Chite Asirwa - Academia.edu (original) (raw)
Papers by Chite Asirwa
Nature reviews. Cancer, Feb 8, 2024
Journal of General Internal Medicine, Jul 3, 2009
BACKGROUND: Poor communication of tests whose results are pending at hospital discharge can lead ... more BACKGROUND: Poor communication of tests whose results are pending at hospital discharge can lead to medical errors. OBJECTIVE: To determine the adequacy with which hospital discharge summaries document tests with pending results and the appropriate follow-up providers. DESIGN: Retrospective study of a randomly selected sample PATIENTS: Six hundred ninety-six patients discharged from two large academic medical centers, who had test results identified as pending at discharge through queries of electronic medical records. INTERVENTION AND MEASUREMENTS: Each patient's discharge summary was reviewed to identify whether information about pending tests and follow-up providers was mentioned. Factors associated with documentation were explored using clustered multivariable regression models. MAIN RESULTS: Discharge summaries were available for 99.2% of 668 patients whose data were analyzed. These summaries mentioned only 16% of tests with pending results (482 of 2,927). Even though all study patients had tests with pending results, only 25% of discharge summaries mentioned any pending tests, with 13% documenting all pending tests. The documentation rate for pending tests was not associated with level of experience of the provider preparing the summary, patient's age or race, length of hospitalization, or duration it took for results to return. Follow-up providers' information was documented in 67% of summaries. CONCLUSION: Discharge summaries are grossly inadequate at documenting both tests with pending results and the appropriate follow-up providers.
Applied Clinical Informatics, 2012
Background: Small numbers of tests with pending results are documented in hospital discharge summ... more Background: Small numbers of tests with pending results are documented in hospital discharge summaries leading to breakdown in communication and medical errors due to inadequate followup. Objective: Evaluate effect of using a computerized provider order entry (CPOE) system to enforce documentation of tests with pending results into hospital discharge summaries. Methods: We assessed the percent of all tests with pending results and those with actionable results that were documented before (n = 182 discharges) and after (n = 203 discharges) implementing the CPOE-enforcement tool. We also surveyed providers (n = 52) about the enforcement functionality. Results: Documentation of all tests with pending results improved from 12% (87/701 tests) before to 22% (178/812 tests) (p = 0.02) after implementation. Documentation of tests with eventual actionable results increased from 0% (0/24) to 50% (14/28)(p<0.001). Survey respondents felt the intervention improved quality of summaries, provider communication, and was not time-consuming. Conclusions: A CPOE tool enforcing documentation of tests with pending results into discharge summaries significantly increased documentation rates, especially of actionable tests. However, gaps in documentation still exist.
JCO global oncology, May 1, 2022
Cancer Epidemiology, Biomarkers & Prevention
Purpose: Close to 70% of all cancer deaths occur in low- and middle-income countries (LMICs) with... more Purpose: Close to 70% of all cancer deaths occur in low- and middle-income countries (LMICs) with the rising cancer burden causing a strain on the already weak health care and economic infrastructures. The extrapolation of the experiences of cancer control programs in High Income Countries (HICs) to LMICs is often inappropriate requiring a regional scale up of successfully implemented cancer programs across LMICs. Methods: International Cancer Institute (ICI) is a non-governmental, not-for-profit organization whose main purpose is to expand education and training opportunities in cancer care, education and research across Sub-Saharan Africa through multisectoral corroborations and partnerships. ICI successfully implemented two Blueprint programs in Kenya thus sought to scale up the program to Western Uganda. An online search of key players in Cancer care in Uganda was conducted that identified six potential partners including Ministry of Health – Uganda, Uganda Cancer Institute (UCI...
JCO global oncology, May 1, 2022
Applied clinical informatics, 2012
Small numbers of tests with pending results are documented in hospital discharge summaries leadin... more Small numbers of tests with pending results are documented in hospital discharge summaries leading to breakdown in communication and medical errors due to inadequate followup. Evaluate effect of using a computerized provider order entry (CPOE) system to enforce documentation of tests with pending results into hospital discharge summaries. We assessed the percent of all tests with pending results and those with actionable results that were documented before (n = 182 discharges) and after (n = 203 discharges) implementing the CPOE-enforcement tool. We also surveyed providers (n = 52) about the enforcement functionality. Documentation of all tests with pending results improved from 12% (87/701 tests) before to 22% (178/812 tests) (p = 0.02) after implementation. Documentation of tests with eventual actionable results increased from 0% (0/24) to 50% (14/28)(p<0.001). Survey respondents felt the intervention improved quality of summaries, provider communication, and was not time-consu...
