1
|
Musa J, Kocherginsky M, Magaji FA, Maryam AJ, Asufi J, Nenrot D, Burdett K, Katam N, Christian EN, Palanisamy N, Odukoya O, Silas OA, Abdulkareem F, Akpa P, Badmos K, Imade GE, Akanmu AS, Gursel DB, Zheng Y, Joyce BT, Achenbach CJ, Sagay AS, Anorlu R, Wei JJ, Ogunsola F, Murphy RL, Hou L, Simon MA. Epidemiology and survival outcomes of HIV-associated cervical cancer in Nigeria. Infect Agent Cancer 2023; 18:68. [PMID: 37915091 PMCID: PMC10619301 DOI: 10.1186/s13027-023-00550-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 10/25/2023] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION Invasive cervical cancer (ICC) is an HIV-associated cancer that is preventable and precancerous stages including early ICC stages could be detected through screening offering opportunities for treatment and cure. The high incidence in women living with HIV and late presentation often at advanced stages of ICC with limited treatment facilities often result in early mortality. We sought to compare the epidemiologic characteristics and survival differences in HIV status of ICC patients in Nigeria. METHODS We conducted a cohort study at two federal academic hospital-based research sites in Jos University Teaching Hospital, and Lagos University Teaching Hospital Nigeria, between March 2018 and September 2022. We enrolled women with histologically confirmed ICC with known HIV status, and FIGO staging as part of the United States of America's National Institutes of Health/National Cancer Institute funded project titled 'Epigenomic Biomarkers of HIV-Associated Cancers in Nigeria'. The primary outcome was all-cause mortality with assessment of overall survival (OS) and time to death after ICC diagnosis. OS distribution was estimated using the method of Kaplan-Meier and compared between groups using the log-rank test. RESULTS A total of 239 women with confirmed ICC were enrolled and included in this analysis, of whom 192 (80.3%) were HIV-negative (HIV-/ICC +), and 47 (19.7%) were HIV-positive (HIV +/ICC +). The HIV +/ICC + patients were younger with median age 46 (IQR: 40-51) years compared to 57 (IQR: 45-66) among HIV-/ICC + (P < 0.001). Squamous cell carcinoma was the commonest histopathologic variant in 80.4% of ICC diagnosis, moderately differentiated tumor grade in 68.1% in both groups. HIV +/ICC + diagnosis was at FIGO advanced stages in 64.9% compared to 47.9% in HIV-/ICC +. The HIV-/ICC + women had better OS compared to HIV +/ICC + participants (p = 0.018), with 12-month OS 84.1% (95%CI 75-90%) and 67.6% (95%CI 42-84%) respectively. CONCLUSION ICC is diagnosed at a relatively young age in women living with HIV, with a significantly lower overall survival probability compared to women without HIV. The trend of presentation and diagnosis at advanced stages in women living with HIV could partly explain the differences in overall survival.
Collapse
Affiliation(s)
- Jonah Musa
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria.
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, Chicago, USA.
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA.
| | - Masha Kocherginsky
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Francis A Magaji
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria
| | - Ali J Maryam
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria
| | - Joyce Asufi
- Department of Nursing, Oncology Unit and Nursing Education, Jos University Teaching Hospital, Jos, Nigeria
| | - Danjuma Nenrot
- Information Technology and Data Management Unit, Adult HIV Clinic, Jos University Teaching Hospital, Jos, Nigeria
| | - Kirsten Burdett
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Neelima Katam
- Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Elizabeth N Christian
- Robert J. Havey MD Institute for Global Health, Northwestern University, Chicago, IL, USA
| | - Nisha Palanisamy
- Robert J. Havey MD Institute for Global Health, Northwestern University, Chicago, IL, USA
| | - Olukemi Odukoya
- Department of Community Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Olugbenga A Silas
- Department of Anatomic and Forensic Pathology, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Fatimah Abdulkareem
- Department of Anatomic and Forensic Pathology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Philip Akpa
- Department of Anatomic and Forensic Pathology, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Kabir Badmos
- Department of Anatomic and Forensic Pathology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Godwin E Imade
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria
- Genomics and Postgraduate Core Facility, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Alani S Akanmu
- Department of Haematology and Blood Transfusion, College of Health Sciences, University of Jos, Jos, Nigeria
| | - Demirkan B Gursel
- Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Yinan Zheng
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Brian T Joyce
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Chad J Achenbach
- Robert J. Havey MD Institute for Global Health, Northwestern University, Chicago, IL, USA
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Atiene S Sagay
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Jos, Plateau State, Nigeria
| | - Rose Anorlu
- Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Jian-Jun Wei
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Folasade Ogunsola
- Department of Medical Microbiology, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Robert L Murphy
- Robert J. Havey MD Institute for Global Health, Northwestern University, Chicago, IL, USA
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Lifang Hou
