Stories From the Field:

EAST AFRICA

Improving cancer screening and treatment for HIV patients in East Africa: Kaposi’s sarcoma

Esther Freeman MD PhD, a resident in Dermatology at MGH, was granted a Center for Global Health Travel Award  to spend two weeks in Uganda and Kenya to establish ties with local institutions working to increase screening for Kaposi’s sarcoma.

I travelled to the Infectious Disease Institute in Kampala, Uganda, and AMPATH in Eldoret, Kenya, with a travel grant from the MGH Center for Global Health.

As a Dermatologist and Epidemiologist working in HIV and Global Health Dermatology, I focus on the role of skin disease as a manifestation of systemic illness. In HIV patients, Kaposi’s sarcoma, a tumor of blood and lymph vessels that often starts on the skin, can then invade patients’ lungs and gut, ultimately killing them. An alternate title for my work, perhaps, should be “HIV patients: how a small purple spot on your skin can kill you.”

Kaposi’s sarcoma (KS), even in the era of antiretroviral therapy, remains one of the most common malignancies in sub-Saharan Africa. Even with the incredible strides made in rolling out antiretroviral therapy in sub-Saharan Africa, survival after a diagnosis with Kaposi’s sarcoma is still poor. The discrepancy between survival in patients in Africa after a KS diagnosis and our patients in the United States with the same diagnosis is striking. Diagnosing and therefore treating Kaposi’s sarcoma early will lead to improved survival for these patients in desperate need.

As a part of our work with KS, in an aim to diagnose patients with the condition earlier, and ultimately treat them earlier as well, we are educating local providers to perform skin biopsies. In the United States, skin biopsies are most often the work of Dermatologists. However, there are only a handful of Dermatologists in Kenya and Uganda, and none of them work in the public sector in the rural health outposts. Therefore, the project has turned to local health workers, not necessarily MDs, who are on the front line of providing HIV care in rural communities. It was amazing to see during this trip the excitement of those rural health workers in being trained in skin biopsy technique, and the skills of those providers that had already been trained. These front-line providers were familiar with KS, and had seen suspicious lesions on their patients, but previously had lacked the tools needed in order to act.

By supporting clinician-scientists like myself, the MGH Center for Global Health is supporting research and care in some of the poorest settings worldwide. Thank you for your support.