title: A prospective ascertainment of cancer incidence in sub-Saharan Africa: The case of Kaposi sarcoma.
abstract: In resource-limited areas, such as sub-Saharan Africa, problems in accurate cancer case ascertainment and enumeration of the at-risk population make it difficult to estimate cancer incidence. We took advantage of a large well-enumerated healthcare system to estimate the incidence of Kaposi sarcoma (KS), a cancer which has become prominent in the HIV era and whose incidence may be changing with the rollout of antiretroviral therapy (ART). To achieve this, we evaluated HIV-infected adults receiving care between 2007 and 2012 at any of three medical centers in Kenya and Uganda that participate in the East Africa International Epidemiologic Databases to Evaluate AIDS (IeDEA) Consortium. Through IeDEA, clinicians received training in KS recognition and biopsy equipment. We found that the overall prevalence of KS among 102,945 HIV-infected adults upon clinic enrollment was 1.4%; it declined over time at the largest site. Among 140,552 patients followed for 319,632 person-years, the age-standardized incidence rate was 334/100,000 person-years (95% CI: 314-354/100,000 person-years). Incidence decreased over time and was lower in women, persons on ART, and those with higher CD4 counts. The incidence rate among patients on ART with a CD4 count >350 cells/mm(3) was 32/100,000 person-years (95% CI: 14-70/100,000 person-years). Despite reductions over time coincident with the expansion of ART, KS incidence among HIV-infected adults in East Africa equals or exceeds the most common cancers in resource-replete settings. In resource-limited settings, strategic efforts to improve cancer diagnosis in combination with already well-enumerated at-risk denominators can make healthcare systems attractive platforms for estimating cancer incidence.
authors.affiliation: Infectious Diseases Institute, Makerere University, Kampala, Uganda.|University of California, San Francisco, CA, USA.
authors.forename: Aggrey
authors.initials: A
authors.lastname: Semeere
authors.affiliation: University of California, San Francisco, CA, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Wenger
authors.affiliation: Moi University, Eldoret, Kenya.
authors.forename: Naftali
authors.initials: N
authors.lastname: Busakhala
authors.affiliation: Moi University, Eldoret, Kenya.
authors.forename: Nathan
authors.initials: N
authors.lastname: Buziba
authors.affiliation: Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Mwebesa
authors.initials: M
authors.lastname: Bwana
authors.affiliation: Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Winnie
authors.initials: W
authors.lastname: Muyindike
authors.affiliation: University of California, San Francisco, CA, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Amerson
authors.affiliation: University of California, San Francisco, CA, USA.
authors.forename: Toby
authors.initials: T
authors.lastname: Maurer
authors.affiliation: University of California, San Francisco, CA, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: McCalmont
authors.affiliation: University of California, San Francisco, CA, USA.
authors.forename: Philip
authors.initials: P
authors.lastname: LeBoit
authors.affiliation: Indiana University, Indianapolis, Indiana.
authors.forename: Beverly
authors.initials: B
authors.lastname: Musick
authors.affiliation: Indiana University, Indianapolis, Indiana.
authors.forename: Constantin
authors.initials: C
authors.lastname: Yiannoutsos
authors.affiliation: Makerere University College of Health Sciences, Kampala, Uganda.
authors.forename: Robert
authors.initials: R
authors.lastname: Lukande
authors.affiliation: Infectious Diseases Institute, Makerere University, Kampala, Uganda.
authors.forename: Barbara
authors.initials: B
authors.lastname: Castelnuovo
authors.affiliation: Infectious Diseases Institute, Makerere University, Kampala, Uganda.|University of California, San Francisco, CA, USA.
authors.forename: Miriam
authors.initials: M
authors.lastname: Laker-Oketta
authors.affiliation: Infectious Diseases Institute, Makerere University, Kampala, Uganda.
authors.forename: Andrew
authors.initials: A
authors.lastname: Kambugu
authors.affiliation: University of California, San Francisco, CA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Glidden
authors.affiliation: Indiana University, Indianapolis, Indiana.
authors.forename: Kara
authors.initials: K
authors.lastname: Wools-Kaloustian
authors.affiliation: University of California, San Francisco, CA, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Martin
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D015994:Incidence; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012514:Sarcoma, Kaposi / Q000453:epidemiology* / Q000276:immunology / Q000821:virology; D017678:Sex Distribution; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: Africa; HIV/AIDS; Kaposi sarcoma; antiretroviral therapy; incidence
references.citation: Int J Cancer. 2005 Feb 10;113(4):632-9
references.pmid: 15472910
references.citation: Infect Agent Cancer. 2014 Mar 05;9(1):1
references.pmid: 24597902
references.citation: Int J Cancer. 2014 Dec 1;135(11):2644-52
references.pmid: 24729433
references.citation: Int J Cancer. 2014 Oct 15;135(8):1774-82
references.pmid: 24945976
references.citation: Nat Rev Cancer. 2006 Aug;6(8):603-12
references.pmid: 16862191
references.citation: Br Med J. 1964 Feb 8;1(5379):336-41
references.pmid: 14079032
references.citation: HIV Med. 2012 Mar;13(3):166-71
references.pmid: 22112164
references.citation: Br Med J. 1965 Sep 25;2(5464):719-22
references.pmid: 4283943
references.citation: Trop Med Int Health. 2001 Apr;6(4):296-304
references.pmid: 11348520
references.citation: Ann Trop Med Parasitol. 2005 Jan;99(1):81-91
references.pmid: 15701259
references.citation: Int J Cancer. 2006 Feb 15;118(4):985-90
references.pmid: 16106415
references.citation: Curr Opin Oncol. 2012 Sep;24(5):522-30
references.pmid: 22729153
references.citation: Int J Epidemiol. 2012 Oct;41(5):1256-64
references.pmid: 21593078
references.citation: Cancer Med. 2016 May;5(5):914-28
references.pmid: 26823008
references.citation: Int J Cancer. 2010 Nov 15;127(10):2395-401
references.pmid: 20143397
references.citation: Am J Epidemiol. 2003 Nov 1;158(9):915-20
references.pmid: 14585769
references.citation: Br J Cancer. 2000 May;82(9):1585-92
references.pmid: 10789729
references.citation: J Acquir Immune Defic Syndr. 2016 Mar 1;71(3):295-301
references.pmid: 26452066