High Cancer Burden Among Antiretroviral Therapy Users in Malawi: A Record Linkage Study of Observational Human Immunodeficiency Virus Cohorts and Cancer Registry Data

Horner, Marie-Josèphe; Chasimpha, Steady; Spoerri, Adrian; Edwards, Jessie K.; Bohlius, Julia; Tweya, Hannock; Tembo, Petros; Nkhambule, Franklin; Phiri, Eddie Moffo; Miller, William C.; Malisita, Kennedy; Phiri, Sam; Dzamalala, Charles P.; Olshan, Andrew F.; Gopal, Satish

doi:10.1093/cid/ciy960

Cited by 16 publications

(21 citation statements)

References 32 publications

(39 reference statements)

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“…A recent systematic review on the Global burden of disease indicates that cancer cases have increased in developing countries of SSA and contribute significantly to years of life lost to disability [43]. Utilizing registry data from Malawi, an earlier study pointed to a high burden of AIDS defining cancers -predominantly Kaposi sarcoma and cervical cancer that were associated with late initiation of ART-WHO stage III and IV [44]. In this study, a low prevalence of cancer (0.7%) was found with cervical cancer as the predominant cancer type.…”

Section: Plos Onementioning

confidence: 99%

High prevalence of non-communicable diseases among key populations enrolled at a large HIV prevention & treatment program in Kenya

et al. 2020

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Introduction People Living with HIV (PLHIV) bear a disproportionate burden of non-communicable diseases (NCDs). Despite their significant toll across populations globally, the NCD burden among key populations (KP) in Kenya remains unknown. The burden of four NCD-categories (cardiovascular diseases, cancer, chronic respiratory diseases and diabetes) was evaluated among female sex workers (FSWs) and men who have sex with men (MSM) at the Sex Workers Outreach Program (SWOP) clinics in Nairobi Kenya. Methods A retrospective medical chart review was conducted at the SWOP clinics among KP clients �15 years living with HIV enrolled between October 1, 2012 and September 30, 2015. The prevalence of the four NCD-categories were assessed at enrollment and during subsequent routine quarterly follow-up care visits as per the Ministry of Health guidelines. Prevalence at enrollment was determined and distributions of co-morbidities assessed using Chi-square and t-tests as appropriate during follow-up visits. Univariate and multivariate analysis were conducted to identify factors associated with NCD diagnoses. Results Overall, 1,478 individuals' records were analyzed; 1,392 (94.2%) were from FSWs while 86 (5.8%) were from MSM over the three-year period. FSWs' median age was 35.3 years (interquartile range (IQR) 30.1-41.6) while MSM were younger at 26.8 years (IQR 23.2-32.1). At enrollment into the HIV care program, most KPs (86.6%) were at an early WHO clinical stage (stage I-II) and 1462 (98.9%) were on first-line anti-retroviral therapy (ART). A total of 271, 18.3% (95% CI: 16.4-20.4%), KPs living with HIV had an NCD diagnosis in

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Section: Plos Onementioning

confidence: 99%

High prevalence of non-communicable diseases among key populations enrolled at a large HIV prevention & treatment program in Kenya

et al. 2020

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“…Other studies examined the management of mental health and substance use disorders [8], or the diagnostic and screening practices for (drug resistant) tuberculosis in adult and paediatric patients [9][10][11]. Furthermore, the routine data collected by participating sites have been enriched in some countries by linking the routine HIV databases to cancer registries [12,13], vital registries [14] or administrative databases [15].…”

Section: Data Collection At Individual and Site Levelmentioning

confidence: 99%

Cohort profile: The International epidemiology Databases to Evaluate AIDS (IeDEA) in sub-Saharan Africa, 2012-2019

