Abstract 24: Compliance with Referral for Evaluation of Breast Abnormalities among HIV-Clinic Patients in Eswatini

Abstract

Purpose: Women living with HIV (WLHIV) are living longer and are at increasing risk for breast cancer (BC). Earlier detection of BC is essential to reduce late-stage diagnosis and BC mortality in sub-Saharan Africa, the region most heavily impacted by HIV. We implemented a pilot BC early detection program in Eswatini HIV clinics and studied patients' compliance with referral for evaluation of breast abnormalities. Methods: Nurses at five Eswatini HIV clinics were trained to ask all WLHIV aged ≥18 years about breast symptoms, to offer clinical breast exam (CBE) to symptomatic women, and to refer for further evaluation if appropriate. Referred, consenting patients completed baseline demographic questionnaires and questionnaires at 30- and 60-days post-enrollment, regarding referral outcomes. We used chi-squared testing to identify patient characteristics associated with completing referral. Results: From June 2019-April 2020, 9,502 WLHIV were screened for breast symptoms: 150 (1.6%) underwent CBE; 93 (62.0%) of those were referred for further evaluation; and 90 (96.7%) were enrolled in the evaluation. Of enrolled WLHIV, median age was 39 (range: 20-65) years, 54 (61.0%) reported completing referral. Referral completion was not associated with age, employment status, relationship status, or various prior experiences related to BC (all p>0.05). Of those who completed referral, 42 (80.7%) reported having no illness identified, 3 (5.8%) reported a new BC diagnosis, 1 (1.9%) reported a breast abscess, and 6 (11.5%) were still undergoing evaluation; diagnosis was missing for 2. The most common reasons cited for not completing referral were cost of transport or care, conflicting employment-related commitments, other conflicting commitments, and the breast clinic not accommodating the patient upon presentation. Conclusion: In this pilot BC screening program, 60% of WLHIV completed referral for further evaluation. Efforts to improve compliance with referral could focus on reducing the time and cost entailed by obtaining specialized breast care. Citation Format: Daniel O'Neil, Sifiso Nxumalo, Cebisile Ngcamphalala, G Tharp, Judith Jacobson, Harriet Nuwagaba-Biribonwoha, Xolisile Dlamini, Alfred Neugut, Tiffany Harris. Compliance with Referral for Evaluation of Breast Abnormalities among HIV-Clinic Patients in Eswatini [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 24.