Visceral Kaposi's sarcoma (KS), like pulmonary KS (PKS), is more common in HIV associated/epidemic KS (EpKS). Its presentation often mimics other opportunistic pulmonary infections and is associated with poor outcomes. This study investigated the prevalence of PKS, and factors associated with overall survival at a tertiary hospital in Tanzania. This retrospective study reviewed records of 269 histologically confirmed cutaneous KS patients treated at the Ocean Road Cancer Institute between January 2019 and December 2022. Sociodemographic, clinical, and survival data were extracted from patients' files. Specialist radiologists reviewed chest radiographs taken at the time of diagnosis, categorizing them as normal, infectious infiltrates, or PKS. Data were analyzed using descriptive statistics, and Cox Proportional Hazard model identified factors linked to overall survival. Statistical significance was defined as p < 0.05. Among 269 patients with cutaneous KS, 195 had EpKS, 66 had Endemic KS (EnKS), and 8 had unknown HIV status and were excluded from further analysis. The male-to-female ratio was 2:1. While all patients had cutaneous KS lesions, 23 (8.8%) had PKS which was significantly more common in the EpKS than EnKS group (p = 0.024). Additionally, 24 patients (9.2%) had Chest X-ray findings (CXR) indicative of infection. At one year, overall survival was 53% for patients with PKS, compared with 87% for those without PKS. In the adjusted analysis, patients without PKS had an 86% lower risk of mortality than those with PKS (aHR = 0.14; 95% CI: 0.07-0.32; P < 0.001). There is high prevalence of advanced KS presentation and poor overall survival especially among PKS in SSA, despite widespread ART use. Although CXR remains the diagnostic mainstay in this setting, it is subject to notable limitations. Simple, low-cost diagnostic algorithms are needed to optimize CXR utility alongside the ongoing expansion of advanced imaging and bronchoscopic services in the region.

Background/Objectives: Tanzania is a low-to-middle-income-country (LMIC) which endures significant adverse impact from HIV-1- and HPV-associated malignancies. We investigated the performance of visual inspection with acetic acid (VIA) compared to the Pap smear. Methods: Screening performance was assessed in a cross-sectional study design across rural catchment clinics in Bagamoyo and Chalinze, and an urban site, Ocean Road Cancer Institute (ORCI), in Dar es Salaam. Pap smears were performed and were read in triplicate by readers blinded to HIV status and patient demographic data. Blood samples were collected for HIV status confirmation. All cytopathology, VIA, and HIV status data were compared with patient demographic factors. Results: Here we present results from 672 patients. Analysis of participants across the cohort revealed a high rate of HIV (25%) and exchange of “sex for money” in the rural site of Chalinze. Bagamoyo and ORCI had slightly lower HIV rates of about 16% and 12%, respectively. Despite the high HIV rates in Chalinze (25%), there was a contrastingly low-level of detectable lesions by VIA (9%) in this region. Conclusions: Overall, VIA-positive cases were 26% HSIL-positive, whereas VIA-negative cases were 14% HSIL-positive, suggesting that performance of VIA is limited.

PURPOSE Cervical cancer remains a leading cause of morbidity and mortality in Tanzania where HIV exacerbates the risk of cancer and dysplasia. In 2017, Tanzania adopted the Test-and-Treat program for patients with HIV, which mandates immediate antiretroviral therapy for people living with HIV, regardless of CD4 count. This study examined the impact of this strategy on the severity of cervical dysplasia among women living with HIV (WLWH) at the Ocean Road Cancer Institute (ORCI). METHODS We used existing data of women who came to the ORCI cervical cancer early detection clinic between 2015 and 2023 for cervical cancer early detection. Of the 3,385 women screened, 1,686 were diagnosed with dysplastic lesions and included in the analysis. This subset consisted of 349 WLWH, 605 HIV-negative women, and 732 women with unknown HIV status. The remaining women either were visual inspection with acetic acid-negative or had suspected cervical cancer and were not included in the final analysis of dysplastic lesions. The year 2017 was chosen as a pivotal point for analysis because it marked the implementation of the Test-and-Treat strategy at the ORCI. The severity of dysplasia before and after 2017 was compared using trend and logistic regression analyses. RESULTS The Test-and-Treat strategy was associated with a significant increase in detecting small/moderate lesions (P < .0001). The odds of being diagnosed with small/moderate lesions versus large lesions were approximately four times higher post-2017 (odds ratio, 3.972 [95% CI, 2.462 to 6.409]). CONCLUSION The Test-and-Treat strategy has significantly reduced the severity of cervical dysplasia among WLWH at the ORCI, highlighting the importance of integrating HIV treatment into cervical cancer prevention programs. Continuous research focusing on the long-term effects of the Test-and-Treat strategy and expansion of on-site pathology services, including timely histopathologic diagnosis, are essential to further reduce cervical cancer incidence, morbidity, and mortality among WLWH.

