Achieving global breast cancer initiative key performance indices for breast cancer patients in Botswana by HIV status.

Abstract

1628 Background: Low- to middle-income countries have disproportionately higher breast cancer (BC) mortality rates, partly due to late-stage diagnosis. In people with HIV (PWH), BC mortality is worse compared to those without HIV. The WHO’s Global Breast Cancer Initiative (GBCI) proposes to reduce mortality through 3 identified pillars: (1) health promotion for early detection with at least 60% of invasive BC diagnosed at stage 1 or 2; (2) timely diagnosis, where evaluation, imaging, and pathology are completed within 60 days from first doctor’s appointment; and (3) ≥80% of patients completing treatment. Few real-world data exist on these key performance indices in PWH. Understanding the influence of clinical and demographic factors associated with achieving the GBCI pillars can inform tailored interventions to increase BC survival. We aimed to assess pillars 1 and 2 in BC patients presenting to a referral hospital in Botswana, by HIV status. Methods: This prospective BC cohort included patients >18 years, presenting for BC care at Princess Marina Hospital between 2015 and 2023. Patients with unknown HIV status and/or unknown stage were excluded. Pillar 1 was assessed using the cancer stage documented in the medical chart. Pillar 2 was assessed using patient recall of first-contact with health facility and pathology report date. We characterized socioeconomically disadvantaged districts as those with poverty rate ≥20% and < 100% of the population living within 5km from a health facility. Descriptive statistics and logistic regression were used. Results were stratified by HIV status. All p-values were two-sided. Data was analyzed using STATA 18.5. Results: 655 patients (median age: 51.2, IQR 42.4, 63.4) met eligibility criteria. 212 (31.8%) were PWH and 11 (1.7%) men. 180 (27.1%) attained pillar 1, and 59 (9.3%) attained pillar 2. PWH were younger (48.9 vs. 58.6; p < 0.001) and more likely to be single (70.3% vs. 47.3%; < 0.001). There was no significant difference between rates of PWH and those without HIV achieving both pillar 1 (23.1% vs 28.9%, p = 0.12) and pillar 2 (11.4% vs 8.3%, p = 0.2). However, PWH had a significantly shorter interval from first contact with the health facility to completed pathology (11.9 months vs. 20.1 months, p = 0.013). There was no significant difference between residents of socioeconomically disadvantaged districts versus non-residents in achieving pillar 1 (29.7% vs. 27.0%, p = 0.72) or pillar 2 (8.3% vs. 9.3%, p = 0.84). Conclusions: Majority of BC patients presenting to the referral hospital in Botswana did not achieve the GBCI pillars 1 and 2. However, PWH had significantly less diagnostic interval, which may be reflective of frequent contact for PWH in established care and may present an opportunity for care integration for PWH. Early detection and patient navigation interventions may potentially help Botswana achieve the WHO’s GBCI goals and reduce BC mortality.