Opened in 1928, the University Teaching Hospital of Butaré (CHUB) in the Southern Province of Rwanda is one of five major medical facilities in the country that diagnoses cancer. While CHUB can perform basic histology and cytology procedures to diagnose cancers, it has been unable to afford the reagents needed to perform immunohistochemistry (IHC) staining. IHC is an advanced technique used to identify tumor biomarkers and subsequently direct treatment selection. Unable to offer patients IHC, CHUB refers its patients to centers several hours away that offer this important diagnostic service. Alternatively, in the absence of IHC results, CHUB staff are forced to rely on basic histology to develop a treatment plan that may not be the most appropriate or effective for a particular patient. Despite the overwhelming value of IHC, due to the costs associated with travel and time away from work, many of CHUB’s patients decide to forego the test and receive treatment solely based on their tumor’s general diagnosis.
To help the hospital expand the diagnostic services available to southern Rwandans, BVGH organized a four-week virtual knowledge exchange program between Dr. Elisée Hategekimana, Head of the Anatomic Pathology Service at CHUB, and 2021 American Society for Clinical Pathology (ASCP) Global Health Fellow, Dr. Kelsey Hummel. Dr. Hummel, a pathology resident at the Baylor College of Medicine (USA), and Dr. Hategekimana examined CHUB’s practical barriers to starting and maintaining IHC services, namely start-up investment costs, recurring costs, and the insufficient number of IHC specimens routinely obtained to sustain the expenses in the long term. Based on these findings, they considered different approaches to secure the needed funding and increase specimen numbers.
Recognizing that research awards could cover IHC start-up costs and support the collection of evidence –such as reagent costs, number of specimens examined, and revenue from the tests – that could convince CHUB leadership of the sustainability of the service, Dr. Hategekimana and Dr. Hummel applied for funding from the American Society of Cytopathology (ASC) and BVGH’s African Consortium for Cancer Clinical Trials (AC3T) Study Pool. With funding from the AC3T Study Pool, Dr. Hategekimana and Dr. Hummel purchased IHC reagents and examined the prevalence of a specific biomarker in breast and gastric tumor specimens processed at CHUB. As expected, a significant percentage of the specimens tested positive for the biomarker – highlighting patients eligible for targeted therapy and underscoring the need to continue to offer IHC to patients. Dr. Hategekimana and Dr. Hummel used the ASC funding award to open a mobile cytology clinic that travels to villages across the Southern Province, collecting putative cancer specimens and transporting them to CHUB for full diagnostic work-up, including, as relevant, IHC.
The early results of these two projects are promising. The mobile cytology clinic is expanding the reach of CHUB’s critical diagnostic services and the biomarker study has demonstrated that the demand for and revenue from IHC tests will be sufficient to maintain the program. Dr. Hategekimana plans to combine his data with those collected by his colleagues from the University Teaching Hospital of Kigali and publish the consolidated data.
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