Lessons from the Field

Development of immunohistochemistry services for cancer care in western Kenya: Implications for low- and middle-income countries

Kirtika Patel, R. Matthew Strother, Francis Ndiangui, David Chumba, William Jacobson, Cecelia Dodson, Murray B. Resnic, Randall W. Strate, James W. Smith
African Journal of Laboratory Medicine | Vol 5, No 1 | a187 | DOI: https://doi.org/10.4102/ajlm.v5i1.187 | © 2016 Kirtika Patel, R. Matthew Strother, Francis Ndiangui, David Chumba, William Jacobson, Cecelia Dodson, Murray B. Resnic, Randall W. Strate, James W. Smith | This work is licensed under CC Attribution 4.0
Submitted: 09 May 2014 | Published: 04 May 2016

About the author(s)

Kirtika Patel, Department of Immunology, Moi University, Eldoret, Kenya
R. Matthew Strother, Oncology Department, University of Otago, Christchurch, New Zealand
Francis Ndiangui, Department of Pathology, Moi Teaching and Referral Hospital, Eldoret, Kenya
David Chumba, Department of Pathology, Moi University College of Health Sciences, Eldoret, Kenya
William Jacobson, Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana, United States
Cecelia Dodson, Histology Laboratory, Indiana University Health, Indianapolis, Indiana, United States
Murray B. Resnic, Department of Pathology, Brown University, Providence, Rhode Island, United States
Randall W. Strate, Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana, United States
James W. Smith, Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana, United States


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Abstract

Background: Cancer is becoming a major cause of mortality in low- and middle-income countries. Unlike infectious disease, malignancy and other chronic conditions require significant supportive infrastructure for diagnostics, staging and treatment. In addition to morphologic diagnosis, diagnostic pathways in oncology frequently require immunohistochemistry (IHC) for confirmation. We present the experience of a tertiary-care hospital serving rural western Kenya, which developed and validated an IHC laboratory in support of a growing cancer care service.

Objectives, methods and outcomes: Over the past decade, in an academic North-South collaboration, cancer services were developed for the catchment area of Moi Teaching and Referral Hospital in western Kenya. A major hurdle to treatment of cancer in a resource-limited setting has been the lack of adequate diagnostic services. Building upon the foundations of a histology laboratory, strategic investment and training were used to develop IHC services. Key elements of success in this endeavour included: translation of resource-rich practices to are source-limited setting, such as using manual, small-batch IHC instead of disposable- and maintenance-intensive automated machinery, engagement of outside expertise to develop reagent-efficient protocols and supporting all levels of staff to meet the requirements of an external quality assurance programme.

Conclusion: Development of low- and middle-income country models of services, such as the IHC laboratory presented in this paper, is critical for the infrastructure in resource-limited settings to address the growing cancer burden. We provide a low-cost model that effectively develops these necessary services in a challenging laboratory environment.


Keywords

cancer care; immunohistochemistry; LMICs

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