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Introduction: Clinical reports of multicentric Castleman disease (MCD) from sub‐Saharan Africa (SSA) are scarce despite high prevalence of HIV and Kaposi sarcoma‐associated herpesvirus (KSHV). Our objective is to describe characteristics and survival for HIV‐associated MCD patients in Malawi. To our knowledge, this is the first HIV‐associated MCD case series from the region. Methods: We describe HIV‐positive patients with MCD in Lilongwe, and compare them to HIV‐associated lymph node Kaposi sarcoma (KS) and non‐Hodgkin lymphoma (NHL) patients treated at our centre. All patients were enrolled into a prospective longitudinal cohort study at a national teaching hospital and cancer referral centre serving half of Malawi's 16 million people. We included adult patients≥18 years of age with HIV‐associated MCD (n=6), lymph node KS (n=5) or NHL (n=31) enrolled between 1 June 2013 and 31 January 2015. Results and discussion: MCD patients had a median age of 42.4 years (range 37.2–51.8). All had diffuse lymphadenopathy and five had hepatosplenomegaly. Concurrent KS was present for one MCD patient, and four had performance status ≥3. MCD patients had lower median haemoglobin (6.4 g/dL, range 3.6–9.3) than KS (11.0 g/dL, range 9.1–12.0, p=0.011) or NHL (11.2 g/dL, range 4.5–15.1, p=0.0007). Median serum albumin was also lower for MCD (2.1 g/dL, range 1.7–3.2) than KS (3.7 g/dL, range 3.2–3.9, p=0.013) or NHL (3.4 g/dL, range 1.8–4.8, p=0.003). All six MCD patients were on antiretroviral therapy (ART) with median CD4 count 208 cells/µL (range 108–1146), and all with HIV RNA Conclusions: HIV‐associated MCD occurs in Malawi, is diagnosed late and is associated with high mortality. Improvements in awareness, diagnostic facilities, treatment and supportive care are needed to address this likely under‐recognized public health problem in SSA., Introduction HIV‐associated multicentric Castleman disease (MCD) is a lymphoproliferative disorder caused by Kaposi sarcoma‐associated herpesvirus (KSHV) [1–5]. Unlike Kaposi sarcoma (KS), MCD incidence may be increasing in the antiretroviral therapy [...]

Background Cancer outcomes in sub-Saharan Africa (SSA) remain suboptimal, in part due to poor patient retention. Many patients travel long distances to receive care, and transportation costs are often prohibitively expensive. These are well-known and established causes of delayed treatment and care abandonment in Malawi and across SSA. Methods We sent visit reminder texts and offered upfront money to cover transportation costs through a mobile money transfer (MMT) platform to lymphoma patients enrolled in a prospective cohort in Malawi. The primary aim was to test the feasibility of upfront MMTs. Results We sent 1034 visit reminder texts to 189 participating patients. Of these texts, 614 (59%) were successfully delivered, with 536 (52%) responses. 320/536 (60%) MMTs were sent to interested patients and 312/320 (98%) came to their appointment on time. Of 189 total patients, 120 (63%) were reached via text and 84 (44%) received MMTs a median of three times (IQR 2–5). Median age of reachable patients was 41 (IQR 30–50), 75 (63%) were male, 62 (52%) were HIV+ and 79 (66%) resided outside of Lilongwe. Conclusion MMTs were a feasible way to cover upfront transportation costs for patients reachable via text, however many of our patients were unreachable. Future studies exploring barriers to care, particularly among unreachable patients, may help improve the efficacy of MMT initiatives and guide retention strategies throughout SSA. [ABSTRACT FROM AUTHOR]

Aggressive non‐Hodgkin lymphoma (NHL) is among the most common cancers in sub‐Saharan Africa (SSA), where CHOP is standard treatment and outcomes are poor. To address this, we treated 17 newly diagnosed adult patients in Malawi with Burkitt (n = 8), plasmablastic (n = 8), and primary effusion lymphoma (n = 1) with a modified EPOCH regimen between 2016 and 2019. Twelve patients (71%) were male and the median age was 40 years (range 16‐63). Eleven (65%) were HIV infected, median CD4 count was 218 cells/µL (range 9‐460), and nine (82%) had suppressed HIV RNA < 400 copies/mL. Patients received a median of six cycles (range 2‐8) and median follow‐up was 14 months (range 2‐34) among patients still alive. Grade 3/4 neutropenia was observed in 26% of cycles and in 65% of patients. Sixteen (94%) responded to EPOCH and 10 (59%) achieved a complete response. One‐year overall survival (OS) was 62% (95% confidence interval [CI], 42%‐91%). Five patients (29%) died from progressive NHL and three (18%) from treatment‐related complications. These data suggest EPOCH with setting‐appropriate modifications may be a practical, safe, and effective option for improving high‐risk NHL outcomes in Malawi and comparable settings, which deserves further prospective evaluation. [ABSTRACT FROM AUTHOR]