Oncolytic viruses (OVs) are emerging as promising cancer immunotherapeutic agents due to their cancer-directed oncolysis and ability to induce potent and durable anticancer immune responses. They have shown encouraging results even in tumors that are resistant to conventional therapies. However, the therapeutic efficacy of OVs is hindered by antiviral immune responses that eliminate OVs before they reach their target site and the tumor stroma, limiting intratumoral virus spread in the tumor microenvironment (TME). To address these challenges, various strategies have been developed to shield OVs from immunosurveillance by loading viruses onto/into cellular carriers, extracellular vesicles, liposomes, and nanoparticles. Despite notable improvements in viral shielding and targeting strategies, inefficient intratumoral viral penetration remains a critical obstacle. In the TME, the tumor stroma accounts for 90% of the entire tumor mass, comprising non-cancerous cells and extracellular matrix. Since OVs are engineered to target only cancer cells, their cytolytic efficacy is counteracted by the tumor stroma. Therefore, innovative approaches are necessary to enhance the penetration of viruses within tumors, thereby increasing the efficacy of oncolytic virotherapy. This review aims to provide a comprehensive overview of OVs in terms of clinical applications, successes, and limitations, while also discussing future directions for enhancing the targeted delivery and intratumoral penetration of OVs.

Globally, cervical cancer is the fourth most common cancer among women, with approximately 604,000 new cases and 342,000 deaths reported in 2020. Like many other countries, Tanzania adopted the National Cancer Treatment Guidelines (NCTGs) in 2020 to improve the quality of care and ensure patient safety. However, despite the adoption of these guidelines, cervical cancer care in many healthcare facilities remains unstandardized. This study aimed to explore the institutional management factors influencing compliance with the NCTGs for cervical cancer care at Ocean Road Cancer Institute (ORCI). A case study design using a process evaluation approach was employed to assess the role of institutional management in influencing guidelines adherence. The study was conducted at ORCI, where 20 healthcare providers were purposively selected for in-depth interviews based on their experience and depth of knowledge on the topic. All interviews were audio-recorded, transcribed, and translated from Swahili to English. Thematic analysis was conducted by coding and organizing the transcribed texts to identify emerging themes and sub-themes. Findings revealed that key institutional management factors promoting compliance with the NCTGs at ORCI include the existence of a well-defined policy on guidelines utilization, a supportive working environment, and a well-established support system. Conversely, a significant barrier identified was the low healthcare provider-to-patient ratio and machine downtime. The study found that strong institutional management characterized by clear policies, a supportive work environment, and effective support systems facilitates adherence to the NCTGs at ORCI. Nonetheless, the shortage of healthcare personnel poses a major challenge. Therefore, it is essential for the Ministry of Health, in collaboration with ORCI management, to recruit additional oncologists, surgeons, and other critical healthcare professionals. Strengthening the provider-to-patient ratio is crucial for improving compliance with the NCTGs and ultimately enhancing the quality of cervical cancer care.

Supplementary Figure S2. Expression of Mutsig CV genes in cohorts from Tanzania (Panel A) and Malawi (Panel B).

