Addressing the Growing Cancer Burden in the Wake of the AIDS Epidemic in Botswana: A Collaborative Partnership

Abstract

The majority of cancer cases and nearly three-quarters of cancer deaths occur in resource-limited settings. With an adult HIV prevalence of 24.8 percent, Botswana has experienced a dramatic increase in HIV-related malignancies over the past decade. The availability of free antiretroviral treatment since 2003 has led to a major reduction in AIDS deaths; however the burden of cancer has continued to increase. The leading cancers in Botswana are cervical, non-Hodgkin lymphoma, head and neck, breast and Kaposi's sarcoma. Limited specialized oncologic services are available in two government and two private facilities, including one linear accelerator and one high dose rate brachytherapy source. With basic oncologic infrastructure in place, we sought to establish a longitudinal collaboration with the Botswana oncology community in order to improve cancer care in this nation. We focused our efforts in the following areas: the creation of a multi-disciplinary tumor board, connecting the Botswana oncology community with Massachusetts General Hospital (MGH)/Harvard-based disease site experts, on site training and capacity building in radiation oncology, and long distance learning and development. Activities have been directed through the active participation of representatives from the Botswana Ministry of Health, Botswana Harvard AIDS Institute, Gaborone Private Hospital, University of Botswana, US Embassy in Botswana, Botswana-University of Pennsylvania partnership and the MGH/Harvard oncology community. We have established the first sustainable multidisciplinary tumor board in Botswana, which has been meeting monthly since February 2012. Utilizing an internet-based platform connecting Botswana and MGH/Harvard oncology providers, case histories and pertinent radiology and pathology images are reviewed from recent challenging cases. Cases are followed by focused review of best practice by MGH/Harvard disease site experts. In addition to providing a venue for education and constructive peer review, the conference provides a regular forum for Botswana oncologists, infectious disease physicians, house officers, surgeons, and pathologists to discuss relevant health systems issues. Furthermore, the collaboration has assisted with the introduction of cervical brachytherapy in Botswana, through on site training in manual skills, treatment planning, and ongoing mentorship. A collaborative relationship in oncology care has been established between MGH/Harvard and Botswana, resulting in the introduction of new approaches to treatment and perceived improvements in patient care. The MGH/Harvard-Botswana collaboration provides a model for partnership between academic oncology centers and high burden countries with limited resources.