Elizabeth Gulleen, MD

Nominated From: University of Washington

Research Site: Uganda Cancer Institute

Research Area: Oncology, HIV

Primary Mentor: Warren Phipps

Research Project

Barriers to timely diagnosis and treatment of neutropenic fever in Ugandan patients with cancer and HIV

Cancer is the second leading cause of global mortality. By 2030, it is anticipated that 1.28 million new cancer cases and 970,000 cancer-related deaths will occur in sub-Saharan Africa (sSA) each year. Infections are one of the most frequently encountered complications that occur during cancer treatment. Neutropenic fever (NF) is associated with particularly high rates of morbidity and mortality. Survival for patients with NF depends on the timely administration of empiric guideline-recommended antibiotics. However, recent studies from Uganda show that less than half of hospitalized patients with NF received guideline-recommended antibiotics on the day that fever occurred.

Given the important implications for patient outcomes, developing strategies to rapidly identify patients with NF and administer appropriate antibiotic therapy is a high priority area of research for cancer care programs in sSA. However, the factors that affect the ability to rapidly initiate guideline-recommended antibiotics in low-resource settings have not been well-studied. Thus, our project aims to describe the current antibiotic delivery process and determine the barriers to rapid antibiotic initiation at the Uganda Cancer Institute (UCI). Since 25% of UCI patients are HIV-seropositive, we will also investigate whether there are specific barriers to antibiotic delivery that affect those with HIV.

Research Significance

Understanding the unique barriers to antibiotic delivery for patients with NF in sub-Saharan Africa will allow us to create targeted strategies to improve timely antibiotic initiation. These strategies will take into account the local context, including the locally available resources. They can ultimately be disseminated to cancer care programs throughout sSA in order to decrease cancer-related mortality.


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