Evaluation of a training intervention to improve cancer care in Zimbabwe: Strategies to Improve Kaposi Sarcoma Outcomes (SIKO), a prospective community‐based stepped‐wedge cluster randomized trial

Introduction Most Zimbabweans access medical care through tiered health systems. In 2013, HIV care was decentralized to primary care clinics; while oncology care remained centralized. Most persons in Zimbabwe with Kaposi sarcoma (KS) are diagnosed late in their disease, and the prognosis is poor. Li...

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Published in:	Journal of the International AIDS Society Vol. 25; no. 8; pp. e25998 - n/a
Main Authors:	Sabourin, Katherine R., Borok, Margaret, Mawhinney, Samantha, Matimba, Maxwell, Jaji, Francis, Fiorillo, Suzanne, Chifamba, Dickson D., Muserere, Claudios, Mashiri, Busisiwe, Bhodheni, Chenjerai, Gambiza, Patricia, Mandidewa, Rachael, Mutimuri, Mercia, Gudza, Ivy, Mulvahill, Matthew, Moore, Camille M., Kutner, Jean S., Simões, Eric A. F., Campbell, Thomas B.
Format:	Journal Article
Language:	English
Published:	Geneva John Wiley & Sons, Inc 01-08-2022 John Wiley and Sons Inc
Subjects:	Acquired immune deficiency syndrome AIDS AIDS (Disease) Care and treatment Chemotherapy Community health care Complications and side effects Evaluation Health care HIV Human immunodeficiency virus Intervention Kaposi sarcoma Kaposi's sarcoma Kaposis sarcoma Medical diagnosis Medical personnel Medical referrals Mortality Nurses Palliative care Patient outcomes Patients Physicians Primary care primary community care Rural areas Sarcoma Skills Training training intervention tools Zimbabwe
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Summary:	Introduction Most Zimbabweans access medical care through tiered health systems. In 2013, HIV care was decentralized to primary care clinics; while oncology care remained centralized. Most persons in Zimbabwe with Kaposi sarcoma (KS) are diagnosed late in their disease, and the prognosis is poor. Little is known about whether educational interventions could improve KS outcomes in these settings. Methods Interventions to improve KS detection and management were evaluated at eight Zimbabwe primary care sites (four rural/four urban) that provided HIV care. Interventions included a standardized KS clinical evaluation tool, palliative care integration, standardized treatment and improved consultative services. Interventions were implemented between February 2013 and January 2016 using a randomized stepped‐wedge cluster design. Sites were monitored for KS diagnosis rates and KS outcomes, including early diagnosis (T0 vs. T1 tumour stage), participant retention and mortality. Analyses controlled for within‐clinic correlations. Results A total of 1102 persons with suspected KS (96% HIV positive) were enrolled: 47% incident (new diagnosis), 20% prevalent (previous diagnosis) and 33% determined as not KS. Early (T0) diagnosis increased post‐intervention, though not significant statistically (adjusted odds ratio [aOR] = 1.48 [95% confidence interval (95% CI): 0.66–3.79], p = 0.37). New KS diagnosis rates increased 103% (95% CI: 11–273%), p = 0.02) post‐intervention; although paired with an increased odds of incorrectly diagnosing KS (aOR = 2.08 [95% CI: 0.33–3.24], p = 0.001). Post‐intervention, non‐significant decreases in 90‐day return rates (adjusted hazard ratio [aHR] = 0.69 [95% CI: 0.38–1.45], p = 0.21) and survival (aHR = 1.36 [95% CI: 0.85–2.20], p = 0.20) were estimated. Conclusions KS training interventions at urban and rural Zimbabwe decentralized primary care clinics significantly increased overall and incorrect KS diagnosis rates, but not early KS diagnosis rates, 90‐day return rates or survival.
Bibliography:	Clinical Trial Number: NCT01764360 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 ObjectType-News-3 content type line 23
ISSN:	1758-2652 1758-2652
DOI:	10.1002/jia2.25998