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Melissa A Simon
- Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
2
|
Musa J, Kocherginsky M, Magaji FA, Maryam AJ, Asufi J, Nenrot D, Burdett K, Katam N, Christian EN, Palanisamy N, Odukoya O, Silas OA, Abdulkareem F, Akpa P, Badmos K, Imade GE, Akanmu AS, Gursel DB, Zheng Y, Joyce BT, Achenbach CJ, Sagay AS, Anorlu R, Wei JJ, Ogunsola F, Murphy RL, Hou L, Simon MA. Epidemiology and Survival outcomes of HIV-associated cervical cancer in Nigeria. medRxiv 2023:2023.08.08.23293820. [PMID: 37609183 PMCID: PMC10441483 DOI: 10.1101/2023.08.08.23293820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Introduction Invasive cervical cancer (ICC) is an HIV-associated cancer that is preventable and precancerous stages including early ICC stages could be detected through screening offering opportunities for treatment and cure. The high incidence in women living with HIV and late presentation often at advanced stages of ICC with limited treatment facilities often result in early mortality. We sought to compare the epidemiologic characteristics and survival differences in HIV status of ICC patients in Nigeria. Methods We conducted a cohort study at two federal academic hospital-based research sites in Jos University Teaching Hospital, and Lagos University Teaching Hospital Nigeria, between March 2018 and September 2022. We enrolled women with histologically confirmed ICC with known HIV status, and FIGO staging as part of the United States of America's National Institutes of Health/National Cancer Institute funded project titled 'Epigenomic Biomarkers of HIV-Associated Cancers in Nigeria'. The primary outcome was all-cause mortality with assessment of overall survival (OS) and time to death after ICC diagnosis. OS distribution was estimated using the method of Kaplan-Meier and compared between groups using the log-rank test. Results A total of 239 women with confirmed ICC were enrolled and included in this analysis, of whom 192 (80.3%) were HIV-negative (HIV-/ICC+), and 47 (19.7%) were HIV-positive (HIV+/ICC+). The HIV+/ICC) patients were younger with median age 46 (IQR: 40-51) years compared to 57 (IQR: 45-66) among HIV-/ICC+) (P<0.001. Squamous cell carcinoma was the commonest histopathologic variant in 80.4% of ICC diagnosis, moderately differentiated tumor grade in 68.1% in both groups. HIV+/ICC+ diagnosis was at FIGO advanced stages in 64.9% compared to 47.9% in HIV-/ICC+. The HIV-/ICC+ women had better OS compared to HIV+/ICC+ participants (p=0.018), with 12-month OS 84.1% (95%CI: 75% - 90%) and 67.6% (95%CI: 42%-84%) respectively. Conclusion ICC is diagnosed at a relatively young age in women living with HIV, with a significantly lower overall survival probability compared to women without HIV. The trend of presentation and diagnosis at advanced stages in women living with HIV could partly explain the differences in overall survival.
Collapse
Affiliation(s)
- Jonah Musa
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Plateau State, Nigeria
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, USA
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Masha Kocherginsky
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University
| | - Francis A. Magaji
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Plateau State, Nigeria
| | - Ali J. Maryam
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Plateau State, Nigeria
| | - Joyce Asufi
- Department of Nursing, Oncology Unit and Nursing Education, Jos University Teaching Hospital, Jos, Nigeria
| | - Danjuma Nenrot
- Information Technology and Data Management Unit, Adult HIV clinic, Jos University Teaching Hospital, Jos, Nigeria
| | - Kristen Burdett
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University
| | - Neelima Katam
- Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Elizabeth N. Christian
- Robert J. Havey MD, Institute for Global Health, Northwestern University, Chicago, IL, USA
| | - Nisha Palanisamy
- Robert J. Havey MD, Institute for Global Health, Northwestern University, Chicago, IL, USA
| | - Olukemi Odukoya
- Department of Community Medicine, College of Medicine, University of Lagos, Nigeria
| | - Olugbenga A. Silas
- Department of Anatomic and Forensic Pathology, College of Health Sciences, University of Jos, Nigeria
| | - Fatimah Abdulkareem
- Department of Anatomic and Forensic Pathology, College of Medicine, University of Lagos, Nigeria
| | - Philip Akpa
- Department of Anatomic and Forensic Pathology, College of Health Sciences, University of Jos, Nigeria
| | - Kabir Badmos
- Department of Anatomic and Forensic Pathology, College of Medicine, University of Lagos, Nigeria
| | - Godwin E. Imade
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Plateau State, Nigeria
- Genomics and Postgraduate Core Facility, College of Health Sciences, University of Jos, Nigeria
| | - Alani S. Akanmu
- Department of Haematology and Blood Transfusion, College of Health Sciences, University of Jos, Nigeria
| | - Demirkan B. Gursel
- Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Yinan Zheng
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, USA
| | - Brian T. Joyce
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, USA
| | - Chad J. Achenbach
- Robert J. Havey MD, Institute for Global Health, Northwestern University, Chicago, IL, USA
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Atiene S. Sagay
- Department of Obstetrics and Gynecology, College of Health Sciences, University of Jos, Plateau State, Nigeria
| | - Rose Anorlu
- Department of Obstetrics and Gynecology, College of Medicine, University of Lagos, Nigeria
| | - Jian-Jun Wei
- Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Folasade Ogunsola
