Childhood leukemia survival in the US-Mexico border: Building sustainable leukemia care using health systems strengthening models.

Abstract

1502 Background: Pediatric leukemia outcomes are poor in most low-and middle-income countries (LMIC) and exacerbated by healthcare systems ill-equipped to manage cancer. Effective leukemia management in LMIC involves curating epidemiologic data; providing healthcare workforce specialty training; developing evidence-based treatments and supportive care; safeguarding access to medications and equipment; providing patient and family psychosocial and financial support; partnering with non-governmental organizations, and ensuring treatment adherence. Methods: We describe the implementation of a collaborative program to achieve sustainable high-quality care for children with leukemia in a unique border health setting. In 2013, in a partnership between North-American and Mexican institutions, we used the health systems strengthening model developed by the World Health Organization (WHO) Framework for Action with domains in Services delivery, Workforce, Information systems, Access to essential medicines, Financing, and Leadership and Governance to implement a sustainable program aimed at improving acute lymphoblastic leukemia (ALL) outcomes at a public, referral hospital in the US-Mexico border region. We evaluated program sustainability indicators, and prospectively assessed clinical features, risk classification, and survival outcomes in children with ALL at Hospital General in Tijuana, Mexico from 2008-2012 (pre-implementation) and from 2013-2017 (post-implementation). Results: Our approach led to a fully-staffed leukemia service, sustainable training programs, evidence-based, data-driven projects to improve clinical outcomes, and funding for medications, supplies and personnel through local partnerships. Pre-implementation and post-implementation 5-year overall survival for children with standard-risk and high-risk ALL improved from 52% to 82% (P = 0 ×023) and from 46% to 76% ( P = 0 ×031), respectively. All sustainability indicators significantly improved between 2013 and 2017. Conclusions: By using a health systems strengthening approach, we improved leukemia care and survival in a public Mexican hospital in the US-Mexico border region. The demonstrated increase in overall survival across a decade after the implementation of our program validates the use of the health systems strengthening models, as they are not only efficacious in improving clinical outcomes, but also serve as financially and organizationally means of building sustainable capacity. Our model serves as an example for future international partnerships aimed at sustainably improving cancer outcomes in LMIC. Future research should evaluate best practices in establishing global health collaborations with particular attention paid towards the individual circumstances that impact healthcare delivery locally in each unique community.