Spatiotemporal Patterns of AIDS-Defining and Non-AIDS-Defining Cancers before and after Antiretroviral Therapy Rollout in Botswana, 1990 to 2021.

BACKGROUND

Human immunodeficiency virus (HIV) and cancer comorbidity in Botswana is high. We sought to explore the distribution of acquired immunodeficiency syndrome (AIDS)-defining cancers (ADC) and non-ADCs (NADC) among people living with HIV (PLHIV) and without HIV during antiretroviral therapy (ART) expansion.

METHODS

We included adults ≥18 years of age reported in Botswana National Cancer Registry (BNCR) between 1990 and 2021. We computed crude, age-standardized incidence rates (ASIR) and age-standardized mortality rates (ASMR) per 100,000 and standardized incidence ratios (SIR) and standardized mortality ratios (SMR) of cancers. We used Bayesian spatial modeling and calculated the relative risk (RR) of cancer.

RESULTS

We reported 27,726 cases of cancer. Of these, 13,737 (49.5%) were among PLHIV, 3,505 (12.6%) among those without HIV, and 9,609 (34.7%) had died from all causes. During ART expansion, the ASIRs and ASMRs of all cancers, ADCs, and NADCs increased significantly in all districts, especially North-East and South-East in 2002 to 2007 and 2008 to 2012 and Central District during 2016 to 2021. The SIRs and SMRs declined during the study period in several districts. Most of the districts experienced high RR >1.0 of cancer during the period of 2016 to 2021. Compared with those without HIV, PLHIV had higher incidences of ADCs, NADCs, and subtypes including cervical cancer and Kaposi sarcoma.

CONCLUSIONS

The overall high cancer risk in several districts, the high burden in more urbanized and populous districts, and increased incidences and all-cause mortality among PLHIV in Botswana highlight the urgent need for improved access to timely cancer screening, diagnosis, and treatment.

IMPACT: Our results will contribute to the National Cancer Control Plan development.