William Ochieng, MPH, BS

Survival outcomes of cervical cancer patients living with HIV and those not living with HIV in Western Kenya.

William Ochieng 1,2
Susan Cu-Uvin 2
Omenge Orang'o 1,3
Katina Robison 4

1. Moi University, Eldoret, Kenya
2. Brown University, Providence, RI
3. The Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
4. Tufts Medical Center, Boston, MA

Survival outcomes among cervical cancer patients living with HIV are still strikingly poor in regions reporting a high prevalence of cervical cancer and HIV. Although the effect of HIV on cervical cancer risk has been well understood globally, a limited number of studies have been conducted to understand its effects on the survival outcomes of cervical cancer patients, particularly in LMICs. This study assessed and compared the survival outcomes of cervical cancer patients who are living with HIV to those not living with HIV. We also assessed factors associated with differences in the survival outcomes of cervical cancer patients.

This retrospective cohort study was conducted at AMPATH among 631 cervical cancer patients diagnosed from 2011 to 2016. Secondary data were retrieved from patients’ hospital files, CanReg5, and Microsoft Access database and used to generate a quantitative data set. Statistical analysis was conducted using RStudio. The Kaplan-Meier survival analysis was used to estimate the overall survival. The log-rank sum test was used to compare survival distribution between groups, and Cox proportional hazards regression was used to conduct univariate and multivariate regression analyses of the factors affecting survival.

The overall five-year survival estimate for cervical cancer patients was 36.40%. Age at diagnosis (p-value = 0.0003), health insurance (p-value = 0.000002), and education level (p-value = 0.005) were statistically associated with the overall survival of cervical cancer patients in the univariate analysis. However, only age at diagnosis (p = 0.0005) was significantly associated with survival in the multivariate analysis.

HIV status was not statistically significant in influencing the survival status of cervical cancer patients. However, HIV, and other covariates such as clinical stage, tumor grade, treatment, and other comorbidities may be clinically significant in influencing the survival of cervical cancer patients