Feasibility of Rapid Case Ascertainment for Cancer in East Africa: An Investigation of Community-Representative Kaposi Sarcoma in the Era of Antiretroviral Therapy |
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| Affiliation: | 1. Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda;2. Harvard Medical School, Boston, MA, United States;3. Moi University, Eldoret, Kenya;4. Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya;5. University of California, San Francisco, CA, United States;6. Masaka Regional Referral Hospital, Masaka, Uganda;7. Mbarara Regional Referral Hospital, Mbarara, Uganda;8. Indiana University, Indianapolis, IN, United States;1. School of Biotechnology, Shri Mata Vaishno Devi University, Katra, India;2. Department of Biotechnology, University of Kashmir, Jammu & Kashmir, India;3. Indian Council of Medical Research-Centre for Advanced Research, Shri Mata Vaishno Devi University, Katra, Jammu & Kashmir, India;4. Centre for Molecular Biology, Central University of Jammu, Jammu & Kashmir, India;1. Institute for Cancer Epidemiology, University of Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany;2. Danish Cancer Society, Strandboulevarden 49, 2100, København, Denmark;1. Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230000, Anhui, China;2. Laboratory for Environmental Toxicology, Anhui Medical University, Hefei 230032, Anhui, China;1. Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran;2. The Persian Gulf Tropical Medicine Research Center, The Persian Gulf Biomedical Sciences Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran;3. Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran;4. Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran;5. Gastroenterology and Hepatology Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran;6. Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences Kerman, Iran;7. Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran;1. Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, United Kingdom;2. Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care (CaP), Bartholin’s Allé 2, 8000, Aarhus C, Denmark;1. Department of Pediatrics, Hematology-Oncology Unit, Faculty of Medicine-Ain Shams University, Cairo, Egypt;2. Department of Community, Environmental and Occupational Medicine, Faculty of Medicine -Ain Shams University, Cairo, Egypt;3. Cook Children’s Medical Center, Fortworth, TX, USA |
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| Abstract: | BackgroundRapid case ascertainment (RCA) refers to the expeditious and detailed examination of patients with a potentially rapidly fatal disease shortly after diagnosis. RCA is frequently performed in resource-rich settings to facilitate cancer research. Despite its utility, RCA is rarely implemented in resource-limited settings and has not been performed for malignancies. One cancer and context that would benefit from RCA in a resource-limited setting is HIV-related Kaposi sarcoma (KS) in sub-Saharan Africa.MethodsTo determine the feasibility of RCA for KS, we searched for all potential newly diagnosed KS among HIV-infected adults attending three community-based facilities in Uganda and Kenya. Searching involved querying of electronic medical records, pathology record review, and notification by clinicians. Upon identification, a team verified eligibility and attempted to locate patients to perform RCA, which included epidemiologic, clinical and laboratory measurements.ResultsWe identified 593 patients with suspected new KS. Of the 593, 171 were ineligible, mainly because biopsy failed to confirm KS (65%) or KS was not new (30%). Among the 422 remaining, RCA was performed within 1 month for 56% of patients and within 3 months for 65% (95% confidence interval: 59 to 70%). Reasons for not performing RCA included intervening death (47%), inability to contact (44%), refusal/unsuitable to consent (8.3%), and patient re-location (0.7%).ConclusionsWe found that RCA ― an important tool for cancer research in resource-rich settings ― is feasible for the investigation of community-representative KS in East Africa. Feasibility of RCA for KS suggests feasibility for other cancers in Africa. |
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| Keywords: | Kaposi sarcoma HIV infection Rapid case ascertainment Feasibility Community Sub-Saharan Africa East Africa Uganda Kenya |
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