Journal of Global Oncology, 2018
Background: The AMPATH Consortium has served to greatly expand healthcare in western Kenya. Gaps ... more Background: The AMPATH Consortium has served to greatly expand healthcare in western Kenya. Gaps and limitations in care still exist, especially in oncology care in rural areas. Telemedicine provides a lower cost, practical method to maximize physician resources and limit cost and stress to families with socioeconomic limitations in rural Kenya. The following paper seeks to discuss the importance of developing a telemedicine model in western Kenya and the many advantages telemedicine can bring, as well as discuss the telemedicine model being developed by AMPATH Oncology. Aim: Integrate paper-based medical records into the AMPATH AIDS EMR; Identify sustainable telemedicine tools to integrate into the EMR; Establish networking in rural clinics; Budget in IT personnel at each clinic to assist in patient setup with central site; use solar as primary power source for devices to aid in power issues. Only 45% of Kenyans have access to power; Use cellular networks for communication; Maximiz...
JCO global oncology, May 1, 2022
JCO global oncology, May 1, 2022
Journal of Investigative Dermatology, 2019
Psoriasis is a systemic inflammatory disease that is associated with major medical comorbidity an... more Psoriasis is a systemic inflammatory disease that is associated with major medical comorbidity and negative psychosocial effects. In the U.S., while psoriasis is most common among whites, some data suggest that it may be more severe and have a greater negative impact on quality-of-life among minorities. Little is known regarding the experience of and concerns about psoriasis among different racial/ethnic groups. In order to better understand patients' perspectives of psoriasis and whether they differ by race, we performed semi-structured interviews of 68 individuals (white N¼36, black N¼32) with moderate to severe plaque psoriasis. The interview assessed knowledge of and experience with psoriasis, as well as patients' beliefs and attitudes towards treatment. Data were independently coded by two members of the research team using NVivo 11. Median (interquartile range, IQR) age was 52 (40-63) years and duration of psoriasis was 13.5 (6.5-26.5) years; 71% were female. These characteristics were similar between white and black subjects (p>0.05). The team identified "concerns about psoriasis" as an important theme. Across all subjects, major themes related to the concerns about psoriasis included discomfort due to the physical presentation and symptoms of psoriasis with concerns ranging from the visual unsightliness to both subtle and overt indications of social and emotional isolation. In particular, concerns about scarring and disease recurrence were prominent among blacks, whereas concerns about comorbid disease beyond psoriatic arthritis and the heritability and possibility of future children having psoriasis were specifically notable among whites. In sum, we found that white and black patients with psoriasis had both shared and specific concerns about psoriasis that may be important for medical providers to consider when discussing disease course and treatment options and goals among a diverse patient population.
Purpose: Quality Cancer treatment is expensive and not accessible to all in LMIC settings in sub-... more Purpose: Quality Cancer treatment is expensive and not accessible to all in LMIC settings in sub-Saharan Africa including Kenya. Despite having a cancer diagnosis, patients and their families not living in major towns and cities, have to travel far to seek treatment incurring cost in transport, upkeep during treatment and out of pocket expenditure to access care. Methods: International Cancer Institute in Eldoret-Kenya, partnered with Taita Taveta County to implement a cancer and other non-communicable disease (NCD) project in August 2020. Taita Taveta County established a technical working group (TWG) in September 2020 to oversee the project activities and identified space and staff to set up a new cancer clinic. ICI provided technical support in project planning, budgeting, capacity/needs assessment, training and mentorship of healthcare providers; and running joint cancer clinics. Results: Periodic review meetings between ICI and Taita Taveta County TWG identified lack of: qualified staff to provide cancer care; cancer screening supplies; and drug stock-outs. In September 2020, ICI and its strategic partners supported Taita Taveta County to launch a Cancer Clinic to provide basic Cancer care. ICI offered trainings and continuous medical education on cancer for 91 healthcare providers both online (26) and on-site (65); ICI provided cervical, breast and prostate cancer screening supplies; established a revolving fund pharmacy as a stop gap measure to drug stock-outs; and held joint cancer clinics twice a month where mentorship and skills training for county staff paired with ICI staff across various disciplines was achieved resulting in the first patient receiving chemotherapy in November 2020; histopathology support was provided for 151 samples. Conclusion: The process of setting up a cancer clinic in a low resource setting requires a systematic needs assessment approach; identifying a core team early that outlines output measures of interest; and having strategic partnership guiding step-by-step developments. Citation Format: Gloria Kitur, Emmah Achieng, Rebecca Mwakichako, Felix Kimotho, Chite Asirwa. Setting up a Cancer Clinic in a Low-and-Middle-Income Country (LMIC) in Sub-Saharan Africa: A Case of Taita Taveta County in Kenya. [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 38.
