(DELTAS Africa) program is a transformative initiative launched in 2015 to enhance Africa's capacity for high-quality research and leadership in science. The program is designed to support collaborative consortia led by African scientists, aiming to strengthen African institutions and foster the development of world-class researchers. Its overarching goal is to drive locally relevant health research that influences science, policy, and practice, ultimately contributing to better health outcomes and development both on the continent and globally.

Managed by the Science for Africa Foundation (SFA Foundation), the second phase of the program, DELTAS Africa II, runs from 2023 to 2026 and features 14 consortia tackling key health and development challenges. One of these consortia, the Research and Excellence in African Capacity to Control and Treat CANcer (REACCT-CAN), is dedicated to advancing cancer research. REACCT-CAN focuses on enhancing cancer care, prevention, and early detection, addressing critical health needs and striving to improve cancer outcomes across Africa.

The DELTAS initiative will ideally increase sustainable development and human well-being in Africa. Increasing the evidence base for health policy development and practice will achieve this impact. Long-term outcomes of Research and Excellence in African Capacity to Control and Treat Cancer (REACCT-CAN) programs will generate high quality research evidence to inform policy formulation and practice for effective primary and secondary cancer prevention programs in Africa and achieve universal access to affordable, high quality and timely diagnosis, treatment and care for cancer patients. Morbidity and mortality due to cancer will thereby be reduced and save lives. To achieve this, the Ethiopia-led Consortium will train and widely capacitate African scientists, students, and network to expand research collaborations. Applying the DELTAS Africa theory of change, activities and outputs will be defined and operationalized through a steering committee focused on research design, leadership, networking and sustainability, 3 work packages , and an independent scientific advisory board. work package1 will focus on regulatory, governance, and capacity building activities; work package2 on research, mentoring, training, data management, monitoring and evaluation; work package3 on contracting, finance and reporting.

Intermediate outcomes to achieve program goals include:

• Strong leadership skills for the Ethiopian lead partner, African scientists and students with academic and entrepreneurial skills, competing globally, networking widely, building research groups and infrastructure.
• High quality primary and secondary cancer prevention research, cost-effective point-of-care diagnostic product development, tumor immunology and precision medicine research designed to meet highest priority needs in Africa building a sound knowledge base for policy and practice.
• Expanded African collaborations and networks sharing existing knowledge and enhance research quality and relevance. Increased societal awareness of growing cancer burdens, needs, evidence and achievements in cancer care. Consulting widely with policy makers and Departments/Ministries of Health in each of the countries research projects will align with National cancer control policies and facilitate their implementation in each country. Academic entrepreneurial skills will be developed for African scientists and students enrolled on study projects who will attend courses on leadership, regulatory submissions, research ethics, contractual agreements, grants writing, management and reporting and publication writing. They will also be exposed to state-of-the-art molecular and cancer epidemiology research methodologies.

Our consortium includes North (Egypt), East (Ethiopia and Tanzania) and Southern Africa partners, uniting institutions with advanced cancer research programs (South Africa and Ethiopia), with those with high quality patient care (Egypt and Tanzania) and research infrastructure (Ethiopia, Tanzania, South Africa). Consortium impacts will compound those of individual partners (i) sharing skills, experience and training between institutions with different cancer research experiences and challenges; (ii) joint molecular and implementation research addressing setting specific cancer challenges which beset the entire continent: preventing cancers, reducing late stage at diagnosis and improving treatment adherence and quality; (iii) partnering with international cancer research institutions in Germany and with WHO’s International Agency for Research on Cancer that will support the scientific programs with relevant expertise spanning cancer registration, epidemiology, aetiology and genetics, implementation research and teaching.

