Abstract
BackgroundCancer is becoming a major cause of mortality in low- and middle-income countries. Unlike infectious disease, malignancy and other chronic conditions require significant supportive infrastructure for diagnostics, staging and treatment. In addition to morphologic diagnosis, diagnostic pathways in oncology frequently require immunohistochemistry (IHC) for confirmation. We present the experience of a tertiary-care hospital serving rural western Kenya, which developed and validated an IHC laboratory in support of a growing cancer care service.Objectives, methods and outcomesOver the past decade, in an academic North-South collaboration, cancer services were developed for the catchment area of Moi Teaching and Referral Hospital in western Kenya. A major hurdle to treatment of cancer in a resource-limited setting has been the lack of adequate diagnostic services. Building upon the foundations of a histology laboratory, strategic investment and training were used to develop IHC services. Key elements of success in this endeavour included: translation of resource-rich practices to a resource-limited setting, such as using manual, small-batch IHC instead of disposable- and maintenance-intensive automated machinery, engagement of outside expertise to develop reagent-efficient protocols and supporting all levels of staff to meet the requirements of an external quality assurance programme.ConclusionDevelopment of low- and middle-income country models of services, such as the IHC laboratory presented in this paper, is critical for the infrastructure in resource-limited settings to address the growing cancer burden. We provide a low-cost model that effectively develops these necessary services in a challenging laboratory environment.
Highlights
Cancer is a leading cause of mortality in low- and middle-income countries (LMICs), already accounting for more deaths than tuberculosis, HIV and/or AIDS and malaria combined.[1,2] According to the International Agency for Research on Cancer there were more than 600 000 new cancer cases and more than half a million cancer deaths in Africa in 2008, with a projected doubling by 2030.3 The need to develop an infrastructure for cancer research and care in LMICs has been recognised by various researchers.[4,5,6] A core component of cancer infrastructure is adequate pathology services
Training of personnel: Four histopathologists, four technicians and two doctoral students in Immunology were trained both through short group workshops conducted by the local IHC expert and representatives from DAKO, the company providing IHC reagents (Nairobi, Kenya), and through one-on-one instruction taught by the consortium of North American universities
Our laboratory performs oestrogen, progesterone and HER2 staining for breast cancer treatment following guidelines,[20,21] differentiation of lymphomas using a basic panel of antibodies,[22,23] research-based diagnostics for Kaposi’s sarcoma (KS) using latency-associated nuclear antigen (LANA-1) and Wilm’s tumour
Summary
Malignancy and other chronic conditions require significant supportive infrastructure for diagnostics, staging and treatment. We present the experience of a tertiary-care hospital serving rural western Kenya, which developed and validated an IHC laboratory in support of a growing cancer care service. Objectives, methods and outcomes: Over the past decade, in an academic North-South collaboration, cancer services were developed for the catchment area of Moi Teaching and Referral Hospital in western Kenya. A major hurdle to treatment of cancer in a resource-limited setting has been the lack of adequate diagnostic services. Key elements of success in this endeavour included: translation of resource-rich practices to a resource-limited setting, such as using manual, small-batch IHC instead of disposable- and maintenance-intensive automated machinery, engagement of outside expertise to develop reagent-efficient protocols and supporting all levels of staff to meet the requirements of an external quality assurance programme
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