Background: Colorectal cancer (CRC) is a leading cause of cancer morbidity and mortality in Tanzania. Non-metastatic CRC is a potentially curable disease that requires multidisciplinary management. This study aimed to evaluate clinicopathologic characteristics for CRC, treatment patterns and select quality metrics at Ocean Road Cancer Institute from 2014 to 2019, the time period immediately preceding the release of Tanzania's first National Cancer Treatment Guidelines in 2020. Methods: Quality metrics were selected a priori based upon existing international quality measures, the newly released Tanzania National Cancer Treatment Guidelines and key stakeholder input. Demographic, clinicopathologic and treatment data were abstracted from medical charts for all adult patients with newly diagnosed non-metastatic CRC presenting to Ocean Road Cancer Institute from 2014 to 2019. A clinician reviewed all case report forms for quality assurance. Patient characteristics, treatment patterns and quality metrics were examined using descriptive analyses. Results: Of 678 patients with CRC, 421 (62%) had non-metastatic disease. Of those with non-metastatic disease, 92 (22%) had colon cancer, 175 (42%) had rectal cancer and 154 (36%) were classified as CRC primary site not otherwise specified. Most patients with colon cancer (n = 86, 93%) underwent surgical resection. Quality of adjuvant chemotherapy was high for colon cancer, with most patients receiving timely treatment (73% within 8 weeks of surgery) and most (81%) with stage III disease receiving appropriate treatment. Documentation in surgical pathology reports was poor, with only 5 of 78 (6%) documenting examination of >12 lymph nodes. Among rectal cancer patients, use of preoperative chemoradiation (7%) and perioperative chemotherapy (27%) was low for locally advanced disease. Overall, only42 (24%) of patients with rectal cancer underwent surgery and 42 (24%) received no treatment. Conclusion: The majority of patients with non-metastatic colon cancer received high-quality care, whereas care delivery was less consistent among patients with rectal cancer. This suggests possible challenges in delivering complex, multidisciplinary care in low-resource settings. These findings will serve as a contemporary benchmark for future evaluations of the Tanzanian National CancerTreatment Guidelines and their impact on CRC care and outcomes.

Supplementary Figure S1. Measurement of RNA Quantity and Quality using PAXgene tissue container vs. RNAlater.

BackgroundCervical cancer (CC) is the leading cancer among women in Tanzania, especially among those between the ages of 15 and 44. The prevalence of high-risk Human papillomavirus (HR-HPV)-16/18 women in the general population at any given time is 3.3%. HR-HPVs 16 or 18 are the primary cause of CC. The distribution of HPV genotypes among women with CC according to HIV status is unknown in Tanzania. This study aimed to determine the HPV genotype distribution according to HIV status among women with CC in Tanzania.MethodsThis cross-sectional study was done at Ocean Road Cancer Institute (ORCI) in Tanzania among women with histologically confirmed CC. HIV serology testing was performed. Biopsy was taken from cervical lesions, and DNA was extracted. HPV DNA was amplified by using a previously validated multiplex HPV PCR assay targeting 14 high-risk HPV genotypes (16,18,30,31,33, 35, 39, 45, 51, 52, 56, 58, 59, and 66) and two low-risk HPV genotypes (6 and 11). Continuous variables were compared using either a student t-test or the Mann-Whitney U test. Fisher's exact test was employed to compare discrete variables. A P-value less than 0.05 was considered statistically significant.ResultsWe included 100 women with CC. The prevalence of HIV infection in this study was 42%. The prevalence of any HPV infection was 94%, ranging from 1-3 genotypes per woman. HPV. The median age for women living with HIV (WLWH) with CC patients was 45 years (IQR, 31-60), while the median age for HIV-uninfected women with CC patients was 57 years (IQR, 30-78). (p = 0.0001). WLWH and HIV-uninfected women had similar HPV prevalence, except for HPV 35, which was more common in WLWH. There was a trend of high prevalence of HPV 52 and HPV 58 in WLHH compared to HIV-uninfected women, but this difference was not statistically significant. The prevalence of HPV 16 and/or 18 infection in the entire sample was 85%. The combined prevalence of HPV 16 and/or 18 was 76% WLWH and 91% amongst HIV-uninfected women (p = 0.036).The majority of women (77.9%) had single-genotype HPV infection. There was no difference in the distribution of multiple or single HPV genotypes infection by HIV status (p = 0.25).ConclusionIn this study, HIV positive women with CC presented at a significantly younger age (45 years) compared to the HIV-negative women (57 years). The prevalence of high-risk HPV is high among women with CC in Tanzania. Distribution of most high-risk HPV genotypes among women with CC was not significantly influenced by HIV status except for HPV 35, which appeared to be more in HIV positive women compared to HIV-negative women. While the majority of the high-risk HPV infections were with single HPV genotypes, the prevalence of multiple high-risk HPV infections was at 22%, with no significant difference between the two HIV statuses. A vaccination program that aptly targets HPV 16 and 18 could prevent up to 85% of CC cases in Tanzania, regardless of HIV. Keywords: Human papillomavirus, cervical cancer, HIV, Tanzania.

