Uganda revised the RMP to align with Uganda Ministry of Health guidelines as national statistics indicated low COVID-19 transmission rates. Like other countries around the world, the COVID-19 situation evolves quickly as new variants result in surges of COVID-19 cases; thus, the RMP may be revised to reflect the changing pandemic or if local pandemic restrictions are reactivated. Yet, as of June 2022, the updated RMP outlines standard operating procedures at the facility (e.g., masking, physical distancing, handwashing) for all staff and participants. Staff were encouraged to get vaccinated against SARS-CoV-2, and vaccines are offered at the Uganda Cancer Institute for all staff and their immediate families.
Learn about our operations that ensure state-of-the-art facilities for research and training
The recently completed build-out of the ground floor of the UCI-Fred Hutch Cancer Centre in Kampala in the spring of 2021 — adding approximately 3,800 square feet — has allowed the program to bring all research and administrative functions under one roof. This video highlights the new ground floor space and other key areas of the facility. This project was led by Magdalene Kintu, director, Administration and Operations, HCRI-Uganda, and Jason Barrett, operations manager, Global Oncology. The video was created by Shot by Mu in 2021.
The associate director of Fred Hutch Facilities and Engineering visited the UCI-Fred Hutch Cancer Centre twice during FY22 to optimize facilities management and equipment with a special interest in the facility’s air handling systems. As a result of these site visits, and with the hard work of the administrative and facility management teams in Kampala, the systems are now functioning optimally. The associate director will plan for annual trips to the facility, with the next one scheduled for October 2022. The associate director and a senior technical engineer plan to evaluate how to renovate the second-floor pharmacy space and will provide options to Fred Hutch leadership.
Since the last annual report, the building oversight committee (BOC) was reconstituted with some new committee members from the UCI and HCRI-Uganda assigned. The Collaboration’s executive committee (EC) tasks the BOC to provide general oversight and monitoring of the UCI-Fred Hutch Cancer Centre operations and its use. The UCI-Fred Hutch Cancer Centre facility rules, originally developed by the previous BOC and ratified by the EC in 2018, define how the UCI and Fred Hutch/HCRI-Uganda operate and maintain the facility. The BOC is required to compile an annual report of the facility’s operations and present the report with recommended operational changes to the EC. The BOC has met frequently to review their charter as well as each focus area’s (e.g., laboratory, research, administration, etc.) section of the facility rules in preparation for the development of the fiscal year 2022 report.
Our teams have been committed to advancing the Global Oncology mission, whether at the forefront or behind the scenes.
“[I’m] passionate about training and health promotion and hope to use my experience and background to coordinate and promote trainings under the UCI-Fred Hutch Collaboration efficiently.”
— Olive Birungi, training project manager, HCRI-Uganda
“In FY22, the lab team was most proud of the leadership in their commitment to support us to do more science. We were especially glad that we have the lab director on site. In this new FY, we are even more fascinated with the introduction of Nanopore sequencing.
— Lazarus Okoche, PCR lab manager, HCRI-Uganda
“I am passionate about human resources as I believe they are critical to the success of any entity. I am very happy to be part of this great team and look forward to a mutually challenging and fulfilling journey with us all.”
— Shiloh Mutabazi, human resources coordinator, HCRI-Uganda
“It was exciting to see everyone’s face in one place after the remote policy was lifted. I remember how gratifying our first physical meeting was after a year long of virtual connection and seeing everyone looking healthy and alive. A couple of months ago we had Hootie [Edus H. Warren] visit Uganda followed by Jason [Barrett] after two years. One happy family reunited! I am excited about Shiloh’s onboard and Sumayah’s, who are great additions to the team.
“I am looking forward to a very productive next year, especially for the HR department, with an extra hand in streamlining existing processes and introducing more exciting employee engagements."
— Andrew Okot, manager, Operations and Human Resources, HCRI-Uganda
“I joined the HCRI-Uganda family on 15 April 2022 as a quality assurance assistant. I will be supporting all data quality assurance issues related to research studies conducted by HCRI-Uganda. I ensure that studies are conducted in accordance with research protocols and other applicable guidelines. I am privileged to join the HCRI-Uganda to contribute to the realization of its mission and vision by ensuring that high-quality research is conducted.”
— Enos Baghendaghe, quality assurance assistant, HCRI-Uganda
On April 25, 2022, the U.S. ambassador to Uganda, Natalie E. Brown, visited the UCI-Fred Hutch Cancer Centre. Dr. Edus H. Warren, the Global Oncology scientific director, was visiting the site and took part in the ambassador’s tour along with the UCI Executive Director Dr. Jackson Orem. Ambassador Brown shared the following Tweet after the visit.
Throughout the year, we host a global oncology seminar series to bring in diverse voices about cancer research, programs or policies from across the globe. In FY22, we were fortunate to have the following experts present at the seminar series. To learn more about this seminar series and upcoming seminars, visit our Global Oncology events webpage.
September 2021: Joyce Balagadde Kambugu, M.D., head of pediatric oncology, Uganda Cancer Institute
October 2021: Satish Gopal, M.D., Ph.D., director, Center for Global Health, National Cancer Institute
November 2021: Leeya Pinder, M.D., M.P.H., fellow, Division of Gynecologic Oncology, University of Washington & research fellow, Galloway Lab, Fred Hutch
January 2022: Solomon Kibudde, M.B.Ch.B., M.Med., radiation oncologist, Uganda Cancer Institute
February 2022: Dan Milner, M.D., M.Sc. (Epidemiology), MBA, FASCP, chief medical officer, American Society for Clinical Pathology
March 2022: Benjamin O. Anderson, M.D., FACS, medical officer, Cancer Control, World Health Organization
April 2022: Julie Gralow, M.D., FACP, FASC, executive vice president and chief medical officer, American Society of Clinical Oncology
May 2022: Doug Pyle, vice president, International Affairs, American Society of Clinical Oncology
June 2022: Clement Okello, M.B.Ch.B., M.Med., medical officer special grade/hematologist, Uganda Cancer Institute
Inspired by research progress despite global challenges
While the world continues to respond and be nimble in the face of many challenges, cancer and other diseases remain an urgent global health priority. We have been inspired by the progress we have made, in particular, how our research is impacting the standard of care for cancer patients at the UCI. The UCI is opening satellite cancer clinics, and we are excited to learn about these sites and how we may collaborate on studies that can improve cancer care, especially locally. Breakthrough research findings should be available everywhere, equitably. We look forward to continuing our ongoing scientific training efforts with our outstanding fellows and to launching the new training program in cancer genomics. We aspire to continue these efforts and to translate findings into clinical care and action. We believe it is critical to pursue our mission and the broader mission of Fred Hutch in our everyday work.