Summary: Outcomes for diffuse large B‐cell lymphoma (DLBCL) in sub‐Saharan Africa (SSA) are poorly described. We report mature data from one of the first prospective SSA cohorts. Patients aged ≥18 years with DLBCL were enrolled in Malawi 2013–2017. Participants were treated with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy and concurrent antiretroviral therapy (ART) if positive for human immunodeficiency virus (HIV+). Eighty‐six participants (mean age 47 years, standard deviation 13) were enrolled: 54 (63%) were male and 51 (59%) were HIV+, of whom 34 (67%) were on ART at DLBCL diagnosis. Median CD4 count was 0·113 cells × 109/l (interquartile range [IQR] 0·062–0·227) and 25 (49%) had HIV viral load <400 copies/μl. Participants received median six cycles CHOP (IQR 4–6). No patients were lost to follow‐up and the 2‐year overall survival was 38% (95% confidence interval 28–49). In multivariable analyses, Eastern Cooperative Oncology Group performance status (PS) ≥2 and lactate dehydrogenase (LDH) >2× upper limit of normal (ULN) were associated with mortality. HIV status was not associated with mortality. A simplified prognostic model of LDH >2× ULN and PS ≥2 performed at least as well as the age‐adjusted International Prognostic Index. DLBCL can be successfully treated in SSA and outcomes did not differ by HIV status. A simplified prognostic model prognosticates well and may be easier to use in resource‐limited settings but requires validation. [ABSTRACT FROM AUTHOR]

Outcomes: 1. Utilize the FACIT methodology for cultural validation of patient-reported outcome (PRO) questionnaires 2. Incorporate PRO measures in a low resource setting to provide a more comprehensive assessment of health-related quality of life and treatment-associated adverse events Palliative care interventions are known to improve outcomes in high-resource contexts. Internationally, patient-reported outcome (PRO) tools to assess health-related quality of life (HRQoL) and adverse events (AE) are available, but efforts to translate and culturally validate such tools in sub-Saharan Africa (SSA) are limited. The Pediatric PRO version of the Common Terminology Criteria for Adverse Events (Ped-PRO-CTCAE) includes a core 15 AE symptoms that are prevalent across pediatric cancer and treatment. The Ped-PRO-CTCAE was translated into Chichewa and culturally validated for use in Malawi using the FACIT method. Psychometric validation assessed using Spearman's correlation for convergent and discriminant validity, Wilcoxon rank-sum for known group validity, and T-test for responsiveness. Fifty-two adolescent and young adult (AYA) patients with lymphoma completed the Ped-PRO-CTCAE survey. When compared to the translated and validated Patient-Reported Outcomes Measurement Information System (PROMIS) pediatric tool, there were stronger correlations when symptoms matched (ie, pain interference r=0.57, fatigue r=0.73, depression r=0.62, and anxiety r=0.75). Known group validity testing showed that patients with poor performance status (ECOG≥2) had higher pain frequency (p<0.001) and pain prevalence (p=0.005); and patients with anemia (hgb<9g/dL) had worse fatigue severity (p<0.001). Ped-PRO-CTCAE when compared to home symptom diary (ie, nausea, constipation, pain, mucositis, insomnia, and abdominal pain) were correlated across all matching PRO-CTCAE domains (p<0.001). Responsiveness was supported when comparing Ped-PRO-CTCAE scores at T0 and T1 (+5 to < 21 days from T0); T1 exhibited higher mean scores associated with expected worse symptoms after chemotherapy across all 15 PRO-CTCAE symptom AEs (p<0.001). This study found supporting evidence for the validity of the Chichewa-translated version of the Ped-PRO-CTCAE. This emphasizes an urgent need to address symptomatic AEs experienced by AYA undergoing cancer treatment in SSA using PRO instruments validated within the local context. [ABSTRACT FROM AUTHOR]

Background: Oncology teams are encouraged to include patient preferences and goals of care in determining appropriate treatment courses. There are no existing data from Malawi exploring decision-making preferences among cancer patients., Methods: In the oncology clinic in Lilongwe, Malawi, 50 patients were surveyed for decision making., Results: Most participants (70%, n  = 35) preferred to engage in shared decision making regarding cancer treatment. About half (52%, n  = 24) did not feel that their medical team involved them in decision making and 64% ( n  = 32) felt that they were never or only sometimes listened to by the medical team. Nearly all (94%, n  = 47) preferred to have their medical team inform them how likely treatments are to lead to cure., Conclusions: Shared decision making was the preferred mode of treatment decision making by the majority of the surveyed cancer patients in Malawi. Cancer patients in Malawi may have similar preferences to cancer patients in other low-resource settings regarding decision making and communication., Competing Interests: No competing financial interests exist., (© Alyssa E. Tilly et al., 2023; Published by Mary Ann Liebert, Inc.)

A process evaluation of nurses' implementation of an infant-feeding counseling protocol was conducted for the Breastfeeding, Antiretroviral and Nutrition (BAN) Study, a prevention of mother-to-child transmission of HIV clinical trial in Lilongwe, Malawi. Six trained nurses counseled HIV-infected mothers to exclusively breastfeed for 24 weeks postpartum and to stop breastfeeding within an additional four weeks. Implementation data were collected via direct observations of 123 infant feeding counseling sessions (30 antenatal and 93 postnatal) and interviews with each nurse. Analysis included calculating a percent adherence to checklists and conducting a content analysis for the observation and interview data. Nurses were implementing the protocol at an average adherence level of 90% or above. Although not detailed in the protocol, nurses appropriately counseled mothers on their actual or intended formula milk usage after weaning. Results indicate that nurses implemented the protocol as designed. Results will help to interpret the BAN Study's outcomes.