Prognosis, diagnostic delay, and patient characteristics associated with diagnostic delay among Kaposi sarcoma (KS) patients in Uganda.

Abstract

6578 Background: The incidence and mortality of KS remain high in sub-Saharan Africa. Delaying treatment might explain poor outcomes, but no study has measured the association between delay, characteristics associated with delay, and prognosis for KS patients in low- and middle-income countries. Methods: This is a prospective, cross-sectional study conducted from June-October 2012 at the Uganda Cancer Institute (UCI) in Kampala, Uganda among HIV-infected adults with histologically confirmed KS. The aim was to measure the association between delay and overall KS stage risk at diagnosis. Standardized interviews were conducted in English or Luganda to measure delay, and medical records were abstracted to obtain KS stage at admission to UCI. Multivariable logistic regression was used to assess the relationship between diagnostic delay and poor-risk stage at diagnosis. Results: 161 patients were enrolled; 68.9% were men, mean age was 34.0 years (SD 7.7), 58.1% had income < $2 per day, and 49.4% had ≥primary education. 25.8% had been seen in an HIV clinic within 3 months, 71.6% were on antiretroviral therapy (ART), and 25.5% had visited a traditional healer prior to being seen at UCI. 45.3% delayed seeking care at UCI for ≥3 months from onset of symptoms. Among those who delayed, 35.6% waited 6 months, and 24.7% waited 12 months. The most common reasons for delay were lack of pain (47.9%), no money (31.5%), and distance to UCI (8.2%). In adjusted analysis patients who experienced diagnostic delay were more likely to have poor-risk stage compared to those who did not delay (OR 3.41, p=0.002, 95%CI: 1.46-7.45). After adjusting for patient characteristics, HIV clinic attendance, and ability to pay out-of-pocket costs, visiting a traditional healer was the only characteristic associated with greater likelihood of delay (OR 2.69, p=0.020, 95%CI: 1.17-6.17). Conclusions: Diagnostic delay was independently associated with poor-risk stage at diagnosis, and visiting a traditional healer was the only patient characteristic independently associated with delay. The relationship between traditional and Western medicine presents a critical point of intervention to improve KS outcomes in Uganda.