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Purpose: Mozambique is a country with a very high prevalence of gynecological cancer and, until 2018 had no training program in gynecologic oncology and no gynecologic oncology specialists. Through the International Gynecologic Cancer Society (IGCS) global fellowship program, three gynecologists in Mozambique were trained to become gynecologic oncologists and completed training in October 2020. Methods: The training program pairs specialists in gynecologic oncology with gynecologists in countries without a formal training program in gynecologic oncology. In Mozambique, fellows were paired with specialists from Brazil and the United States, due to a common language with Brazilians and pre-existing partnerships. Over a 2.5 year period, fellows performed self-study using an on-line curriculum, received training in clinical practice and surgery with specialist mentors who traveled to Mozambique 3-4 times/year, attended monthly tumor boards and other regular virtual meetings, and visited the mentors' hospitals in Brazil for a 3 month observership. All surgical cases were logged in REDCap. after completing all requirements, the fellows successfully completed a final exam and received a certificate of successful completion of training. Results: During the training, each fellow participated on average of 251 surgical procedures where they performed: 69 radical hysterectomies, 80 simple hysterectomies, 92 salpingo-oophorectomies, 73 pelvic lymphadenectomies, 2 para-aortic lymphadenectomies, 14 radical vulvectomies, 19 inguinal lymphadenectomies, 34 cold knife conizations and 38 loop electrosurgical excision procedures (LEEPs). At the conclusion of the fellowship, the fellows were performing these procedures independently. Conclusion: The IGCS program and international mentors supported the training of physicians in Mozambique, a country without formal gynecologic oncology training, facilitating the acquisition of the knowledge and skills to effectively care for women with gynecologic cancers. Citation Format: Ricardina Rangeiro, Dercia Changule, Siro Daud, Magda Ribeiro, Elvira Luis, Flora Mabota, Georgia Cintra, Renato Moretti-Marques, Andre Lopes, Marcelo Vieira, Mila Salcedo, Ellen Baker, Cesaltina Lorenzoni, Kathleen Schemeler. IGCS Fellowship Program in Mozambique: the Results [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 91.

Abstract 5 Purpose There are more than 530,000 new cases of cervical cancer and 275,000 related deaths annually worldwide. More than 85% of cases and deaths occur in low- and middle-income countries and some areas of the United States. There is a shortage of medical specialists to provide prevention, screening, and treatment services in these regions. Needed are programs that are focused on increasing the clinical capacity to improve cancer prevention services via innovative, locally held, hands-on training courses in conjunction with regular telementoring. Locally held, hands-on training courses for colposcopy, cervical biopsy, and loop electrosurgical excisional procedures using innovative training models and theoretical practical lectures were held in conjunction with telementoring using Project ECHO (Extension for Community Health Outcomes). Methods We initiated a cervical cancer prevention education program with two complementary components: locally held, hands-on training courses using innovative teaching aids that were developed by Rice University, and Project ECHO telementoring using regularly held videoconferences to ensure regular mentoring. These innovative training models are low cost (< $80 USD) and allow course participants to simulate different cervical cancer screening and early treatment techniques, including VIA, colposcopy, cervical biopsies, cryotherapy, and loop electrosurgical excisional procedures. Results To date, four hands-on training programs have been held in Mozambique (n = 2) and underserved areas of Texas, including the Rio Grande Valley (n = 1) and Laredo (n = 1). In addition, since 2014, 99 ECHO telementoring sessions have been held with providers in the Rio Grande Valley and Laredo (average, n = 23 providers) as well as Mozambique (average, n = 11 providers). Conclusion Through this cervical cancer prevention education program, we have found that locally held, hands-on training courses using innovative models, complemented with Project ECHO telementoring, is an innovative way to improve cervical cancer screening and prevention efforts in low-resource settings. Evaluation is ongoing to determine the efficacy of these programs compared with traditional training methods. Funding: The Cancer Prevention Research Institute of Texas, The University of Texas MD Anderson Sister Institution Network Fund, The University of Texas MD Anderson Cancer Center Moon Shots program, and The Prevent Cancer Foundation. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