Purpose: Delays in diagnosis and treatment of cancers in low-and-middle-income countries (LMICs) ... more Purpose: Delays in diagnosis and treatment of cancers in low-and-middle-income countries (LMICs) attributable to provider and/or systemic factors are linked to poor patient outcomes. Pathology services are not available in most lower level facilities hence, there's delayed diagnosis and initiation of treatment for cancers. There is also limited availability of specialized pathology tests. Methods: International Cancer Institute (ICI), conducts joint clinics and cancer screening with partner counties where same-day screening and on-site biopsing is conducted after which samples for cytology, histology and/or histochemistry are sent for processing in the ICI diagnostics and research laboratory at a subsidized cost with a turn-around-time for results being 14 days or less. Results get discussed virtually by a multi-disciplinary team (MDT) of both ICI and the outreach site and positive results are singled out for further diagnostics like computerized tomography (CT) scan and blood work ups. Results: Between September and December 2020, a total of 146 samples for Cytology; 197 biopsy samples for histology and 66 samples for immunohistochemistry were shipped to the ICI Diagnostics and research laboratory from five ICI Outreach sites namely: Kisumu, Taita Taveta, Meru &amp; Makueni counties and Sori Lakeside Hospital. In less than 28 days from date of screening, the MDT discussed positive results and gave recommendations; results were disseminated to outreach sites for patient counseling and drawing of treatment plans; and appropriate treatment was initiated at the outreach sites in established cancer clinics run jointly by ICI and the counties. The ICI Consultant Pathologist and Histotechnologist provide further technical support and consultation to the clinic team when necessary. Conclusion: Better patient outcomes are assured when there is reduced turn-around time from screening to diagnosis and initiation of treatment for cancers in LMICs. Accessibility of pathology services through strengthening of existing health systems can be achieved through multi-sectoral partnerships. Citation Format: Gloria Kitur, Emmah Achieng, George Gitau, Chite Asirwa. Enhancing Cancer Diagnostics through Provision of Pathology Support for Hospitals in Low and Middle-Income Countries: A Case of International Cancer Institute (ICI), Kenya [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 37.
World journal of clinical oncology, Jan 10, 2015
To explore lay perceptions of causes, severity, presenting symptoms and treatment of breast cance... more To explore lay perceptions of causes, severity, presenting symptoms and treatment of breast cancer. In October-November 2012, we recruited men and women (18 years and older) from households and health facilities in three different parts of Western Kenya, chosen for variations in their documented burdens of breast cancer. A standardized and validated tool, the breast cancer awareness measure (BCAM), was administered in face-to-face interviews. Survey domains covered included socio-demographics, opinions about causes, symptoms, severity, and treatment of breast cancer. Descriptive analyses were done on quantitative data while open-ended answers were coded, and emerging themes were integrated into larger categories in a qualitative analysis. The open-ended questions had been added to the standard BCAM for the purposes of learning as much as the investigators could about underlying lay beliefs and perceptions. Most respondents were female, middle-aged (mean age 36.9 years), married, and...
