Korir Anne, Mauti Nathan, Moats Pamela, Gurka Matthew J, Mutuma Geoffrey, Metheny Christine, Mwamba Peter M, Oyiro Peter O, Fisher Melanie, Ayers Leona W, Rochford Rosemary, Mwanda Walter O, Remick Scot C
Kenya Medical Research Institute, Nairobi Cancer Registry, Nairobi, Kenya.
West Virginia University Hospitals, Health Information Management-Cancer Registry, Morgantown, West Virginia, United States of America.
PLoS One. 2014 Jan 23;9(1):e85881. doi: 10.1371/journal.pone.0085881. eCollection 2014.
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.
撒哈拉以南非洲地区的癌症登记机构面临着日益加重的癌症负担，而艾滋病疫情更是雪上加霜，该地区在癌症与艾滋病匹配联合登记方面能力有限。我们基于“证据强度”方法开展了一项试点研究，使用在癌症登记时提取的临床数据，以便将癌症诊断与艾滋病诊断相联系。
方法/研究结果：对内罗毕癌症登记处的标准表格进行了修改，以便登记员在癌症登记时，按照从最高到最低证据强度的分层方法，从医疗记录中提取以下关于艾滋病毒感染/艾滋病的临床数据：1）艾滋病毒血清学阳性记录；2）抗逆转录病毒药物处方；3）CD4 +淋巴细胞计数；4）世界卫生组织艾滋病毒临床分期或免疫抑制综合征（ISS，这是肯尼亚对艾滋病的称呼）。2011年8月1日至10月31日期间，共登记了1200例癌症病例。其中，171例（14.3%）符合与艾滋病毒感染/艾滋病相关的临床证据强度标准；69%（118例为已知与艾滋病毒相关的肿瘤类型——卡波西肉瘤、宫颈癌、非霍奇金淋巴瘤和霍奇金淋巴瘤以及结膜癌），31%（53例）与非艾滋病定义的癌症相符。在47例（27%）病例中发现了可核实的艾滋病毒血清学阳性，在登记的癌症病例中绝对血清流行率为4%，在符合至少一项证据强度标准的病例中上限为14%。
结论/意义：肯尼亚这种用于癌症与艾滋病登记的分层临床证据强度方法的试点示范证明了其可行性，易于调整，务实且不需要为人员严重不足的癌症登记机构额外提供资源。癌症是一个新出现的公共卫生挑战，非洲国家需要开展精心设计的基于人群的研究，以便在艾滋病毒感染背景下更好地界定恶性疾病的影响和范围。
