Stemming from the results of three EU-funded projects, DIABFRAIL-LATAM intends to make a scaling up of a multimodal intervention in older people with diabetes very vulnerable because of their frailty status. The scaling up will take place in 5 Latin-American countries (1 HIC and 4 LMICs), in different settings of care. The project embraces three main parts: 1) a validation study (an open Randomized Clinical Trial) that mimics the intervention to be transferred and that was shown to be effective and with a good cost-effective relationship; 2) a feasibility study that will include an economic analysis, adherence assessment and an analysis of the barriers and key factor of success; and 3) a proper scaling up process using a methodology based on the recommendations of the WHO (“WHO ExpandNet model”) and the European Union (“Maturity Model” and “11 success factors” suggested by the Expert Group on Health Systems Performance Assessment) that will take place not only in the five countries participating in the validation of the intervention, but also in other four countries, under the auspices of the Pan-American Health Organization and the cooperation of the local governments. The consortium of the project is composed by a multidisciplinary team of partners involving academic partners, research partners, clinical partners, public health partners and citizen organizations. In addition, several local, national and international stakeholders, including governmental organizations and NGOs will also provide support in the several settings of care. The project is clearly aligned with the programs of many of the institutions constituting the Global Alliance for Chronic Diseases (GACD), including the Research&Innovation DG of the European Commission, with projects supported by GACD, with several actions of the EIP-AHA initiative and with strategies on non-communicable chronic conditions in the EU, in several countries of the Latin-American and Caribbean Region, PAHO and WHO.

Hepatobiliary malignancies represent a major cause of mortality globally and are uniquely aggressive in Latin America. The most common tumors are: hepatocellular carcinoma (HCC) affecting young individuals in Latin America and being the second most common cause of cancer-related death worldwide; cholangiocarcinoma (CCA) with minimal survival upon diagnosis and largely understudied in the region; gallbladder cancer (GBC) being a rare tumor worldwide but representing the second most common cause of cancer-related death in women in Chile. Key factors related to the excessive mortality of these tumors are the lack of reliable screening methods and the complexity of diagnosis, which requires advanced imaging technology and difficult-to-access tissue. These barriers are amplified by poor accessibility present in resource-limited regions, all of which leads to tumors being diagnosed at advanced stages in which curative therapy is not an option. To overcome these barriers, we propose to: A) validate immune-related markers in serum to predict HCC in South America and evaluate factors associated to early HCC development; B) define the utility of extracellular vesicles in serum as biomarkers for diagnosis of CCA and determine genetic and infectious factors that increase risk for this cancer; and C) identify biomarkers for GBC detection and evaluate novel immune factors that affect the geographical impact of this tumor. This project advances the field by focusing on a unique approach to screen and diagnose tumors based on serum detection of biomarkers before a tumor is visible on imaging, allowing for early tumor detection in a cost effective manner that will lead to implementation of curative therapies. In addition, this project addresses modifiable risk factors for hepatobiliary tumors that could be targeted for prevention. This project will result in novel tools that are easily accessible and will dramatically reduce the burden of cancer-related mortality in Latin America.