Journal of Global Oncology, 2015
Purpose The prognosis for the majority of patients with cancer in Kenya is poor, with most patien... more Purpose The prognosis for the majority of patients with cancer in Kenya is poor, with most patients presenting with advanced disease. In addition, many patients are unable to afford the optimal therapies required. Therefore, palliative care is an essential part of comprehensive cancer care. This study reviews the implementation of a palliative care service based at the Moi Teaching and Referral Hospital in Eldoret, Kenya, and describes the current scope and challenges of providing palliative care services in an East African tertiary public referral hospital. Methods This is a review of the palliative care clinical services at the only tertiary public referral hospital in western Kenya from January 2012 through September 2014. Palliative care team members documented each patient's encounter on standardized palliative care assessment forms; data were then entered into the Academic Model Providing Access to Health Care (AMPATH)-Oncology database. Interviews were also conducted to i...
Oncology, 2015
performed. Although originally targeted to be used by physicians, biopsies were performed predomi... more performed. Although originally targeted to be used by physicians, biopsies were performed predominantly by nurses (62%), followed by physicians (15%), clinical officers (12%) and technicians (11%). There were no reports of recurrent bleeding or infection. After minimal training and provision of inexpensive equipment (USD 3.06 per biopsy), HIV clinics in East Africa can integrate same-day skin punch biopsy for suspected KS. Task shifting from physician to non-physician greatly increases access. Skin punch biopsy should be part of any HIV clinic's essential procedures. This example of task shifting may also be applicable to the diagnosis of other cancers (e.g., breast) in resource-limited settings.
Journal of General Internal Medicine, 2009
BACKGROUND: Poor communication of tests whose results are pending at hospital discharge can lead ... more BACKGROUND: Poor communication of tests whose results are pending at hospital discharge can lead to medical errors. OBJECTIVE: To determine the adequacy with which hospital discharge summaries document tests with pending results and the appropriate follow-up providers. DESIGN: Retrospective study of a randomly selected sample PATIENTS: Six hundred ninety-six patients discharged from two large academic medical centers, who had test results identified as pending at discharge through queries of electronic medical records. INTERVENTION AND MEASUREMENTS: Each patient's discharge summary was reviewed to identify whether information about pending tests and follow-up providers was mentioned. Factors associated with documentation were explored using clustered multivariable regression models. MAIN RESULTS: Discharge summaries were available for 99.2% of 668 patients whose data were analyzed. These summaries mentioned only 16% of tests with pending results (482 of 2,927). Even though all study patients had tests with pending results, only 25% of discharge summaries mentioned any pending tests, with 13% documenting all pending tests. The documentation rate for pending tests was not associated with level of experience of the provider preparing the summary, patient's age or race, length of hospitalization, or duration it took for results to return. Follow-up providers' information was documented in 67% of summaries. CONCLUSION: Discharge summaries are grossly inadequate at documenting both tests with pending results and the appropriate follow-up providers.
Infectious Agents and Cancer, 2013
Journal of Clinical Oncology, 2016
Breakthroughs in our global fight against cancer have been achieved. However, this progress has b... more Breakthroughs in our global fight against cancer have been achieved. However, this progress has been unequal. In low- and middle-income countries and for specific populations in high-income settings, many of these advancements are but an aspiration and hope for the future. This review will focus on health disparities in cancer within and across countries, drawing from examples in Kenya, Brazil, and the United States. Placed in context with these examples, the authors also draw basic recommendations from several initiatives and groups that are working on the issue of global cancer disparities, including the US Institute of Medicine, the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries, and the Union for International Cancer Control. From increasing initiatives in basic resources in low-income countries to rapid learning systems in high-income countries, the authors argue that beyond ethics and equity issues, it makes economic sense to invest in ...
Scientific Abstracts, 2021
Purpose: Health Information Technology has hugely improved patient healthcare with fast and simpl... more Purpose: Health Information Technology has hugely improved patient healthcare with fast and simple information access and communication. Telemedicine uses telecommunications technology as a tool to deliver health care to populations with limited access to care. International Cancer Institute (ICI) number one goal is to provide end-to-end solutions for optimization of care on patients' journey in sub-Saharan Africa. Supporting the end-user clearly shows there is a lot going on “under the skin” in healthcare Information technology (IT) to bring information access to life and patients closer to the oncology experts. Methods: In 2020, ICI IT team provided end-user support in bi-weekly multidisciplinary oncology –tumour boards with specialists from Africa and the world. It also provided support in Provider-to-provider tele-consults for patients in 10 partner counties in Kenya. The IT team also provided online support to healthcare providers to access online oncology preceptorships/tr...
