Task Shifting and Skin Punch for the Histologic Diagnosis of Kaposi's Sarcoma in Sub-Saharan Africa: A Public Health Solution to a Public Health Problem
Task Shifting and Skin Punch for the Histologic Diagnosis of Kaposi's Sarcoma in Sub-Saharan Africa: A Public Health Solution to a Public Health Problem
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DOI：
10.1159/000375165
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发表时间：
2015-01-01
期刊：
影响因子：
3.5
通讯作者：
Martin, Jeffrey
中科院分区：
文献类型：
--
作者：
Laker-Oketta, Miriam O.;Wenger, Megan;Martin, Jeffrey
在艾滋病毒的推动下，撒哈拉以南非洲地区卡波西氏肉瘤(KS)的发病率是世界上最高的。尽管如此，该地区的KS诊断主要基于临床。在有活组织检查可用的地方，传统上是切除并由外科医生进行，导致多次预约、后续检查以拆除缝合线，并且成本高昂。我们假设，一种更简单的方法-皮肤穿孔活检-将使组织学诊断更容易获得。为了解决这一问题，我们向东非的三家艾滋病毒诊所提供了对疑似KS的皮肤穿孔活检的培训和设备。这一过程包括局部麻醉，然后用一次性圆柱形冲头刀片获取标本。明胶海绵(R)有助于止血。患者在4天后取出敷料。从2007年到2013年，共进行了2799例活组织检查。虽然最初的目标是由医生使用，但活组织检查主要由护士(62%)进行，其次是医生(15%)、临床官员(12%)和技术人员(11%)。没有复发出血或感染的报告。经过最低限度的培训和提供廉价的设备(每次活检3.06美元)，东非的艾滋病毒诊所可以为疑似KS患者整合当天的皮肤穿孔活检。从内科医生到非内科医生的任务转移大大增加了访问权限。皮肤穿孔活检应该是任何HIV诊所基本程序的一部分。任务转移的这个例子也可以适用于在资源有限的情况下对其他癌症(例如，乳腺癌)的诊断。(C)2015年S.Karger AG，巴塞尔
Fueled by HIV, sub-Saharan Africa has the highest incidence of Kaposi's sarcoma (KS) in the world. Despite this, KS diagnosis in the region is based mostly on clinical grounds. Where biopsy is available, it has traditionally been excisional and performed by surgeons, resulting in multiple appointments, follow-up visits for suture removal, and substantial costs. We hypothesized that a simpler approach - skin punch biopsy - would make histologic diagnosis more accessible. To address this, we provided training and equipment for skin punch biopsy of suspected KS to three HIV clinics in East Africa. The procedure consisted of local anesthesia followed by a disposable cylindrical punch blade to obtain specimens. Hemostasis is facilitated by Gelfoam (R) . Patients removed the dressing after 4 days. From 2007 to 2013, 2,799 biopsies were performed. Although originally targeted to be used by physicians, biopsies were performed predominantly by nurses (62%), followed by physicians (15%), clinical officers (12%) and technicians (11%). There were no reports of recurrent bleeding or infection. After minimal training and provision of inexpensive equipment (USD 3.06 per biopsy), HIV clinics in East Africa can integrate same-day skin punch biopsy for suspected KS. Task shifting from physician to non-physician greatly increases access. Skin punch biopsy should be part of any HIV clinic's essential procedures. This example of task shifting may also be applicable to the diagnosis of other cancers (e.g., breast) in resource-limited settings. (C) 2015 S. Karger AG, Basel