We are looking for key research questions that help to advance knowledge in your chosen field and are underpinned by scientific originality, rigor and excellence. REACCT-CAN will focus on primary and secondary prevention research for common cancers in Africa to reduce mortality and achieve UN Sustainable Development Goal 3a. What are successful strategies to achieving universal access to cancer prevention, early diagnosis, treatment and care in the 21st century in Africa? African country public health systems focus primarily on infectious, infant, maternal and nutritional conditions. Knowledge and understanding about cancer and effective treatment options and improved survival outcomes for early stage disease detection is extremely low in the majority of socioeconomically disadvantaged communities and among health workers in low- and middle- income African countries. Patients with chronic diseases including cancer are under-served; either never diagnosed or diagnosed at late stage, resulting in lowest cancer survival rates globally. We aim to utilize modern m/eHealth interventions to create community awareness of cancer early symptoms, and algorithm driven high-risk community screening programs. Peripheral health services are not able to timely and accurately diagnose and refer symptomatic patients, to tertiary cancer facilities. Clinicians and nurses need training and appropriate infrastructures.

Regional treatment guidelines have been published for common cancers according to resource levels and also for sub Saharan Africa [NCCN] – but feasibility of implementation is not yet studied. We will evaluate and assess impact on outcomes with realtime data collections for large clinical cohorts. In the context of widely initiated cervical cancer screening programs, we aim to optimize uptake and precision testing. Fast-tracking referrals from primary health care clinics to oncology centers will be explored in our partner countries. Optimum allocation of few available experts, task sharing and shifting to lower levels and how to implement survivorship and palliative care needs is understudied. We will adapt South African experiences of improving access to care in urban and rural areas to partner country settings. Implementing extensively trained cancer nurses at rural health facilities is a promising concept. These research questions address consortium-wide problems that will be jointly addressed through shared and local approaches. In order to increase the scientific knowledge base on cancer we will enhance high-quality African populationbased cancer registration to monitor changes of incidence and mortality over time with the objectives to downstage and effectively treat patients through health system interventions (34 registries, 24 countries linked). Research on unique aspects of cancer aetiology and tumor biology in Africa Cancer in Africa has unique features. Many cancer patients are younger than 50 years due to the young demographic structure, present at advanced stage with high prevalence of HIV, NCD’s and other comorbidities such as malaria, other parasites and tropical diseases. These factors and the broad genetic variation are not well studied but may lead to different tumor biology, pharmaco-genetics and -kinetics (influencing treatment efficacy and tolerance). Unique environments of the partner countries have differing nutrition patterns with differing impact on microbiome – that all influence immune reactions to cancer. We will thus investigate tumor immunology in Africa expecting unique results. Finally, East Africa has an understudied hot spot of some of the world’s highest rates of esophageal cancer.

REACCT-CAN focuses on cancer research, i.e. working towards the World Cancer Declaration and the 2030 Sustainable Development Goal 3 to reduce non-communicable diseases. In Africa, cancer is currently characterized by increasing incidence (1 to 2 million annual cases from 2018 to 2040).

The annual number of deaths from cancer in our participating countries are 85 432 in Egypt, 47954 in Ethiopia, 28610 in Tanzania, and 5,373 in South Africa (GLOBCAN). Due to this need, all countries have cancer control plans which pointing out the need for more scientific evidence and to implement prevention strategies to prevent 30–50% of cancers.

Hence, cancer control research needs to include primary prevention research, whilst advanced diagnosis, inadequate treatment and low survival are near ubiquitous problems owing to overstretched oncology services. Tackling these problems requires knowledge of cancer in the context of African patients, health systems and socio-cultural norms. Today, only 1 in 5 LMICs have the necessary data to drive cancer policy.

REACCT-CAN’s research will build Africa’s future generation of cancer scientists. We have selected the research themes based on the following criteria (i) encompass the cancer research and care continuum; (ii) feed into national cancer control plans through research into early-diagnosis and common cancers (refs); (iii) balance epidemiology and laboratory research; (iv) form natural networks across Egypt, Ethiopia, Tanzania and South Africa with each theme involving at least two partners. Graduates will design and shape narrower fields within these areas.