Background Cervical cancer is the leading cause of cancer-related deaths in Tanzania and the most common form of cancer among Tanzanian women. Screening attendance remains among the lowest globally, necessitating improved attendance and screening methods. Objective This study aims to assess the feasibility of implementing the World Health Organization’s 2021 hPV-based screening guideline in Tanzania by identifying potential barriers and facilitators to HPV-based screening among screening clients, healthcare providers, and stakeholders. Methods From October 2022 to February 2023, 25 semi-structured interviews were conducted with screening clients (n = 16) and healthcare providers and stakeholders (n = 9) in Moshi and Dar es Salaam. Data were analyzed using a deductive framework based on Bronfenbrenner’s Social Ecological Model, supplemented with inductive subcategories from the transcripts. Results Barriers and facilitators emerged across all levels of the Social Ecological Model. At the individual level, clinic-based screening and a one-visit approach were barriers, while HPV-self-sampling was a facilitator. Interpersonal barriers included limited social support, while referrals served as facilitators. Community-level barriers included fear and misconceptions, countered by facilitators such as increased awareness and health education. Health system challenges included restrictive age limits and urbanization of human resources, with uptake through other health services acted as a facilitator. Political barriers highlighted the need for a steady local supply chain, while cost reduction could serve as a facilitator for guideline implementation. Conclusion WHO’s 2021 hPV-based screening guideline shows promise in Tanzania, but barriers such as clinic availability, fear, misconceptions, and supply chain issues must be addressed to ensure successful implementation.

e13031 Background: Comprehensive targeting of cancer communication through inhibition of Tumor-derived exosomes (TDEs) secretion by tumor cells and blocking the selective uptake by recipient cells could potentially control cancer progression. We evaluated the effect of inhibiting TDEs secretion on restricting tumor progression. Methods: Cells of triple-negative breast cancer (MDA MB-231) were cultured in a conditioned culture medium either supplemented with or without 100 µg/ml of pantoprazole for 24 hours. TDEs were isolated using exosome isolation kit from conditioned culture media harvested 24 hours after treating cells with pantoprazole. Transmission Electron Microscope (TEM), and Western blot analysis were used to characterize TDEs, while micro-RNA analysis was performed to assess TDEs cargo. Cell proliferation analysis for the experiment and control groups were conducted on day 3 of cell culture. A 2-tailed Student's unpaired t-test with a 95% confidence interval (CI) with a p-value less than 0.05was used to compare the means of two data sets that were taken between the experimental and the control groups. Results: The assessment conducted using the TEM scanning, and Western Blot analysis verified that the particles we isolated were indeed TDEs. Pantoprazole reduced the proliferation of MDA MB-231 cells. The mean difference in cellular proliferation between the experimental and control groups was -9000 ± 2887 cells/ml (S.E), (P-value = 0.089). The 95% CI was also determined to be (-21421, 3421). Pantoprazole also inhibited TDE secretion, the mean difference in TDE secretion between the experimental group and the control was -3.697 x 10 9 ± 3.722 x 10 8 particles/ml (S.E), P-value = 0.01 and the 95% CI was -5.2 x 10 9 to -2.1 x 10 9 . Furthermore,, pantoprazole was found to reduce the negative surface charge of TDEs. The mean difference in zeta potential between the experimental and control groups was 4.1 ± 0.57 mV (S.E), with a 95% CI ranging from 1.64 to 6,571, and a P-value was 0.019. This indicates that pantoprazole affected the surface charge of TDEs, by rendering them less negative hence affecting the electrostatic binding of TDEs to targeted cells, consequently impairing their uptake. The evaluation of molecular cargo shuttled by TDEs indicated that TDEs carries oncogenic biomolecules that support tumor growth and metastasis. In our research, we identified hsa-miR-372-3p, which is transported by TDEs and is essential in the carcinogenesis of several human cancers. Conclusions: Our preliminary work established that inhibition of TDEs secretion restricted growth of cancer cells by impairing exchange of oncogenic cargo. A novel and comprehensive strategy of targeting TDEs secretion and uptake by recipient cells is required for effective treatment of cancer.

