Obstetrics & Gynaecology
http://hdl.handle.net/10311/1253
2024-03-19T11:13:56ZGynecologic cancer: new and follow-up patient appointments in Botswana during the COVID-19 pandemic
http://hdl.handle.net/10311/2186
Gynecologic cancer: new and follow-up patient appointments in Botswana during the COVID-19 pandemic
Davey, Sonya MD; Bazzette-Matebele, Lisa MD; Monare, Barati RN, MPH; Seiphetleng, Alexander RN, BPH; Ramontshonyana, Gaobakwe RN; Vuylsteke, Peter MD; Chiyapo, Sebathu MD; Luckett, Rebecca MD; Ramogola-Masire, Doreen MD; Grover, Surbhi MD, MPH
The article presents descriptive data on oncology appointments during COVID-19 lockdown in sub-Saharan Africa. Mobile applications can provide a platform for tracking missed and attended appointments. There was a significant increase in missed follow-up appointments during the COVID-19 lockdown in Botswana.
2021-04-06T00:00:00ZHIV infection and survival among women with cervical cancer
http://hdl.handle.net/10311/2185
HIV infection and survival among women with cervical cancer
Drysen-Peterson, Scott; Bvochora-Nsingo, Memory; Suneja, Gita; Efstathiou, Jason, A.; Grover, Surbhi; Chiyapo, Sebathu; Ramogola-Masire, Doreen; Kebabonye-Pusoentsi, Malebogo; Clayman, Rebecca; Mapes, Abigail, C.; Tapela, Neo; Asmelash, Aida; Medhin, Heluf; Viswanathan, Akila, N.; Russell, Anthony H.; Lin, Lilie, L.; Kayembe, Mukendi K.A.; Mmalane, Mompati; Randall, Thomas C.; Chabner, Bruce; Lockman, Shahin
Purpose
Cervical cancer is the leading cause of cancer death among the 20 million women with HIV worldwide. We sought to determine whether HIV infection affected survival in women with invasive cervical cancer.
Patients and Methods
We enrolled sequential patients with cervical cancer in Botswana from 2010 to 2015. Standard treatment included external beam radiation and brachytherapy with concurrent cisplatin chemotherapy. The effect of HIV on survival was estimated by using an inverse probability weighted marginal Cox model.
Results
A total of 348 women with cervical cancer were enrolled, including 231 (66.4%) with HIV and 96 (27.6%) without HIV. The majority (189 [81.8%]) of women with HIV received antiretroviral therapy before cancer diagnosis. The median CD4 cell count for women with HIV was 397 (interquartile range, 264 to 555). After a median follow-up of 19.7 months, 117 (50.7%) women with HIV and 40 (41.7%) without HIV died. One death was attributed to HIV and the remaining to cancer. Three-year survival for the women with HIV was 35% (95% CI, 27% to 44%) and 48% (95% CI, 35% to 60%) for those without HIV. In an adjusted analysis, HIV infection significantly increased the risk for death among all women (hazard ratio, 1.95; 95% CI, 1.20 to 3.17) and in the subset that received guideline-concordant curative treatment (hazard ratio, 2.63; 95% CI, 1.05 to 6.55). The adverse effect of HIV on survival was greater for women with a more-limited stage cancer (P = .035), those treated with curative intent (P = .003), and those with a lower CD4 cell count (P = .036). Advanced stage and poor treatment completion contributed to high mortality overall.
Conclusion
In the context of good access to and use of antiretroviral treatment in Botswana, HIV infection significantly decreases cervical cancer survival.
2016-08-29T00:00:00ZExplaining disparities in oncology health systems delays and stage at diagnosis between men and women in Botswana: A cohort study
http://hdl.handle.net/10311/2184
Explaining disparities in oncology health systems delays and stage at diagnosis between men and women in Botswana: A cohort study
Iyer, Hari S.; Kohler, Racquel E.; Ramogola-Masire, Doreen; Brown, Carolyn; Molebatsi, Kesaobaka; Grover, Surbhi; Kablay, Irene; Bvochora-Nsingo, Memory; Efstathiou, Jason, A.; Lockman, Shahin; Tapela, Neo; Dryden-Peterson, Scott L.
Purpose
Men in Botswana present with more advanced cancer than women, leading to poorer outcomes. We sought to explain sex-specific differences in time to and stage at treatment initiation.
Methods
Cancer patients who initiated oncology treatment between October 2010 and June 2017 were recruited at four oncology centers in Botswana. Primary outcomes were time from first visit with cancer symptom to treatment initiation, and advanced cancer (stage III/IV). Sociodemographic and clinical covariates were obtained retrospectively through interviews and medical record review. We used accelerated failure time and logistic models to estimate standardized sex differences in treatment initiation time and risk differences for presentation with advanced stage. Results were stratified by cancer type (breast, cervix, non-Hodgkin’s lymphoma, anogenital, head and neck, esophageal, other).
Results
1886 participants (70% female) were included. After covariate adjustment, men experienced longer excess time from first presentation to treatment initiation (8.4 months) than women (7.0 months) for all cancers combined (1.4 months, 95% CI: 0.30, 2.5). In analysis stratified by cancer type, we only found evidence of a sex disparity (Men: 8.2; Women: 6.8 months) among patients with other, non-common cancers (1.4 months, 95% CI: 0.01, 2.8). Men experienced an increased risk of advanced stage (Men: 67%; Women: 60%; aRD: 6.7%, 95% CI: -1.7%, 15.1%) for all cancers combined, but this disparity was only statistically significant among patients with anogenital cancers (Men: 72%; Women: 50%; aRD: 22.0%, 95% CI: 0.5%, 43.5%).
Conclusions
Accounting for the types of cancers experienced by men and women strongly attenuated disparities in time to treatment initiation and stage. Higher incidence of rarer cancers among men could explain these disparities.
2019-06-06T00:00:00ZBotswana's HIV response: policies, context, and future directions
http://hdl.handle.net/10311/2180
Botswana's HIV response: policies, context, and future directions
Ramogola-Masire, Doreen; Poku, Ohemaa; Mazhani, Loeto; Ndwapi, Ndwapi; Misra, Supriya; Arscott-Mills, Tonya; Blank, Lilo; Ho-Foster, Ari; Becker, Timothy D.; Yang, Lawrence
This brief report describes key periods in the history of the national public health response to the HIV epidemic in Botswana. It reveals the context leading to the development of HIV policies presently in place and current challenges that remain. The report concludes with opportunities for future directions, initiatives, and policy changes to reduce the high rates of HIV.
2020-01-17T00:00:00Z