Currently, 95% of global child lymphoma blood cancer cases are found in sub-Saharan Africa. A subset of these, Epstein-Barr virus (EBV)-related lymphomas such as Burkitt lymphoma, are particularly aggressive.
Burkitt lymphoma is often curable when diagnosed and treated quickly, but access to timely diagnosis remains a major barrier in many parts of sub-Saharan Africa.
Conventional tests require specialist expertise and laboratory equipment that are often unavailable in low-resource settings. As a result, most children remain undiagnosed or are diagnosed too late, and survival rates in much of the region can fall below 50%.
Speed matters. The NIHR-funded Aggressive Infection-Related East Africa Lymphoma (AI-REAL) programme is addressing this challenge. It is evaluating whether a minimally invasive blood test, known as a liquid biopsy, can provide a faster and more practical way to diagnose Burkitt lymphoma in East Africa.
Led by Professor Anna Schuh at the University of Oxford, the programme brings together teams in Uganda, Tanzania and Oxford, working in partnership with four hospitals.
More than a diagnostic test
From the outset, AI-REAL was designed to do more than test a new diagnostic technology. New equipment has been installed and training programmes established, with live-streaming technology also used to share clinical knowledge between teams in Oxford, Uganda and Tanzania.
“The aim is not just to improve the diagnosis for these children, but also to build capacity so that DNA-based cancer diagnostics can be used for many other cancers in sub-Saharan Africa,” said Professor Anna Schuh.
The programme's main research sites are located at the Muhimbili University of Health and Allied Sciences in Tanzania and in northern Uganda. The programme has created around 30 jobs for doctors, pathologists, nurses, laboratory scientists and bioinformaticians, alongside postgraduate opportunities in health economics, biology and oncology.
The creation of a public-private partnership, SerenOx Africa, is helping to build on this initial investment, with the expertise and infrastructure developed through the programme already supporting the diagnosis of cancers beyond Burkitt lymphoma.
From blood test to earlier treatment
The potential impact became tangible in August 2022, when a four-year-old child from a remote area of northern Uganda became the first patient in the programme to receive an earlier diagnosis using liquid biopsy technology.
The child, who was diagnosed with Burkitt lymphoma at St Mary's Hospital Lacor, was able to begin treatment and responded well.
The programme has since produced strong evidence that the approach can work in clinical settings. A 2026 study involving children and young adults with suspected lymphoma at four hospitals in Uganda and Tanzania found that the liquid biopsy achieved 98% overall diagnostic accuracy and provided a diagnosis around 40 days faster on average than tissue biopsy.
For a cancer that can progress extremely quickly, reducing the time to diagnosis enables children to start life-saving treatment weeks earlier.
Beyond Burkitt lymphoma
The significance of AI-REAL extends beyond a single diagnostic test. By combining technological innovation with investment in people, infrastructure and partnerships, the programme is strengthening local capacity for advanced cancer diagnostics and research.
The collaboration also creates opportunities to apply genomic and liquid-biopsy technologies to other cancers. While further work is needed before the approach can be scaled for routine clinical use, AI-REAL is helping to build the expertise and infrastructure needed to make faster, more advanced cancer diagnosis more accessible in sub-Saharan Africa.
Read about AI-REAL and other Oxford research developing new approaches to cancer detection in Pulse: Cancer detection.