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.


RESULTS
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
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.
Kenya Medical Research Institute, Nairobi Cancer Registry, Nairobi, Kenya.
Anne
A
Korir
Kenya Medical Research Institute, Nairobi Cancer Registry, Nairobi, Kenya.
Nathan
N
Mauti
West Virginia University Hospitals, Health Information Management-Cancer Registry, Morgantown, West Virginia, United States of America.
Pamela
P
Moats
Department of Biostatistics, West Virginia University School of Public Health, Morgantown, West Virginia, United States of America.
Matthew J
MJ
Gurka
Kenya Medical Research Institute, Nairobi Cancer Registry, Nairobi, Kenya.
Geoffrey
G
Mutuma
West Virginia University Hospitals, Health Information Management-Cancer Registry, Morgantown, West Virginia, United States of America.
Christine
C
Metheny
University of Nairobi Institute of Tropical and Infectious Diseases (UNITID), University of Nairobi College of Health Sciences, and Kenyatta National Hospital, Nairobi, Kenya.
Peter M
PM
Mwamba
University of Nairobi Institute of Tropical and Infectious Diseases (UNITID), University of Nairobi College of Health Sciences, and Kenyatta National Hospital, Nairobi, Kenya.
Peter O
PO
Oyiro
Department of Medicine, Global Health Program (MF) and Mary Babb Randolph Cancer Center (SCR), West Virginia University School of Medicine, Morgantown, West Virginia, United States of America.
Melanie
M
Fisher
Department of Pathology, The Ohio State University College of Medicine, Columbus, Ohio, United States of America.
Leona W
LW
Ayers
Department of Microbiology and Immunology, SUNY Upstate Medical University, Syracuse, New York, United States of America.
Rosemary
R
Rochford
University of Nairobi Institute of Tropical and Infectious Diseases (UNITID), University of Nairobi College of Health Sciences, and Kenyatta National Hospital, Nairobi, Kenya.
Walter O
WO
Mwanda
Department of Medicine, Global Health Program (MF) and Mary Babb Randolph Cancer Center (SCR), West Virginia University School of Medicine, Morgantown, West Virginia, United States of America.
Scot C
SC
Remick
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D055317:Evidence-Based Practice; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015995:Prevalence; D012042:Registries; D012514:Sarcoma, Kaposi / Q000453:epidemiology / Q000821:virology*; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology / Q000821:virology*; D055815:Young Adult