McMahon Devon E, Singh Rhea, Chemtai Linda, Semeere Aggrey, Byakwaga Helen, Grant Merridy, Laker-Oketta Miriam, Lagat Celestine, Collier Sigrid, Maurer Toby, Martin Jeffrey, Bassett Ingrid V, Butler Lisa, Kiprono Samson, Busakhala Naftali, Freeman Esther E
Department of Dermatology, Harvard Medical School, Massachusetts General Hospital, 50 Staniford St, Boston, MA, 02114, USA.
Virginia Commonwealth University School of Medicine, Richmond, VA, USA.
Infect Agent Cancer. 2022 Jul 6;17(1):37. doi: 10.1186/s13027-022-00444-0.
Kaposi sarcoma is one of the most prevalent HIV-associated malignancies in sub-Saharan Africa and is often diagnosed at advanced stage of disease. Only 50% of KS patients who qualify for chemotherapy receive it and adherence is sub-optimal.
57 patients > 18 years with newly diagnosed KS within the AMPATH clinic network in Western Kenya were purposively selected to participate in semi-structured interviews stratified by whether they had completed, partially completed, or not completed chemotherapy for advanced stage KS. We based the interview guide and coding framework on the situated Information, Motivation, Behavioral Skills (sIMB) framework, in which the core patient centered IMB constructs are situated into the socioecological context of receiving care.
Of the 57 participants, the median age was 37 (IQR 32-41) and the majority were male (68%). Notable barriers to chemotherapy initiation and adherence included lack of financial means, difficulty with convenience of appointments such as distance to facility, appointment times, long lines, limited appointments, intrapersonal barriers such as fear or hopelessness, and lack of proper or sufficient information about chemotherapy. Factors that facilitated chemotherapy initiation and adherence included health literacy, motivation to treat symptoms, improvement on chemotherapy, prioritization of self-care, resilience while experiencing side effects, ability to carry out behavioral skills, obtaining national health insurance, and free chemotherapy.
Our findings about the barriers and facilitators to chemotherapy initiation and adherence for KS in Western Kenya support further work that promotes public health campaigns with reliable cancer and chemotherapy information, improves education about the chemotherapy process and side effects, increases oncology service ability, supports enrollment in national health insurance, and increases incorporation of chronic disease care into existing HIV treatment networks.
卡波西肉瘤是撒哈拉以南非洲最常见的与艾滋病相关的恶性肿瘤之一，通常在疾病晚期被诊断出来。符合化疗条件的卡波西肉瘤患者中只有50%接受了化疗，且依从性不理想。
在肯尼亚西部的AMPATH诊所网络中，有目的地选择了57名年龄大于18岁、新诊断为卡波西肉瘤的患者，根据他们是否完成、部分完成或未完成晚期卡波西肉瘤化疗进行分层，参与半结构化访谈。我们基于情境信息、动机、行为技能（sIMB）框架制定访谈指南和编码框架，其中以患者为中心的IMB核心构建体被置于接受护理的社会生态背景中。
57名参与者中，年龄中位数为37岁（四分位间距32 - 41岁），大多数为男性（68%）。化疗开始和依从性的显著障碍包括缺乏经济手段、预约不便，如距离医疗机构远、预约时间、长队、预约有限、个人内在障碍，如恐惧或绝望，以及缺乏关于化疗的适当或充分信息。促进化疗开始和依从性的因素包括健康素养、治疗症状的动机、化疗改善、自我护理的优先级、经历副作用时的恢复力、执行行为技能的能力、获得国家医疗保险和免费化疗。
我们关于肯尼亚西部卡波西肉瘤化疗开始和依从性的障碍及促进因素的研究结果支持进一步开展工作，以推广包含可靠癌症和化疗信息的公共卫生运动，改善关于化疗过程和副作用的教育，提高肿瘤学服务能力，支持参加国家医疗保险，并将慢性病护理纳入现有的艾滋病治疗网络。