Nature reviews. Cancer, Feb 8, 2024
Journal of General Internal Medicine, Jul 3, 2009
BACKGROUND: Poor communication of tests whose results are pending at hospital discharge can lead ... more BACKGROUND: Poor communication of tests whose results are pending at hospital discharge can lead to medical errors. OBJECTIVE: To determine the adequacy with which hospital discharge summaries document tests with pending results and the appropriate follow-up providers. DESIGN: Retrospective study of a randomly selected sample PATIENTS: Six hundred ninety-six patients discharged from two large academic medical centers, who had test results identified as pending at discharge through queries of electronic medical records. INTERVENTION AND MEASUREMENTS: Each patient's discharge summary was reviewed to identify whether information about pending tests and follow-up providers was mentioned. Factors associated with documentation were explored using clustered multivariable regression models. MAIN RESULTS: Discharge summaries were available for 99.2% of 668 patients whose data were analyzed. These summaries mentioned only 16% of tests with pending results (482 of 2,927). Even though all study patients had tests with pending results, only 25% of discharge summaries mentioned any pending tests, with 13% documenting all pending tests. The documentation rate for pending tests was not associated with level of experience of the provider preparing the summary, patient's age or race, length of hospitalization, or duration it took for results to return. Follow-up providers' information was documented in 67% of summaries. CONCLUSION: Discharge summaries are grossly inadequate at documenting both tests with pending results and the appropriate follow-up providers.
Applied Clinical Informatics, 2012
Background: Small numbers of tests with pending results are documented in hospital discharge summ... more Background: Small numbers of tests with pending results are documented in hospital discharge summaries leading to breakdown in communication and medical errors due to inadequate followup. Objective: Evaluate effect of using a computerized provider order entry (CPOE) system to enforce documentation of tests with pending results into hospital discharge summaries. Methods: We assessed the percent of all tests with pending results and those with actionable results that were documented before (n = 182 discharges) and after (n = 203 discharges) implementing the CPOE-enforcement tool. We also surveyed providers (n = 52) about the enforcement functionality. Results: Documentation of all tests with pending results improved from 12% (87/701 tests) before to 22% (178/812 tests) (p = 0.02) after implementation. Documentation of tests with eventual actionable results increased from 0% (0/24) to 50% (14/28)(p<0.001). Survey respondents felt the intervention improved quality of summaries, provider communication, and was not time-consuming. Conclusions: A CPOE tool enforcing documentation of tests with pending results into discharge summaries significantly increased documentation rates, especially of actionable tests. However, gaps in documentation still exist.
JCO global oncology, May 1, 2022
Cancer Epidemiology, Biomarkers & Prevention
Purpose: Close to 70% of all cancer deaths occur in low- and middle-income countries (LMICs) with... more Purpose: Close to 70% of all cancer deaths occur in low- and middle-income countries (LMICs) with the rising cancer burden causing a strain on the already weak health care and economic infrastructures. The extrapolation of the experiences of cancer control programs in High Income Countries (HICs) to LMICs is often inappropriate requiring a regional scale up of successfully implemented cancer programs across LMICs. Methods: International Cancer Institute (ICI) is a non-governmental, not-for-profit organization whose main purpose is to expand education and training opportunities in cancer care, education and research across Sub-Saharan Africa through multisectoral corroborations and partnerships. ICI successfully implemented two Blueprint programs in Kenya thus sought to scale up the program to Western Uganda. An online search of key players in Cancer care in Uganda was conducted that identified six potential partners including Ministry of Health – Uganda, Uganda Cancer Institute (UCI...
JCO global oncology, May 1, 2022
Applied clinical informatics, 2012
Small numbers of tests with pending results are documented in hospital discharge summaries leadin... more Small numbers of tests with pending results are documented in hospital discharge summaries leading to breakdown in communication and medical errors due to inadequate followup. Evaluate effect of using a computerized provider order entry (CPOE) system to enforce documentation of tests with pending results into hospital discharge summaries. We assessed the percent of all tests with pending results and those with actionable results that were documented before (n = 182 discharges) and after (n = 203 discharges) implementing the CPOE-enforcement tool. We also surveyed providers (n = 52) about the enforcement functionality. Documentation of all tests with pending results improved from 12% (87/701 tests) before to 22% (178/812 tests) (p = 0.02) after implementation. Documentation of tests with eventual actionable results increased from 0% (0/24) to 50% (14/28)(p<0.001). Survey respondents felt the intervention improved quality of summaries, provider communication, and was not time-consu...
