Princess Marina Hospital

HIV, cancer, and their respective treatments are independently associated with cardiovascular risk, but limited data exist on the intersection of these conditions. The purpose of this study was to gain insights into the cardiovascular risk factor burden and cardiac function in people with HIV (PWH) treated for breast cancer. In a cohort of PWH and breast cancer treated with anthracyclines and/or trastuzumab (2017–2022) in Botswana, we assessed pre-treatment (baseline) left ventricular ejection fraction (LVEF), and prospectively obtained an echocardiogram at least one year after cancer treatment initiation. Wilcoxon signed rank sum test was used to test the differences between baseline and follow-up LVEF. Thirty-three women were enrolled at a median of 2.1 years (Quartile (Q)1-Q3 1.8–3.1) from their cancer treatment initiation. The median age was 48.0 years (Q1-Q3 44.0–54.0). All but one patient was on antiretroviral therapy (ART); the median ART duration was 11.6 years (Q1-Q3 6.3–15 years) with a median viral load of 30 (Q1-Q3 0–30) and CD4 count of 874 (Q1-Q3 361–1131). At baseline, 70

Background: Neonatal intestinal obstruction (NIO) is a surgical condition with good outcomes in well-resourced health facilities. In Botswana, there are no data on NIO. During the study, all NIO cases across the country were treated at Princess Marina Hospital (PMH), the nation’s largest referral hospital. For NIO in Botswana. Aim: to determine the incidence, spectrum, outcomes and factors associated with mortality. Methods: A retrospective descriptive case series of neonates admitted between January 2010 and December 2012 to PMH with NIO. Data were collected from medical and surgical records. All cases under one month of age at admission were included. The incidence was calculated using national birth statistics and risk factors for mortality were explored using univariable and multivariable regression. Results: Seventy-nine NIO patients had a median age at admission of 3 days (IQR: 2-6), 49% were male, and median time from birth to surgery was 5 days (IQR: 3-6). The incidence of NIO was 5.96 per 10,000 live births. The most common diagnosis was jejunal obstruction (35%). In-hospital case fatality rate was 37%. In a multivariable model that included birth weight, time to surgery and maternal HIV status, only birth weight of >2500g was significantly associated with survival (OR=25.7, 95% CI 2.71-243.1; p<0.01). Conclusion: In Botswana, the incidence of NIO is similar to that in other settings. Overall mortality is high and low birth weight confers risk for mortality. This study provides a platform for further research to study the trends of NIO and explore other factors that affect outcomes. Keywords: Neonates, Atresia, Intestinal Obstruction, Birth Weight, Congenital

PURPOSEThe number of cancer survivors from low- and middle-income countries is rising, but most research has been conducted in high-income countries. Although studies have characterized the detection and treatment of cervical cancer in Botswana, survivorship care is a severely understudied area. We assessed short- and long-term survivorship visit adherence and factors associated with adherence in patients treated for cervical cancer in Botswana.METHODSBetween 2015 and 2022, females with cervical cancer were prospectively enrolled in an observational cohort study. Based on recommendations in the Botswana National Cervical Cancer Guidelines, adherence was defined as completion of a clinical visit biannually (every 6 months) during short-term survivorship care (0-2 years after treatment) and annually for long-term survivorship care (3-5 years after treatment). Generalized estimating equations (adjusted odds ratio [aOR]) were used to evaluate factors associated with short- and long-term adherence.RESULTSThis cohort included 857 females treated with definitive- or curative-intent surgery- or radiation-based treatment, with a median age of 47.7 years (IQR, 41.6-58.2 years) and 68.6% living with HIV. On multivariable analysis of short-term care (n = 772), patients who traveled ≥100 km to the treatment facility (aOR, 0.35; P < .001), had advanced-stage (III and IV) cervical cancer (aOR, 0.69; P = .007), and were undergoing care during the COVID-19 pandemic (aOR, 0.72; P = .005) were less likely to be adherent. Results were similar for long-term care.CONCLUSIONAdherence to recommended survivorship visits in Botswana is suboptimal. Strategies to help survivors, particularly those living farther away from treatment facilities and with advanced disease, are needed to improve adherence and reduce cervical cancer mortality.

BACKGROUND:Delays in initiating radiation therapy for cervical cancer are common and may contribute to poorer outcomes. However, the pace of stage progression remains uncertain, limiting the development of quality targets and mitigation strategies. METHODS:We conducted a prospective cohort study of women with cervical cancer treated with radiation in Botswana between 2012 and 2019. We used an instrumental variable (IV) approach based on seasonal variation in access to treatment to estimate the causal effect of treatment delay on cancer stage progression. The month of cancer diagnosis served as a natural source of variation, with women diagnosed during end-of-year holiday disruptions (November-February) experiencing longer delays on average than women at other times of the year. Using two-stage weighted models of mean delay and mean cancer stage at time of treatment, we estimated the average time required for cervical cancer stage to progress (eg, IIIA to IIIB). To contextualize findings we examined the association between cancer stage at treatment initiation and overall survival. RESULTS:Among 763 eligible participants, 494 were diagnosed during routine access periods and 269 during delayed periods. The mean time to treatment initiation was longer (IV partial F statistic 13.1) in the delayed access group (12.4 weeks) compared to the routine access group (11.2 weeks). The groups were otherwise well-balanced. In the primary analysis, cervical cancer stage progression was estimated to occur over a mean of 8.6 weeks (95% CI: 7.1-10.9). Modeled time to stage progression differed by HIV status (p <0.001) with estimated 7.6 weeks (95% CI: 6.4-9.2) for women with HIV and 8.7 weeks (95% CI: 6.1-15.3) for women without HIV. Stage increase was associated with 38% (95% CI: 33 to 44%) reduction in survival time. CONCLUSIONS:Modest treatment delays commonly encountered in routine care were associated with measurable cervical cancer progression likely decreasing survival. Initiating treatment within four weeks from diagnosis minimizes the risk of stage progression.