title: Prognosis and delay of diagnosis among Kaposi's sarcoma patients in Uganda: a cross-sectional study.
abstract: BACKGROUND
  In low- and middle-income countries, the association between delay to treatment and prognosis for Kaposi's sarcoma (KS) patients is yet to be studied.
  
  
  METHODS
  This is a prospective study of HIV-infected adults with histologically-confirmed KS treated at the Uganda Cancer Institute (UCI). Standardized interviews were conducted in English or Luganda. Medical records were abstracted for KS stage at admission to UCI. Multivariable logistic regression assessed relationships between diagnostic delay and stage at diagnosis.
  
  
  RESULTS
  Of 161 patients (90% response rate), 69% were men, and the mean age was 34.0 years (SD 7.7). 26% had been seen in an HIV clinic within 3 months, 72% were on antiretroviral therapy, and 26% had visited a traditional healer prior to diagnosis. 45% delayed seeking care at UCI for ≥3 months from symptom onset. Among those who delayed, 36% waited 6 months, and 25% waited 12 months. Common reasons for delay were lack of pain (48%), no money (32%), and distance to UCI (8%). In adjusted analysis patients who experienced diagnostic delay were more likely than those who did not delay to have poor-risk KS stage (OR 3.41, p = 0.002, 95% CI: 1.46-7.45). In adjusted analyses visiting a traditional healer was the only variable associated with greater likelihood of delay (OR 2.69, p = 0.020, 95% CI: 1.17-6.17).
  
  
  CONCLUSIONS
  Diagnostic delay was associated with poor-risk stage at diagnosis, and visiting a traditional healer was associated with higher odds of delay. The relationship between traditional and Western medicine presents a critical intervention point to improve KS-related outcomes in Uganda.
authors.affiliation: Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710, USA ; University of Iowa Carver College of Medicine, 375 Newton Road, Iowa City, IA 52242, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: De Boer
authors.affiliation: Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710, USA ; Uganda Cancer Institute, Upper Mulago Hill Rd, Kampala, Uganda ; College of Health Sciences, Makerere University, Kampala, Uganda ; University of Washington, Seattle, WA, USA ; Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Nixon
authors.initials: N
authors.lastname: Niyonzima
authors.affiliation: Uganda Cancer Institute, Upper Mulago Hill Rd, Kampala, Uganda ; College of Health Sciences, Makerere University, Kampala, Uganda ; Uganda Program on Cancer and Infectious Disease, Kampala, Uganda.
authors.forename: Jackson
authors.initials: J
authors.lastname: Orem
authors.affiliation: Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710, USA ; Duke University Medical Center, Duke University, 10 Bryan Searle Drive, Durham, NC 27710, USA.
authors.forename: John
authors.initials: J
authors.lastname: Bartlett
authors.affiliation: Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710, USA ; Duke University Medical Center, Duke University, 10 Bryan Searle Drive, Durham, NC 27710, USA ; Duke Cancer Institute, Durham, NC, USA.
authors.forename: S Yousuf
authors.initials: SY
authors.lastname: Zafar
keywords: Cancer; Delayed diagnosis; HIV; Kaposi’s sarcoma; Uganda