Journal of Global Oncology, 2018
Background: The AMPATH Consortium has served to greatly expand healthcare in western Kenya. Gaps ... more Background: The AMPATH Consortium has served to greatly expand healthcare in western Kenya. Gaps and limitations in care still exist, especially in oncology care in rural areas. Telemedicine provides a lower cost, practical method to maximize physician resources and limit cost and stress to families with socioeconomic limitations in rural Kenya. The following paper seeks to discuss the importance of developing a telemedicine model in western Kenya and the many advantages telemedicine can bring, as well as discuss the telemedicine model being developed by AMPATH Oncology. Aim: Integrate paper-based medical records into the AMPATH AIDS EMR; Identify sustainable telemedicine tools to integrate into the EMR; Establish networking in rural clinics; Budget in IT personnel at each clinic to assist in patient setup with central site; use solar as primary power source for devices to aid in power issues. Only 45% of Kenyans have access to power; Use cellular networks for communication; Maximiz...
JCO global oncology, May 1, 2022
JCO global oncology, May 1, 2022
Journal of Investigative Dermatology, 2019
Psoriasis is a systemic inflammatory disease that is associated with major medical comorbidity an... more Psoriasis is a systemic inflammatory disease that is associated with major medical comorbidity and negative psychosocial effects. In the U.S., while psoriasis is most common among whites, some data suggest that it may be more severe and have a greater negative impact on quality-of-life among minorities. Little is known regarding the experience of and concerns about psoriasis among different racial/ethnic groups. In order to better understand patients' perspectives of psoriasis and whether they differ by race, we performed semi-structured interviews of 68 individuals (white N¼36, black N¼32) with moderate to severe plaque psoriasis. The interview assessed knowledge of and experience with psoriasis, as well as patients' beliefs and attitudes towards treatment. Data were independently coded by two members of the research team using NVivo 11. Median (interquartile range, IQR) age was 52 (40-63) years and duration of psoriasis was 13.5 (6.5-26.5) years; 71% were female. These characteristics were similar between white and black subjects (p>0.05). The team identified "concerns about psoriasis" as an important theme. Across all subjects, major themes related to the concerns about psoriasis included discomfort due to the physical presentation and symptoms of psoriasis with concerns ranging from the visual unsightliness to both subtle and overt indications of social and emotional isolation. In particular, concerns about scarring and disease recurrence were prominent among blacks, whereas concerns about comorbid disease beyond psoriatic arthritis and the heritability and possibility of future children having psoriasis were specifically notable among whites. In sum, we found that white and black patients with psoriasis had both shared and specific concerns about psoriasis that may be important for medical providers to consider when discussing disease course and treatment options and goals among a diverse patient population.
Purpose: Quality Cancer treatment is expensive and not accessible to all in LMIC settings in sub-... more Purpose: Quality Cancer treatment is expensive and not accessible to all in LMIC settings in sub-Saharan Africa including Kenya. Despite having a cancer diagnosis, patients and their families not living in major towns and cities, have to travel far to seek treatment incurring cost in transport, upkeep during treatment and out of pocket expenditure to access care. Methods: International Cancer Institute in Eldoret-Kenya, partnered with Taita Taveta County to implement a cancer and other non-communicable disease (NCD) project in August 2020. Taita Taveta County established a technical working group (TWG) in September 2020 to oversee the project activities and identified space and staff to set up a new cancer clinic. ICI provided technical support in project planning, budgeting, capacity/needs assessment, training and mentorship of healthcare providers; and running joint cancer clinics. Results: Periodic review meetings between ICI and Taita Taveta County TWG identified lack of: qualified staff to provide cancer care; cancer screening supplies; and drug stock-outs. In September 2020, ICI and its strategic partners supported Taita Taveta County to launch a Cancer Clinic to provide basic Cancer care. ICI offered trainings and continuous medical education on cancer for 91 healthcare providers both online (26) and on-site (65); ICI provided cervical, breast and prostate cancer screening supplies; established a revolving fund pharmacy as a stop gap measure to drug stock-outs; and held joint cancer clinics twice a month where mentorship and skills training for county staff paired with ICI staff across various disciplines was achieved resulting in the first patient receiving chemotherapy in November 2020; histopathology support was provided for 151 samples. Conclusion: The process of setting up a cancer clinic in a low resource setting requires a systematic needs assessment approach; identifying a core team early that outlines output measures of interest; and having strategic partnership guiding step-by-step developments. Citation Format: Gloria Kitur, Emmah Achieng, Rebecca Mwakichako, Felix Kimotho, Chite Asirwa. Setting up a Cancer Clinic in a Low-and-Middle-Income Country (LMIC) in Sub-Saharan Africa: A Case of Taita Taveta County in Kenya. [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 38.
