Cancer diagnostic service use in people living with HIV in South Africa: A cross-sectional study

The objective of this study was to map place of cancer diagnosis in relation to Human Immunodeficiency Virus (HIV) care centre among people living with HIV (PLHIV) within South Africa (SA) using national laboratory database.
We linked HIV and cancer laboratory data from 2004–2014 using supervised machine-learning algorithms. We performed a cross-sectional analysis comparing province where individuals accessed their HIV care versus where they had their cancer diagnosis.
We used laboratory test records related to HIV diagnostics and care, such as CD4 cell counts and percentages, rapid tests, qualitative Polymerase Chain Reaction (PCR), antibody and antigen tests for HIV data that was documented as HIV positive and laboratory diagnosed cancer records from SA.
Our study population consisted of HIV records from the National Health Laboratory Service (NHLS) that linked to cancer record at the National Cancer Registry (NCR) between 2004–2014.
We linked HIV records from NHLS to cancer records at NCR in order to study the inherent characteristics of the population with both HIV and cancer.
The study population was 68,284 individuals with cancer and documented HIV related laboratory test. The median age at cancer diagnosis was 40 [IQR, 33–48] years for the study population with most cancers in PLHIV diagnosed in females 70.9% [n = 46,313]. Of all the PLHIV and cancer, 25% (n = 16,364 p < 0.001) sought treatment outside their province of residence with 60.7% (n = 10,235) travelling to Gauteng. KZN had 46.6% (n = 4,107) of its PLHIV getting cancer diagnosis in Gauteng. Western Cape had 95% (n = 6,200) of PLHIV getting cancer diagnosis within the province.
Our results showed health systems inequalities across provinces in SA with respect to cancer diagnosis. KZN for example had nearly half of the PLHIV getting cancer diagnosis outside the province while Western Cape is able to offer cancer diagnostic services to most of the PLHIV in the province. Gauteng is getting over burdened with referral for cancer diagnosis from other provinces. More effort is required to ensure equitable access to cancer diagnostic services within the country.

本研究旨在利用南非（South Africa, SA）国家实验室数据库，绘制人类免疫缺陷病毒（Human Immunodeficiency Virus, HIV）感染者（People Living with HIV, PLHIV）的癌症诊断地点与HIV诊疗中心的关联图谱。
研究团队采用监督式机器学习算法，对2004至2014年的HIV与癌症实验室数据进行关联分析。本研究为横断面分析，对比了感染者接受HIV诊疗的省份与癌症诊断所在的省份。
本研究使用了与HIV诊断及诊疗相关的实验室检测记录，包括CD4细胞计数与百分比、快速检测、定性聚合酶链式反应（Polymerase Chain Reaction, PCR）、HIV抗体及抗原检测等被记录为HIV阳性的HIV数据，以及南非境内经实验室确诊的癌症记录。
本研究的研究人群来自2004至2014年间，国家卫生实验室服务中心（National Health Laboratory Service, NHLS）的HIV记录与国家癌症登记处（National Cancer Registry, NCR）的癌症记录相匹配的人群。
研究团队将NHLS的HIV记录与NCR的癌症记录进行关联，以探究同时感染HIV与罹患癌症的人群的内在特征。
本研究的研究人群共68284名癌症患者且持有记录在案的HIV相关实验室检测结果。该研究人群的癌症诊断中位年龄为40岁[四分位距，33–48岁]，其中女性HIV感染者的癌症确诊占比最高，达70.9%[n=46313]。在所有合并感染HIV与罹患癌症的人群中，25%（n=16364，p<0.001）在居住省外寻求治疗，其中60.7%（n=10235）前往豪登省（Gauteng）。夸祖鲁-纳塔尔省（KwaZulu-Natal, KZN）有46.6%（n=4107）的HIV感染者在豪登省完成癌症诊断。西开普省（Western Cape）则有95%（n=6200）的HIV感染者在省内完成癌症诊断。
研究结果显示，南非各省在癌症诊断服务方面存在卫生系统不平等现象。例如，夸祖鲁-纳塔尔省近半数HIV感染者需在省外完成癌症诊断，而西开普省则可为省内绝大多数HIV感染者提供癌症诊断服务。豪登省因接收来自其他省份的癌症诊断转诊，负担已过重。该国需付出更多努力，以确保民众能够公平获取癌症诊断服务。