- Department of Medical Microbiology, College of Medicine, University of Lagos, Nigeria
| | - Robert L. Murphy
- Robert J. Havey MD, Institute for Global Health, Northwestern University, Chicago, IL, USA
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Lifang Hou
- Department of Preventive Medicine, Division of Cancer Epidemiology and Prevention, Feinberg School of Medicine, Northwestern University, USA
- Center for Global Oncology, Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, USA
- Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Melissa A. Simon
- Robert H. Lurie Comprehensive Cancer Center and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
3
|
Odukoya O, Nenrot D, Adelabu H, Katam N, Christian E, Holl J, Okonkwo A, Kocherginsky M, Kim KY, Akanmu S, Abdulkareem FB, Anorlu R, Musa J, Lesi O, Hawkins C, Okeke O, Adeyemo WL, Sagay S, Murphy R, Hou L, Ogunsola FT, Wehbe FH. Application of the research electronic data capture (REDCap) system in a low- and middle income country- experiences, lessons, and challenges. Health Technol (Berl) 2022; 11:1297-1304. [PMID: 35251887 PMCID: PMC8896572 DOI: 10.1007/s12553-021-00600-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The challenges of reliably collecting, storing, organizing, and analyzing research data are critical in low- and middle-income countries (LMICs), particularly in Sub-Saharan Africa where several healthcare and biomedical research organizations have limited data infrastructure. The Research Electronic Data Capture (REDCap) System has been widely used by many institutions and hospitals in the USA for data collection, entry, and management and could help solve this problem. This study reports on the experiences, challenges, and lessons learned from establishing and applying REDCap for a large US-Nigeria research partnership that includes two sites in Nigeria, (the College of Medicine of the University of Lagos (CMUL) and Jos University Teaching Hospital (JUTH)) and Northwestern University (NU) in Chicago, Illinois in the United States. The largest challenges to this implementation were significant technical obstacles: the lack of REDCap-trained personnel, transient electrical power supply, and slow/intermittent internet connectivity. However, asynchronous communication and on-site hands-on collaboration between the Nigerian sites and NU led to the successful installation and configuration of REDCap to meet the needs of the Nigerian sites. An example of one lesson learned is the use of Virtual Private Network (VPN) as a solution to poor internet connectivity at one of the sites, and its adoption is underway at the other. Virtual Private Servers (VPS) or shared online hosting were also evaluated and offer alternative solutions. Installing and using REDCap in LMIC institutions for research data management is feasible; however, planning for trained personnel and addressing electrical and internet infrastructural requirements are essential to optimize its use. Building this fundamental research capacity within LMICs across Africa could substantially enhance the potential for more cross-institutional and cross-country collaboration in future research endeavors.
Collapse
Affiliation(s)
- O Odukoya
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos State, Nigeria
| | - D Nenrot
- College of Health Sciences, University of Jos, Plateau state, Nigeria
| | - H Adelabu
- AIDS Prevention Initiative of Nigeria, Lagos University Teaching Hospital, Lagos State, Nigeria
| | - N Katam
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| | - E Christian
- Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - J Holl
- Department of Neurology and Center for Healthcare Delivery Science and Innovation, Biological Sciences Division, University of Chicago, Chicago, IL, USA
| | - A Okonkwo
- Research Management Office, College of Medicine, University of Lagos, Lagos, Nigeria
| | - M Kocherginsky
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.,Department of Preventive Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - K-Y Kim
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.,Department of Preventive Medicine, Division of Biostatistics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - S Akanmu
- AIDS Prevention Initiative of Nigeria, Lagos University Teaching Hospital, Lagos State, Nigeria
| | - F B Abdulkareem
- Department of Anatomic & Molecular Pathology, College of Medicine, University of Lagos, Lagos State, Nigeria
| | - R Anorlu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Lagos, Lagos State, Nigeria
| | - J Musa
- College of Health Sciences, University of Jos, Plateau state, Nigeria.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.,Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - O Lesi
- Department of Medicine, College of Medicine, University of Lagos, Lagos State, Nigeria
| | - C Hawkins
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.,Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - O Okeke
- College of Health Sciences, University of Jos, Plateau state, Nigeria
| | - W L Adeyemo
- Department of Maxillofacial Surgery, College of Medicine, University of Lagos, Lagos State, Nigeria
| | - S Sagay
- College of Health Sciences, University of Jos, Plateau state, Nigeria
| | - R Murphy
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.,Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - L Hou
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.,Havey Institute for Global Health, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - F T Ogunsola
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Lagos, Lagos State, Nigeria
| | - F H Wehbe
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA
| |
Collapse
|