Chammartin

Ostinelli

Anastos

et al. 2019

Preprint

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Purpose: The objectives of the International epidemiology Databases to Evaluate AIDS (IeDEA) are to (i) evaluate the delivery of combination antiretroviral therapy (ART) in children, adolescents and adults in sub-Saharan Africa, (ii) to describe ART regimen effectiveness, durability and tolerability, (iii) to examine HIV-related comorbidities and co-infections, and (iv) to examine the pregnancy- and HIV-related outcomes of women on ART and their infants exposed to HIV or antiretroviral therapy in utero or via breastmilk. Participants: IeDEA is organized in four regions (Central, East, Southern and West Africa), with 240 treatment and care sites, six data centres at African, European and US universities, and almost 1.4 million children, adolescents and adult people living with HIV (PLWHIV) enrolled. Findings to date: The data include socio-demographic characteristics, clinical outcomes, opportunistic events, treatment regimens, clinic visits and laboratory measurements. They have been used to analyse outcomes in people living with HIV-1 or HIV-2 who initiate ART, including determinants of mortality, of switching to second-line and third-line ART, drug resistance, loss to follow-up and the immunological and virological response to different ART regimens. Programme-level estimates of mortality have been corrected for loss to follow-up. We examined the impact of co-infection with hepatitis B and C, and the epidemiology of different cancers and of (multi-drug resistant) tuberculosis, renal disease and of mental illness. The adoption of 'Treat All', making ART available to all PLWHIV regardless of CD4+ cell count or clinical stage was another important research topic. Future plans: IeDEA has formulated several research priorities for the 'Treat All' era in sub-Saharan Africa. It recently obtained funding to set up sentinel sites where additional data are prospectively collected on cardiometabolic risks factors as well as mental health and liver diseases, and is planning to create a drug resistance database.

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“…Privacy-preserving probabilistic record linkage (PPPRL) methods were developed and are applied in high-income countries to link records within and between organizations while strictly protecting patients' privacy [1][2], but we found no evidence PPPRL has been used in African settings. To study cancer related morbidity in people living with HIV (PLWH), HIV and cancer registry match studies have linked data from patients in HIV cohorts to cancer registry records based on plain names [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

“…But HIV cohorts in sub-Saharan Africa (SSA) are often small groups of children and adults who are treated in specialized HIV clinics in urban settings; these groups do not represent the HIV population of the whole country [5][6][7]. Two-thirds of the world's HIV-positive population lives in SSA and we need large, representative, population-based cohort studies of PLWH in this region to inform cancer epidemiology and policy.…”

Section: Introductionmentioning

confidence: 99%

Privacy preserving-probabilistic record linkage to assess cancer outcomes in people living with HIV in South Africa

Bohlius¹,

Bartels²,

Chammartin³

et al. 2021

Preprint

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Background: Privacy-preserving probabilistic record linkage (PPPRL) methods were developed and applied in high-income countries to link records within and between organizations under strict privacy protections. PPPRL has not yet been used in African settings.Methods: We used HIV-related laboratory records from National Health Laboratory Services (NHLS) in South Africa to construct a cohort of HIV-positive patients and link them to the National Cancer Registry (NCR) with PPPRL. The study was restricted to Gauteng province from 2004 to 2014. We used records with national IDs (gold standard) to determine precision, recall, and f-measure of the linkages. We included all patients with ≥ 2 HIV-related lab records measured in the cohort and assessed the number of cancers diagnosed in people living with HIV (PLWH).Results: We included 11,480,118 HIV-related laboratory records and 664,869 cancer records in the linkage. We included 1,173,908 persons in the HIV cohort; 66.6% were female and median age at first HIV-related lab test was 33.9 years (IQR 27.4-41.3). Of the patients in the cohort, 26,348 were diagnosed with at least one cancer and 8,329 of these cancers were diagnosed before or on the date of the patient’s first HIV-related record; 18,019 were diagnosed after their first HIV-related record. For all linkages, precision, recall, and f-measures were high.Conclusion: Our study showed it is feasible to use PPPRL in an African setting to link routinely collected health records from different data sources and create a longitudinal HIV cohort with cancer outcomes while strictly protecting patient privacy. This work served as the foundation to create a nationwide population-based cohort including all South African provinces which will be used to inform cancer control programs.

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High Cancer Burden Among Antiretroviral Therapy Users in Malawi: A Record Linkage Study of Observational Human Immunodeficiency Virus Cohorts and Cancer Registry Data

Cited by 16 publications

References 32 publications

High prevalence of non-communicable diseases among key populations enrolled at a large HIV prevention & treatment program in Kenya

High prevalence of non-communicable diseases among key populations enrolled at a large HIV prevention & treatment program in Kenya

Cohort profile: The International epidemiology Databases to Evaluate AIDS (IeDEA) in sub-Saharan Africa, 2012-2019

Privacy preserving-probabilistic record linkage to assess cancer outcomes in people living with HIV in South Africa

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