Project 1

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Despite more than a decade of implementing universal access to antiretroviral therapy (ART) in sub-Saharan Africa (SSA), Kaposi’s sarcoma (KS) remains the most common malignancy in people living with HIV/AIDS (PLWH), causing significant morbidity and mortality. Compared to the US, ART implementation in SSA has not resulted in a significant reduction of KS cases. For many PLWH in SSA, the only connection to health care is through HIV care and treatment centers (CTC). Lack of recognition of early KS by both CTC care providers and PLWH, and ineffective connection to diagnosis, care, and treatment when the disease presents in the setting of HIV management at CTC may foster late presentation and ultimately, poor outcomes. Compared to cervical cancer, where screening and early detection approaches have been successfully integrated into HIV care for PLWH, efforts to detect, diagnose, and treat KS early are lacking. Since KS presents mostly cutaneous, coupling KS detection to HIV management as has been done in cervical cancer for early detection should readily improve early KS detection, definitive diagnosis, and linkage to care. As services for HIV management are conducted through CTCs throughout SSA, these community-associated structures are the best platform to integrate KS interventions and can be leveraged to increase early-stage presentation, early KS diagnosis, and early treatment initiation. In this study, we will implement an integrated education package to raise awareness and to impart the skills for early KS detection and diagnosis to PLWH, health care providers, and community workers. This package includes recurrent educational sessions at CTCs in order to enhance detection, diagnosis, and to initiate KS treatment early to improve outcomes of PLWH. It will also include a social network-based strategy to enhance the sustainability of such an implementation program. We hypothesize that an integrated care approach will increase the number and proportion of PLWH detected with early KS, thereby improving early KS diagnosis and treatment to improve KS outcomes. There are 3 Specific Aims. 1) Implement KS education, early detection, diagnosis, and linkage to care program at CTCs in Tanzania and Zambia. 2) To enhance and sustain early KS detection, diagnosis, and linkage to care program through a community network-based respondent-driven sampling (RDS) strategy in Tanzania and Zambia. 3) To evaluate the effectiveness of integrating early KS detection, diagnosis, and RDS strategy in existing HIV care services for PLWH in Tanzania and Zambia. Together, this will determine whether sensitization of providers and PLWH to a combined HIV care and early KS detection approach is efficacious and viable in the setting. This study is significant, as it will increase the proportion of PLWH examined for early KS detection, diagnosed, and linked to cancer care. It will also focus on empowering and equipping providers and PLWH to make more informed health decisions. This can be readily adopted and scaled up in Tanzania and Zambia, and subsequently in other SSA to facilitate early KS diagnosis and treatment.