Global Health Access Initiative

Cancer Management in Africa

HIV continues to be a major global public health issue, having claimed 40.1 million lives so far.1 And while we continue to support the eradication of HIV in high-burden settings, we have also expanded our reach to include HIV-associated malignancies such as leukemias and rare lymphomas.

HIV-associated malignancies in low- and middle-income countries (LMIC) are becoming increasingly prevalent. Unfortunately, many low-resource countries are unprepared to address these types of cancers due to a lack of infrastructure and a scarcity of trained health workers.

Through our Global Health Access Initiative, we have formed alliances and collaborations with other organizations to help establish capacity for testing and classification of hematological malignancies commonly seen among people living with HIV (PLHIV).

Our initiatives have included two early access pilot programs located in Western Kenya and Uganda, which were made possible with significant support from several organizations:

  • Burkitt’s Lymphoma Fund for Africa (BLFA)
  • Fred Hutchinson Cancer Institute
  • Uganda Ministry of Health
  • Uganda Cancer Institute
  • AMPATH Reference Laboratories at Moi Teaching and Referral Hospital
  • Indiana University School of Medicine and Riley Children’s Hospital

Rapid diagnosis is critical

The goal has been to demonstrate the feasibility of using flow cytometry to improve diagnosis of blood cancers throughout Uganda and Western Kenya.

Previously, the main diagnostic method had been histology—looking at cells under the microscope to determine morphology. However, due to the limited number of trained professionals, diagnostic accuracy was challenging. One reason was that technicians required training to diagnose blood cancers using flow cytometry, which is more accurate than visual morphology alone and does much of the diagnostic work for the technician. Since there are effective and affordable treatments for certain blood cancers, establishing the diagnostic element is critical.

The cancer pilot program fills a gap in East Africa to diagnose and monitor HIV. The network is centralized, so the patient’s blood is collected locally and transferred to a central testing facility. Two additional flow cytometers were deployed to help support the cancer diagnosis initiative. A key advantage of the instruments used is that the reagents required are cold chain-independent, meaning they don’t require refrigerated transport. They also use preformulated components, so there’s less room for error and less waste of expensive reagents.

Though the primary goal of the initiative is to expand testing capacity in the two countries and develop a model that others can follow, another significant aim is to ensure that patients receive local treatment after diagnosis.

In the case of Burkitt’s lymphoma, the survival rate without treatment and supportive care is low. It’s an aggressive and disfiguring form of cancer that can grow exponentially fast, but with proper treatment, which is generally affordable, it can subside just as quickly. Centers like the Uganda Cancer Institute have been successful in this area, but more countries need to be able to adopt affordable, advanced flow cytometry so they can better classify hematological malignancies such as aggressive lymphomas and acute leukemias.

Another aim is to understand the disease patterns of blood cancers and the discrepancies that exist between regions. There may also be a benefit in transferring diagnostics closer to patients—in other words, decentralizing the highly centralized system, which would mean faster turnaround times and better patient care using diagnostic screening. A recent 5-year NIH RO1 Grant Award will enable trials into innovations for early detection screening using an innovative flow cytometry panel that uses peripheral blood and does not rely on invasive bone marrow aspirate patient sampling for rapid diagnosis.

Finally, our work may one day help inform policy and lead to the implementation of more effective testing strategies. These changes would filter down into the countries and inform their day-to-day healthcare practices for cancer control programs.

Learn More

Our team continues to partner with the scientific community to expand critical resources through our Global Health Access Initiative. If you’d like more information, including collaboration opportunities, please contact us.

References

  1. The urgency of now: AIDS at a crossroads. Geneva: Joint United Nations Programme on HIV/AIDS; 2024. Licence: CC BY-NC-SA 3.0 IGO.