Purpose: Delays in diagnosis and treatment of cancers in low-and-middle-income countries (LMICs) ... more Purpose: Delays in diagnosis and treatment of cancers in low-and-middle-income countries (LMICs) attributable to provider and/or systemic factors are linked to poor patient outcomes. Pathology services are not available in most lower level facilities hence, there's delayed diagnosis and initiation of treatment for cancers. There is also limited availability of specialized pathology tests. Methods: International Cancer Institute (ICI), conducts joint clinics and cancer screening with partner counties where same-day screening and on-site biopsing is conducted after which samples for cytology, histology and/or histochemistry are sent for processing in the ICI diagnostics and research laboratory at a subsidized cost with a turn-around-time for results being 14 days or less. Results get discussed virtually by a multi-disciplinary team (MDT) of both ICI and the outreach site and positive results are singled out for further diagnostics like computerized tomography (CT) scan and blood work ups. Results: Between September and December 2020, a total of 146 samples for Cytology; 197 biopsy samples for histology and 66 samples for immunohistochemistry were shipped to the ICI Diagnostics and research laboratory from five ICI Outreach sites namely: Kisumu, Taita Taveta, Meru &amp; Makueni counties and Sori Lakeside Hospital. In less than 28 days from date of screening, the MDT discussed positive results and gave recommendations; results were disseminated to outreach sites for patient counseling and drawing of treatment plans; and appropriate treatment was initiated at the outreach sites in established cancer clinics run jointly by ICI and the counties. The ICI Consultant Pathologist and Histotechnologist provide further technical support and consultation to the clinic team when necessary. Conclusion: Better patient outcomes are assured when there is reduced turn-around time from screening to diagnosis and initiation of treatment for cancers in LMICs. Accessibility of pathology services through strengthening of existing health systems can be achieved through multi-sectoral partnerships. Citation Format: Gloria Kitur, Emmah Achieng, George Gitau, Chite Asirwa. Enhancing Cancer Diagnostics through Provision of Pathology Support for Hospitals in Low and Middle-Income Countries: A Case of International Cancer Institute (ICI), Kenya [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 37.
World journal of clinical oncology, Jan 10, 2015
To explore lay perceptions of causes, severity, presenting symptoms and treatment of breast cance... more To explore lay perceptions of causes, severity, presenting symptoms and treatment of breast cancer. In October-November 2012, we recruited men and women (18 years and older) from households and health facilities in three different parts of Western Kenya, chosen for variations in their documented burdens of breast cancer. A standardized and validated tool, the breast cancer awareness measure (BCAM), was administered in face-to-face interviews. Survey domains covered included socio-demographics, opinions about causes, symptoms, severity, and treatment of breast cancer. Descriptive analyses were done on quantitative data while open-ended answers were coded, and emerging themes were integrated into larger categories in a qualitative analysis. The open-ended questions had been added to the standard BCAM for the purposes of learning as much as the investigators could about underlying lay beliefs and perceptions. Most respondents were female, middle-aged (mean age 36.9 years), married, and...
