DETERMINING THE SUITABILITY OF BIO-SPECIMENS OBTAINED BY FINE NEEDLE ASPIRATION BIOPSY AT A TERTIARY HOSPITAL IN MALAWI FOR IMMUNOCYTOCHEMICAL ASSESSMENT

Pathology: Anatomical Patholog

High pretreatment plasma Epstein-Barr virus (EBV) DNA level is a poor prognostic marker in HIV-associated, EBV-negative diffuse large B-cell lymphoma in Malawi

Plasma Epstein-Barr virus (EBV) DNA measurement has established prognostic utility in EBV-driven lymphomas, where it serves as a circulating tumor DNA marker. The value of plasma EBV measurement may be amplified in sub-Saharan Africa (SSA), where advanced imaging and molecular technologies for risk stratification are not typically available. However, its utility in diffuse large B-cell lymphoma (DLBCL) is less certain, given that only a subset of DLBCLs are EBV-positive. To explore this possibility, we measured plasma EBV DNA at diagnosis in a cohort of patients with DLBCL in Malawi. High plasma EBV DNA at diagnosis (≥3.0 log10 copies/mL) was associated with decreased overall survival (OS) (P =.048). When stratified by HIV status, the prognostic utility of baseline plasma EBV DNA level was restricted to HIV-positive patients. Unexpectedly, most HIV-positive patients with high plasma EBV DNA at diagnosis had EBV-negative lymphomas, as confirmed by multiple methods. Even in these HIV-positive patients with EBV-negative DLBCL, high plasma EBV DNA remained associated with shorter OS (P =.014). These results suggest that EBV reactivation in nontumor cells is a poor prognostic finding even in HIV-positive patients with convincingly EBV-negative DLBCL, extending the potential utility of EBV measurement as a valuable and implementable prognostic marker in SSA

Plasmablastic lymphoma in Malawi

Abstract Plasmablastic lymphoma (PBL) clinical descriptions are scarce from sub-Saharan Africa (SSA) where both HIV and EBV are highly endemic. We identified 12 patients with pathologically confirmed PBL from a prospective cohort in Lilongwe, Malawi. Median age was 46 (range 26–71), seven (58%) were male, and six (50%) were HIV-positive. Eight patients were treated with CHOP and four with a modified EPOCH regimen. One-year overall survival was 56% (95% CI 24–79%), without clear differences based on HIV status. PBL occurs in Malawi in HIV-positive and HIV-negative individuals and can be treated successfully with curative intent, even in a low-resource setting in SSA

Update on pathology laboratory development and research in advancing regional cancer care in Malawi

The pathology laboratory at Kamuzu Central Hospital (KCH) in Lilongwe, Malawi was established in 2011. We published our initial experiences in laboratory development and telepathology in 2013 and 2016, respectively. The purpose of this paper is to provide an update on our work by highlighting the positive role laboratory development has played in improving regional cancer care and research. In addition, we provide a summary of the adult pathology data from specimens received between July 1, 2011, and May 31, 2019, with an emphasis on malignant diagnoses. We compare these summaries to estimates of cancer incidence in this region to identify gaps and future needs

Intersections of financial agency, gender dynamics, and HIV risk: A qualitative study with adolescent girls and young women in Zambia

Objectives: Recent research demonstrates that economic interventions may positively effect HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. Some evidence reveals potential associations between financial decision-making and bargaining power in sexual relationships. However, this evidence is mixed, nuanced, and limited. This paper explores how AGYW in Zambia understand financial agency and its effect on intimate relationships. Methods: In-depth qualitative interviews were conducted with 30 females aged 15–24 years residing in Kalingalinga, a low income, high-density residential area in Lusaka. Data were analysed using thematic content analysis. Results: Participants spoke of the ability to earn and spend money as reality for some and aspirational for many others, intrinsic to cultural and religious caveats influencing perceptions of agency for women. The transfer of financial independence to sexual agency within relationships was viewed as a mechanism for HIV risk reduction; however, male sexual privilege was an obstacle irrespective of financial decision-making. Conclusions: Programmes aiming to enhance financial agency for AGYW have the potential to reduce HIV sexual risk. Yet, to be most effective, integration with gender-transformative programmes is needed to address norms of male dominance that keep AGYW in positions of vulnerability

DREAMS implementation science: Round 2 Data, Zambia

The Population Council is the research partner to DREAMS—a global partnership to reduce HIV infections among AGYW in Haiti and over 10 sub-Saharan African countries. DREAMS aims to reduce HIV infections among adolescent girls and young women (AGYW). This dataset is Round 2 data collection with young Zambian women (aged 15–24 years at Round 1) enrolled in DREAMS programming. Almost all respondents also participated in the Round 1 survey. These data are from a Population Council-led implementation science study to assess the reach and effectiveness of DREAMS programming in two catchment areas

Dataset: DREAMS Implementation Science: Phase 1 Analysis Data, Zambia

DREAMS aims to reduce HIV infections among adolescent girls and young women in 10 sub Saharan African countries. Girls and young women account for 74 percent of new HIV infections among adolescents in sub-Saharan Africa. The 10 DREAMS countries account for more than half of all the new HIV infections that occurred among adolescent girls and young women globally in 2016. This data set draws on rosters that were used to recruit adolescent girls and young women, including survey Phase 1 data collection with young women ages 15–24 years from Lusaka and Ndola, Zambia; cross sectional data collection; and age-stratified random sampling of eligible respondents

DREAMS implementation science: All Round 1 Data, Zambia

The Population Council is the research partner to DREAMS—a global partnership to reduce HIV infections among adolescent girls and young women (AGYW) in 10 sub-Saharan African countries. DREAMS aims to reduce HIV infections among adolescent girls and young women. This dataset is Round 1 data collection with young women (ages 15–24 years) from Zambia from a Population Council-led implementation science study to assess the reach and effectiveness of DREAMS programming in two catchment areas (one each in Lusaka and Ndola). This cross-sectional data includes data from AGYW enrolled in DREAMS programming and AGYW who lived in the catchment area but were not enrolled in DREAMS

DREAMS Implementation Science: Phase 1 Analysis Data, Zambia

DREAMS aims to reduce HIV infections among adolescent girls and young women in 10 sub-Saharan African countries. Girls and young women account for 74 percent of new HIV infections among adolescents in sub-Saharan Africa. The 10 DREAMS countries account for more than half of all the new HIV infections that occurred among adolescent girls and young women globally in 2016. Phase 1 data collection with young women aged 15-24 years from Lusaka and Ndola, Zambia. Cross-sectional data collection. Age-stratified random sampling from rosters of eligible respondents were used to recruit adolescent girls and young women into survey.</p