Seasonal coronaviruses (HCoVs) are known to contribute to cross-reactive antibody (Ab) responses against SARS-CoV-2. While these responses are predictable due to the high homology between SARS-CoV-2 and other CoVs, the impact of these responses on susceptibility to SARS-CoV-2 infection in cancer patients is unclear. To investigate the influence of prior HCoV infection on anti-SARS-CoV-2 Ab responses among COVID-19 asymptomatic individuals with cancer and controls without cancers, we utilized the VirScan technology in which phage immunoprecipitation and sequencing (PhIP-seq) of longitudinal plasma samples was performed to investigate high-resolution (i.e., epitope level) humoral CoV responses. Despite testing positive for anti-SARS-CoV-2 Ab in the plasma, a majority of the participants were asymptomatic for COVID-19 with no prior history of COVID-19 diagnosis. Although the magnitudes of the anti-SARS-CoV-2 Ab responses were lower in individuals with Kaposi sarcoma (KS) compared to non-KS cancer individuals and those without cancer, the HCoV Ab repertoire was similar between individuals with and without cancer independent of age, sex, HIV status, and chemotherapy. The magnitudes of the anti-spike HCoV responses showed a strong positive association with those of the anti-SARS-CoV-2 spike in cancer patients, and only a weak association in non-cancer patients, suggesting that prior infection with HCoVs might play a role in limiting SARS-CoV-2 infection and COVID-19 disease severity.

Background Human papilloma virus (HPV) is a sexually transmitted infection causing more than 80% of cervical cancers. WHO recommends using of sensitive screening methods like HPV-testing to timely prevent future morbidity and mortality from cervical cancer. Pilot studies have shown that HPV-testing is feasible and can be scaled in developing country like Tanzania. However, there is limited information on women understanding, reactions and psychological challenges following diagnosis of high risk HPV (HR-HPV). This study explored the knowledge of women on HPV and their experience after HPV positive results in Kilimanjaro, Tanzania. Methods The study was part of a larger study that assessed incidence and persistence of HR-HPV among women aged 18 years and above in Kilimanjaro. This was a cross sectional study conducted in Moshi municipal council among women who had HR-HPV positive results at enrollment. In-depth interviews were conducted with 13 randomly selected women who were attending for follow-up after enrollment. Interviews were conducted at the health facility and Atlas.ti.8 was used to analyze the data using thematic framework analysis. Results Women had knowledge on HPV infection but they had different reactions following receiving positive HPV results. Reaction toward the positive HPV results had two extremes; some women had psychological effect (hopeless, death sentence, having cancer, being shocked, failure to disclose and psychosexual effects) while others women explained positive results is good as they are identified earlier, will be followed up and it has made them plan to continue with cervical cancer screening in future. Conclusion Women had knowledge on HPV, but positive results lead to negative and positive experiences by women. Clinicians and programs need to develop interventions and good strategies to minimize the psychological and social burden of testing positive for HPV.

BACKGROUND:Kaposi sarcoma (KS) is a neoplastic disease etiologically associated with infection by the Kaposi sarcoma-associated herpesvirus (KSHV). KS manifests primarily as cutaneous lesions in individuals due to either age (classical KS), HIV infection (epidemic KS), or tissue rejection preventatives in transplantation (iatrogenic KS) but can also occur in individuals, predominantly in sub-Saharan Africa (SSA), lacking any obvious immune suppression (endemic KS). The high endemicity of KSHV and human immunodeficiency virus-1 (HIV) co-infection in Africa results in KS being one of the top 5 cancers there. As with most viral cancers, infection with KSHV alone is insufficient to induce tumorigenesis. Indeed, KSHV infection of primary human endothelial cell cultures, even at high levels, is rarely associated with long-term culture, transformation, or growth deregulation, yet infection in vivo is sustained for life. Investigations of immune mediators that distinguish KSHV infection, KSHV/HIV co-infection, and symptomatic KS disease have yet to reveal consistent correlates of protection against or progression to KS. In addition to viral infection, it is plausible that pathogenesis also requires an immunological and metabolic environment permissive to the abnormal endothelial cell growth evident in KS tumors. In this study, we explored whether plasma metabolomes could differentiate asymptomatic KSHV-infected individuals with or without HIV co-infection and symptomatic KS from each other.METHODS:To investigate how metabolic changes may correlate with co-infections and tumorigenesis, plasma samples derived from KSHV seropositive sub-Saharan African subjects in three groups, (A) asymptomatic (lacking neoplastic disease) with KSHV infection only, (B) asymptomatic co-infected with KSHV and HIV, and (C) symptomatic with clinically diagnosed KS, were subjected to analysis of lipid and polar metabolite profiles RESULTS: Polar and nonpolar plasma metabolic differentials were evident in both comparisons. Integration of the metabolic findings with our previously reported KS transcriptomics data suggests dysregulation of amino acid/urea cycle and purine metabolic pathways, in concert with viral infection in KS disease progression.CONCLUSIONS:This study is, to our knowledge, the first to report human plasma metabolic differentials between in vivo KSHV infection and co-infection with HIV, as well as differentials between co-infection and epidemic KS.

