Developing clinical strength-of-evidence approach to define HIV-associated malignancies for cancer registration in Kenya.

BACKGROUND: Sub-Saharan Africa cancer registries are beset by an increasing
cancer burden further exacerbated by the AIDS epidemic where there are limited
capabilities for cancer-AIDS match co-registration. We undertook a pilot study
based on a "strength-of-evidence" approach using clinical data that is abstracted
at the time of cancer registration for purposes of linking cancer diagnosis to
AIDS diagnosis.
METHODS/FINDINGS: The standard Nairobi Cancer Registry form was modified for
registrars to abstract the following clinical data from medical records regarding
HIV infection/AIDS in a hierarchal approach at time of cancer registration from
highest-to-lowest strength-of-evidence: 1) documentation of positive HIV
serology; 2) antiretroviral drug prescription; 3) CD4+ lymphocyte count; and 4)
WHO HIV clinical stage or immune suppression syndrome (ISS), which is Kenyan
terminology for AIDS. Between August 1 and October 31, 2011 a total of 1,200
cancer cases were registered. Of these, 171 cases (14.3%) met clinical
strength-of-evidence criteria for association with HIV infection/AIDS; 69% (118
cases were tumor types with known HIV association - Kaposi's sarcoma, cervical
cancer, non-Hodgkin's and Hodgkin's lymphoma, and conjunctiva carcinoma) and 31%
(53) were consistent with non-AIDS defining cancers. Verifiable positive HIV
serology was identified in 47 (27%) cases for an absolute seroprevalence rate of
4% among the cancer registered cases with an upper boundary of 14% among those
meeting at least one of strength-of-evidence criteria.
CONCLUSIONS/SIGNIFICANCE: This pilot demonstration of a hierarchal, clinical
strength-of-evidence approach for cancer-AIDS registration in Kenya establishes
feasibility, is readily adaptable, pragmatic, and does not require additional
resources for critically under staffed cancer registries. Cancer is an emerging
public health challenge, and African nations need to develop well designed
population-based studies in order to better define the impact and spectrum of
malignant disease in the backdrop of HIV infection.

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