Participation in HIV Care Is Associated With Decreased Time to Cancer Treatment in Those With HIV-Associated Malignancy in Uganda

Abstract

Background. Comorbid HIV infection is common among cancer patients in Uganda and is associated with a more than 2-fold risk of death. At the Uganda Cancer Institute (UCI), the country's national cancer hospital, nearly two-thirds of patients with HIV-associated malignancies (HIVAM) present with late-stage cancer. Understanding the care cascade and barriers to cancer treatment among patients with HIVAM could guide interventions to promote earlier detection and treatment. Methods. Patients aged ≥18 with confirmed diagnoses of both cancer and HIV who registered at the UCI between 1 June 2015 and 31 January 2016 were included in this study. Consenting participants had a one-time structured interview and phlebotomy for CD4 T cell count. We used analysis of variance, t-tests, and linear regression to compare quantitative responses. [Figure Presented] Results. We enrolled 101 patients; 52% were female, median age 41 years, 69% had an AIDS-defining cancer (ADC), and the remainder had a non-ADC such as breast or lung cancer. Median time from cancer symptoms to arrival at the UCI was 207 days (interquartile range 117-270 days, figure). HIV had been diagnosed in 73% before cancer symptom onset, and 27% were diagnosed with HIV during cancer work-up. Prior to cancer symptoms, 61% were on antiretroviral therapy (ART). Receiving HIV care was associated with decreased time to seeking care for cancer symptoms (30 versus 106 days, P= 0.002) and decreased time to cancer diagnosis (138 versus 208 days, P= 0.02). Being on ART prior to cancer symptoms was associated with a shorter total time to cancer treatment (189 days, IQR 104-333 days) and remained significant in multivariate analyses (P = 0.01). Gender, age, CD4 count, ADC, distance to HIV care, and distance to the UCI did not predict time to cancer care. ART interruption, often due to cancer care, was common among participants. Conclusion. Persons receiving HIV care, especially those on ART, moved more quickly through the cancer care cascade than HIV+ cancer patients whose HIV had not been diagnosed or treated when cancer developed. It is likely that routine engagement with the healthcare system facilitates diagnosis and referral for cancer treatment in a country where access to primary care is limited. Delayed diagnosis and lack of coordinated care present barriers to patients with HIVAM in sub-Saharan Africa.