Journal of Global Oncology, 2015
Purpose The prognosis for the majority of patients with cancer in Kenya is poor, with most patien... more Purpose The prognosis for the majority of patients with cancer in Kenya is poor, with most patients presenting with advanced disease. In addition, many patients are unable to afford the optimal therapies required. Therefore, palliative care is an essential part of comprehensive cancer care. This study reviews the implementation of a palliative care service based at the Moi Teaching and Referral Hospital in Eldoret, Kenya, and describes the current scope and challenges of providing palliative care services in an East African tertiary public referral hospital. Methods This is a review of the palliative care clinical services at the only tertiary public referral hospital in western Kenya from January 2012 through September 2014. Palliative care team members documented each patient's encounter on standardized palliative care assessment forms; data were then entered into the Academic Model Providing Access to Health Care (AMPATH)-Oncology database. Interviews were also conducted to i...
Oncology, 2015
performed. Although originally targeted to be used by physicians, biopsies were performed predomi... more performed. Although originally targeted to be used by physicians, biopsies were performed predominantly by nurses (62%), followed by physicians (15%), clinical officers (12%) and technicians (11%). There were no reports of recurrent bleeding or infection. After minimal training and provision of inexpensive equipment (USD 3.06 per biopsy), HIV clinics in East Africa can integrate same-day skin punch biopsy for suspected KS. Task shifting from physician to non-physician greatly increases access. Skin punch biopsy should be part of any HIV clinic's essential procedures. This example of task shifting may also be applicable to the diagnosis of other cancers (e.g., breast) in resource-limited settings.
Journal of General Internal Medicine, 2009
BACKGROUND: Poor communication of tests whose results are pending at hospital discharge can lead ... more BACKGROUND: Poor communication of tests whose results are pending at hospital discharge can lead to medical errors. OBJECTIVE: To determine the adequacy with which hospital discharge summaries document tests with pending results and the appropriate follow-up providers. DESIGN: Retrospective study of a randomly selected sample PATIENTS: Six hundred ninety-six patients discharged from two large academic medical centers, who had test results identified as pending at discharge through queries of electronic medical records. INTERVENTION AND MEASUREMENTS: Each patient's discharge summary was reviewed to identify whether information about pending tests and follow-up providers was mentioned. Factors associated with documentation were explored using clustered multivariable regression models. MAIN RESULTS: Discharge summaries were available for 99.2% of 668 patients whose data were analyzed. These summaries mentioned only 16% of tests with pending results (482 of 2,927). Even though all study patients had tests with pending results, only 25% of discharge summaries mentioned any pending tests, with 13% documenting all pending tests. The documentation rate for pending tests was not associated with level of experience of the provider preparing the summary, patient's age or race, length of hospitalization, or duration it took for results to return. Follow-up providers' information was documented in 67% of summaries. CONCLUSION: Discharge summaries are grossly inadequate at documenting both tests with pending results and the appropriate follow-up providers.
Infectious Agents and Cancer, 2013
Journal of Clinical Oncology, 2016
Breakthroughs in our global fight against cancer have been achieved. However, this progress has b... more Breakthroughs in our global fight against cancer have been achieved. However, this progress has been unequal. In low- and middle-income countries and for specific populations in high-income settings, many of these advancements are but an aspiration and hope for the future. This review will focus on health disparities in cancer within and across countries, drawing from examples in Kenya, Brazil, and the United States. Placed in context with these examples, the authors also draw basic recommendations from several initiatives and groups that are working on the issue of global cancer disparities, including the US Institute of Medicine, the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries, and the Union for International Cancer Control. From increasing initiatives in basic resources in low-income countries to rapid learning systems in high-income countries, the authors argue that beyond ethics and equity issues, it makes economic sense to invest in ...
Scientific Abstracts, 2021
Purpose: Health Information Technology has hugely improved patient healthcare with fast and simpl... more Purpose: Health Information Technology has hugely improved patient healthcare with fast and simple information access and communication. Telemedicine uses telecommunications technology as a tool to deliver health care to populations with limited access to care. International Cancer Institute (ICI) number one goal is to provide end-to-end solutions for optimization of care on patients' journey in sub-Saharan Africa. Supporting the end-user clearly shows there is a lot going on “under the skin” in healthcare Information technology (IT) to bring information access to life and patients closer to the oncology experts. Methods: In 2020, ICI IT team provided end-user support in bi-weekly multidisciplinary oncology –tumour boards with specialists from Africa and the world. It also provided support in Provider-to-provider tele-consults for patients in 10 partner counties in Kenya. The IT team also provided online support to healthcare providers to access online oncology preceptorships/tr...