Abstract 8 Background: Worldwide, 14.1 million new cancer cases and 8.2 million cancer-related deaths occur annually. Of global cancer deaths, 65% occur in low- and middle-income countries, where there are not enough medical specialists to provide prevention, screening, and treatment services. For example, there are 245 physicians per 100,000 people in the United States and four physicians per 100,000 people in Mozambique. We undertook this work to investigate how to increase clinical capacity and improve cancer prevention and treatment services to ultimately reduce cancer mortality in Mozambique. Methods: Our education program has three complementary components: Strong partnerships with four academic institutions in Brazil, the Ministry of Health of Mozambique, Maputo Central Hospital, and Mavalane Hospital (Maputo) to develop educational programs and collaborative research; use of technology to implement resource-specific and culturally appropriate telementoring programs; and in-country, hands-on training. Collaboration with Brazilian institutions facilitates communication and provides clinical expertise and program expansion opportunities. The telementoring component uses the Project ECHO model, a program that was developed at the University of New Mexico to engage providers in a horizontal manner through regular case-based discussions. Hands-on training complements the telementoring program and increases the level of expertise. Results: Since January 2015, 120 training hours have been provided through ECHO videoconferences to an average of 11 participants on breast, cervical, and head and neck cancers. Two in-country workshops have provided an average of 1,200 training hours to approximately 100 providers in diagnosis, secondary prevention, and surgical management of breast, cervical, and head and neck cancers, as well as training for medical oncology, oncology nursing, palliative care, and radiation physics. Conclusion: Collaborations with Pink Ribbon Red Ribbon, US academic institutions, and industry partners are being developed to strengthen these programs. Funding: The Cancer Prevention Research Institute of Texas Grant No. PP150012; The University of Texas MD Anderson Cancer Center R. Lee Clark Fellowship award, generously supported by the Jeanne F. Shelby Scholarship Fund; The University of Texas MD Anderson Sister Institution Network Fund (SINF) award; The University of Texas MD Anderson Cancer Center HPV-related cancers Moon Shot program; and The University of Texas MD Anderson Cancer Center Cancer Prevention and Control Platform. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Melissa S. Lopez No relationship to disclose Ellen S. Baker Stock or Other Ownership: Merck Cesaltina Lorenzoni No relationship to disclose Elvira Xavier Luis No relationship to disclose Flora Mabota No relationship to disclose Pedro Rafael Machava No relationship to disclose Jose Humberto Tavares No relationship to disclose Donato Callegaro Filho No relationship to disclose Thiago Chulam Travel, Accommodations, Expenses: AC Camargo Cancer Center Kathleen M. Schmeler Research Funding: Becton Dickinson Patents, Royalties, Other Intellectual Property: UpToDate

There are limited data on human papillomavirus (HPV) type-specific cervical cancer risk among human immunodeficiency virus (HIV)-positive women. Previous studies have suggested that HPV 16 would be relatively less important as a causative agent among HIV-positive compared with HIV-negative women. This study investigates HPV type-specific cervical cancer risk in a population in which HIV is endemic. At the Central Hospital, Maputo, Mozambique, 221 cervical cancer cases and 203 hospital-based controls were consecutively enrolled. HPV typing from cervical samples, HIV testing and recording of socio-demographic factors were performed. Logistic regression modelling was used to assess HPV type-specific risk and effect modification between HIV and HPV infection. Infection with HPV 16, 18 and ‘high-risk non-HPV 16/18 types’ (HPV 31, 33, 35, 39, 45, 51, 52, 56, 58 and 59) was associated with cervical cancer in both crude and adjusted analyses. HPV 16 and 18 were the most common types detected in cancer biopsies among both HIV-negative and HIV-positive women. There was no significant evidence of effect modification between any HPV type and HIV infection, and there were no significant differences in the HPV type-specific prevalence when cervical cancers among HIV-positive and HIV-negative women were compared. Within the limitations of the study, the relative importance of different HPV types in cervical carcinogenesis appears not to be modified greatly by HIV infection, suggesting that HPV vaccines might not need to be type-specifically modified to be suitable for populations where HIV is endemic.

The distribution of human papillomavirus (HPV) types in cervical cancers is essential for design and evaluation of HPV type-specific vaccines. To follow up on a previous report that HPV types 35 and 58 were the dominant HPV types in cervical neoplasia in Mozambique, the HPV types in a consecutive case series of 74 invasive cervical cancers in Mozambique were determined. The most common worldwide major oncogenic HPV types 16 and 18 were present in 69 % of cervical cancers, suggesting that a vaccine targeting HPV-16 and -18 would have a substantial impact on cervical cancer also in Mozambique.