Cervical cancer is the most common female cancer in Eastern Africa, and the World Health Organization (WHO) recommends human papillomavirus (HPV)‐based screening as a key element to eliminate the disease. In this cross‐sectional study from Tanzania, we compared nine HPV‐based cervical cancer screening strategies, including HPV testing at standard cut‐off; HPV testing at increased viral load cut‐offs; HPV testing with partial/extended genotyping, and HPV testing with visual inspection with acetic acid (VIA). We pooled data collected during 2008 to 2009 and 2015 to 2017 from 6851 women aged 25 to 65. Cervical cytology samples were HPV tested with Hybrid Capture 2, and HPV positive samples were genotyped with INNO‐LiPA Extra II. Human immunodeficiency virus (HIV) testing and VIA were done according to local standards. We calculated sensitivity, specificity, positive and negative predictive value of screening strategies, with high‐grade cytological lesions as reference, separately for women with and without HIV. HPV testing at standard cut‐off (1.0 relative light units [RLU]) had highest sensitivity (HIV+: 97.8%; HIV−: 91.5%), but moderate specificity (HIV+: 68.1%; HIV−: 85.7%). Increasing the cut‐off for HPV positivity to higher viral loads (5.0/10.0 RLU) increased specificity (HIV+: 74.2%‐76.5%; HIV−: 89.5%‐91.2%), with modest sensitivity reductions (HIV+: 91.3%‐95.7%; HIV−: 83.5%‐87.8%). Limiting test positivity to HPV types 16/18/31/33/35/45/52/58 improved specificity while maintaining high sensitivity (HIV+: 90.2%; HIV−: 81.1%). Triage with VIA and/or partial genotyping for HPV16/18 or HPV16/18/45 had low sensitivities (≤65%). In conclusion, HPV testing alone, or HPV testing with extended genotyping or increased viral load cut‐offs, may improve cervical cancer screening in Sub‐Saharan Africa.

AbstractBackground: Esophageal squamous cell carcinoma (ESCC) comprises 90% of all esophageal cancer cases globally and is the most common histology in low-resource settings. Eastern Africa has a disproportionately high incidence of ESCC. Methods: We describe the genomic profiles of 61 ESCC cases from Tanzania and compare them to profiles from an existing cohort of ESCC cases from Malawi. We also provide a comparison to ESCC tumors in The Cancer Genome Atlas (TCGA). Results: We observed substantial transcriptional overlap with other squamous histologies via comparison with TCGA PanCan dataset. DNA analysis revealed known mutational patterns, both genome-wide as well as in genes known to be commonly mutated in ESCC. TP53 mutations were the most common somatic mutation in tumors from both Tanzania and Malawi but were detected at lower frequencies than previously reported in ESCC cases from other settings. In a combined analysis, two unique transcriptional clusters were identified: a proliferative/epithelial cluster and an invasive/migrative/mesenchymal cluster. Mutational signature analysis of the Tanzanian cohort revealed common signatures associated with aging and cytidine deaminase activity (APOBEC) and an absence of signature 29, which was previously reported in the Malawi cohort. Conclusions: This study defines the molecular characteristics of ESCC in Tanzania, and enriches the Eastern African dataset, with findings of overall similarities but also some heterogeneity across two unique sites. Impact: Despite a high burden of ESCC in Eastern Africa, investigations into the genomics in this region are nascent. This represents the largest comprehensive genomic analysis ESCC from sub-Saharan Africa to date.

