ASPO Abstracts
Feasibility of Using Rapid Case Ascertainment to Evaluate Kaposi Sarcoma in Africa
Category: Early Detection & Risk Prediction
Conference Year: 2019
Abstract Body:
PURPOSE OF THE STUDY: Even with increasing availability of antiretroviral therapy (ART), HIV-related Kaposi’s sarcoma (KS) remains amongst the commonest cancers in sub-Saharan Africa. In the ART era in Africa, the main questions are why does KS occur despite undetectable HIV viremia, at what clinical stage does KS get diagnosed, and what are the determinants of prognosis? Addressing these questions requires detailed characterization of patients at the time of diagnosis and prior to worsening of disease, death, or loss-to-follow-up – a characterization that is typically performed in resource-rich settings by rapid case ascertainment (RCA). We set forth to evaluate the feasibility of RCA for KS in Africa.METHODS: We used electronic medical record (EMR) query, histopathology lab (HL) review and clinician notifications to find all new adult HIV-related KS diagnoses in the 52-clinic AMPATH HIV primary care network in Kenya. Upon identification of a potential case, an RCA team confirmed incident diagnosis, and, if confirmed, interviewed the patient, performed a physical exam and collected biological specimens.RESULTS: Over 28 months, we identified 287 patients with suspected new KS. Clinician notification yielded 88% of the cases, EMR query 9%, and HL review 3%. Of the 287, 197 were eligible for RCA with the remainder ineligible because of negative pathology, non-incident diagnosis, or origination outside the network. Of the 197 patients who were eligible, RCA was performed in 148 (75%); 26% of these were done within 14 days after diagnosis, 53% by 30 days, and 67% by 90 days. Logistical challenges were the main cause of failing to perform RCA in the remainder. Among 148 patients for whom RCA was done, median age was 36 years, 39% were women, and 75% had taken ART for over 30 days. Clinically, 96% had T1 (i.e., advanced) clinical stage and 73% had undetectable HIV plasma RNA.CONCLUSIONS: In a primary care network in East Africa, we demonstrated that RCA for KS is feasible. Most patients were diagnosed with advanced KS and most were on ART with undetectable HIV plasma RNA. Overcoming logistical challenges should enable optimization of the RCA process. The feasibility of RCA for KS suggests that RCA is also feasible for the study of other cancers in Africa.
Keywords: HIV-Related Kaposi's Sarcoma Sub-Saharan Africa Rapid Case Ascertainment