Secure the Future Helen Joseph Hospital Centre for Respiratory Excellence

Partnership objectives

To establish a Centre of Respiratory Excellence (CORE) in Gauteng Province (South Africa) based at Helen Joseph Hospital (HJH), and to formalize a tripartite service delivery, training and research partnership with Chris Hani Baragwanath Academic Hospital (CHBAH) and Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) respiratory departments.

The Centre will incorporate a multi-disciplinary team of pulmonologists, histopathologists (based at the National Institute of Occupational Diseases (NIOH)), oncologists, radiologists, nurses, palliative care professionals, community field workers, public, private, NGO and academic research partners.

The increasing incidence of lung cancer among black women is of particular concern. The increasing incidence of lung cancer among black women is of particular concern. Copyright Bristol-Myers Squibb

What are the health needs and challenges?

Sub-Saharan Africa (SSA) has endemic HIV prevalence (>15%) and the highest (>70%) global HIV- Tuberculosis (TB) co-infection rate, primarily affecting socioeconomically disadvantaged urban and rural populations, the majority of whom are black. Patients in Gauteng Province are referred to the 3 participating hospitals. The WITS Healthcare complex serves two thirds of the Gauteng population of 13 million people that includes 3 million people from Soweto and more than a million migrants. The population has a high HIV, TB and smoking prevalence particularly among males. Because of their vulnerable status, patients experience significant morbidity and mortality. Of particular concern is the increasing incidence of lung cancer among black women, associated with increased smoking and potentially indoor air pollution from coal stoves.

Latest 2011 SA National Cancer Registry (NCR) age standardized incidence rates for lung cancer are under-reported at 11/100,000 population, as the NCR is pathology-based relying on lung tissue biopsy specimens. The most important cause of lung cancer is tobacco smoking. Large numbers of lung cancers related to asbestos and other occupational exposures (from mining), indoor biomass-fuel exposure and chronic inflammatory lung diseases – in particular tuberculosis also occur. With the successful scale-up of antiretroviral therapy (ART), SA is facing an epidemic of non-communicable diseases (NCD’s) among aging people living with HIV/AIDS (APLWH). This population group is expected to triple by 2040 and the burden of COPD and lung cancer will increase, highlighting the need for health system planning and for burden of disease research to inform health system responses.

Lung cancer is the most common non-AIDS defining cancer among HIV-positive individuals with an incidence two to four fold higher than in HIV-negative patients, caused mainly by high prevalence of cigarette smoking among the HIV population. 

Description of partnership activities and how they address needs and challenges

Project Goals/Objectives

Goal 1: To conduct a needs assessment to identify inequities in patient access, diagnosis, treatment and palliation

Objectives: Identify a) patient level barriers to early stage lung cancer presentation at respiratory clinics, b) health system barriers to timely lung cancer identification, referral, diagnosis and treatment, and c) unmet end-of-life needs among lung cancer patients and their caregivers.

Goal 2: To implement minimally invasive lung cancer diagnosis and treatment procedures

Objective: Assess their impact on diagnosis and staging delays.

Goal 3: To provide multi-level training for healthcare and community fieldworkers workers

Objective: Provide training on lung cancer causes, symptoms, diagnosis, treatment, management, palliation, and epidemiologic research.  

Goal 4: To assess the feasibility of introducing limited lung cancer screening services in the Gauteng Province

Objective: Establish a pilot lung cancer screening program for high risk patients from the mining industry and determine the unit costs and proportion of cases diagnosed with early and late lung cancer.

Goal 5: To provide palliative care services for respiratory patients from CMJAH and HJH:

Objective: Coordinate, train, integrate and extend all WITS/Gauteng Palliative Care services to terminal respiratory patients and their caregivers referred from HJH and CMJAH and to enroll patients and caregivers on ongoing research projects.

Goal 6: To initiate research to assess the burden of lung cancer at CBHAH, CMJAH and HJH:

Objectives: 1) Characterize lung cancer disease and determine incidence and outcomes for HIV-positive and HIV-negative patients and the impacts of comorbidities and smoking habits on fitness for treatment and survival; 2) develop an electronic database for patient records and research information.

Summary of impact and forward looking information

Expected Outcomes

  • Patient level barriers to health care access data collected, analyzed and published and interventions planned.
  • Health systems barriers to timely lung cancer identification, referral, diagnosis and treatment identified in all 3 tiers of the health system involved in identification, referral, diagnosis and management of lung cancer patients.
  • Unmet- end-of-life needs among lung cancer patients and their caregivers and effectiveness of palliative care interventions identified.
  • Community lung cancer awareness education and patient navigation services integrated in Community Advisory Board and well established NGO community workers.
  • State of the art diagnosis equipment installed and routinely used and pulmonologists from the partner WITS hospitals and 6 pulmonology fellows/year trained.
  • Training courses for primary care practitioners on lung cancer management and palliative care management developed and piloted and offered for sustainability.
  •  Data published and presented at congresses and to the Department of Health.

Measurement of progress towards objectives:

Estimated overall value of partnership: US$ 1,557,692 over three years

Project Components

Goal 1: Needs assessment to identify inequities in patient access, diagnosis, treatment and palliation

  • Complete CORE facility renovation, staff employment and training on programme methods
  • Conduct study on patient barriers to care and analyze results
  • Identify healthcare provider delays and resource limitations
 

Goal 2: Implement minimally invasive lung cancer diagnosis and treatment procedures

  • Purchase equipment and train health care providers on its use
 

Goal 3: Provide multi-level training for healthcare and community fieldworkers workers

  • Lung cancer training course development and piloting. 
  • Community Advisory Board/NGO training and community outreach project
 

Goal 4: Assess the feasibility of introducing limited lung cancer screening services in Gauteng

  • Provide commercial screening and diagnostic service planning
 

Goal 5: Provide palliative care services for respiratory patients from CMJAH and HJH

  • Provide palliative care services for respiratory diseases
  • Conduct research on palliate care patient & caregiver needs analysis
 

Goal 6: Initiate research to assess the burden of lung cancer at CBHAH, CMJAH and HJH

  • Conduct research on lung cancer incidence and outcomes
 

Monitoring and Evaluation 

A detailed monitoring and evaluation framework has been developed covering each objective under each goal listing until completion. Regular meetings will be scheduled with BMSF and formal reports noting progress will be provided.

Partnership information

Partner(s) Bristol-Myers Squibb Foundation, Charlotte Maxeke Johannesburg Academic Hospital, Chris Hani Baragwanath Academic Hospital (CHBAH), Gauteng Palliative Care Center, Helen Joseph Hospital, National Cancer Registry, National Institute for Occupational Diseases (NIOH), Wits Health Consortium

Type of Partner(s) Academia / Hospitals, Government

Therapeutic Focus Non-Communicable Diseases, Women and Children's Health

Disease(s) Cancer, Children's Health, Respiratory Diseases, Women's Health

Program Type(s) Availability of Treatment - Financial Support, Health System Infrastructure - Development of Physical Infrastructure, Health System Infrastructure - Outreach & Medical Services, Health System Infrastructure - Training, Prevention Programs - Awareness & Outreach, Research & Development - Development of Treatments

Region(s) Sub-Saharan Africa

Number of Countries 1

Country(ies) South Africa

Start Date 2017

Anticipated completion date 2020