PURPOSECervical cancer (CC) is the leading malignancy in Tanzania. Low-income countries are faced with double epidemics of HIV and CC. This study aimed to investigate how HIV and cancer stage at diagnosis affect early treatment outcomes among women with CC treated with concurrent chemoradiation in Tanzania in the highly active antiretroviral therapy era.MATERIALS AND METHODSThis was a prospective cohort study of patients newly diagnosed with CC at the Ocean Road Cancer Institute from November 2019 to January 2020. The tumor response was assessed using RECIST 3 months post-treatment. The tumor response was categorized as a complete or partial response according to the ultrasound and pelvic examination findings. The univariate and multivariate logistic regression explained the relationship between several covariates (age, stage, HIV status, equivalent dose in 2 Gy fractions, chemotherapy cycles, and treatment time) and treatment response.RESULTSA total of 102 patients with CC were included in this study at baseline. After adjusting for other covariates, only completion of treatment within 56 days (odds ratio [OR], 9.23; 95% CI, 1.53 to 55.85; P = .016) and receiving at least three cycles of cisplatin (OR, 5.6; 95% CI, 1.47 to 21.34; P = .012) were significantly associated with complete tumor response. HIV status was not significantly associated with complete tumor response (OR, 1.534; 95% CI, 0.424 to 5.545; P = .5144).CONCLUSIONEarly treatment response was independent of HIV status. With wide coverage of anitretroviral therapy, patients with HIV can receive radical treatment and have the same early outcomes as their HIV-negative counterparts.

Purpose Reducing time between cancer screening, diagnosis, and initiation of treatment is best achieved when services are available in the same hospital. Yet, comprehensive cancer centers are typically unavailable in low- and middle-income countries (LMICs), where resources are limited and services scattered. This study explored the impact of establishing an in-house pathology laboratory at the largest public cancer hospital in Tanzania on the downstaging of cervical cancer. Methods We examined clinical datasets of 8,322 cervical cancer patients treated at the Ocean Road Cancer Institute (ORCI). The first period included patients treated from 2002 to 2016, before establishment of the pathology laboratory at ORCI; the second period (post-pathology establishment) included data from 2017 to 2020. Logistic regression analysis evaluated the impact of the pathology laboratory on stage of cervical cancer diagnosis. Results Patients treated during the post-pathology period were more likely to be clinically diagnosed at earlier disease stages compared to patients in the pre-pathology period (pre-pathology population diagnosed at early disease stage: 44.08%; post-pathology population diagnosed at early disease stage: 59.38%, p < 0.001) . After adjustment for age, region of residence, and place of biopsy, regression results showed patients diagnosed during the post-pathology period had higher odds of early stage cervical cancer diagnosis than patients in the pre-pathology period (OR 1.35, 95% CI (1.16, 1.57), p < 0.001). Conclusions Integrated and comprehensive cancer centers can overcome challenges in delivering expedited cervical cancer diagnosis and treatment. In-house pathology laboratories play an important role in facilitating timely diagnosis and rapid treatment of cervical and possibly other cancers in LMICs.

Background: Cancer in Africa is an emerging public health problem that needs urgent preventive measures, particularly in workplaces where exposure to carcinogens may occur. In Tanzania, the incidence rate of cancer and mortality rates due to cancers are increasing, with approximately 50,000 new cases each year. This is estimated to double by 2030. Methods: Our hospital-based cross-sectional study describes the characteristics of newly diagnosed patients with head and neck or esophageal cancer from the Ocean Road Cancer Institute (ORCI), Tanzania. We used an ORCI electronic system to extract secondary data for these patients. Results: According to the cancer registration, there were 611 head and neck and 975 esophageal cancers recorded in 2019–2021. Two-thirds of these cancer patients were male. About 25% of the cancer patients used tobacco and alcohol, and over 50% were involved in agriculture. Conclusion: Descriptions of 1586 head and neck cancer patients and esophageal cancer patients enrolled in a cancer hospital in Tanzania are given. The information may be important for designing future studies of these cancers and may be of value in the development of cancer prevention measures.