Abstract:
Fueled by HIV, sub-Saharan Africa has the highest incidence
of Kaposi’s sarcoma (KS) in the world. Despite this, KS diagnosis
in the region is based mostly on clinical grounds.
Where biopsy is available, it has traditionally been excision
and performed by surgeons, resulting in multiple appointments,
follow-up visits for suture removal, and substantial
costs. We hypothesized that a simpler approach – skin punch
biopsy – would make histologic diagnosis more accessible.
To address this, we provided training and equipment for skin
punch biopsy of suspected KS to three HIV clinics in East Africa.
The procedure consisted of local anesthesia followed by
a disposable cylindrical punch blade to obtain specimens.
Hemostasis is facilitated by Gelfoam ® . Patients removed the
dressing after 4 days. From 2007 to 2013, 2,799 biopsies were 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.
