Evaluation of Hepatocellular Carcinoma care capacity in Tanzania

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality in sub-Saharan Africa (SSA). Pathogenesis is driven by high rates of viral hepatitis, untreated cirrhosis, and limited access to HCC screening and treatment. Globally, 2.5% of patients with cirrhosis will develop HCC each year. With adequate resources around 40% of diagnosed HCC patients will receive curative surgical resection, local ablation, or transplant, however in SSA less than 1% of patients receive such treatment. In Tanzania, there is a national effort to improve early diagnosis and treatment of HCC. Despite this, the multidisciplinary liver tumor board (MDTB) at the Muhimbili National Hospital (MNH) notes that treatment rates for localized HCC are less than 25% of expected. Access to treatment and resources are limited outside of the largest hospitals and care recommendations vary by location, resulting in delayed, disjointed, and uncoordinated care. The landscape for HCC care in Tanzania is unknown. We hypothesize that lack of established referral pathways and treatment guidelines contribute to deficient treatment rates. To address the current absence of HCC data and facilitate treatment, we aim to perform the following: 1) Perform a national assessment of HCC diagnostic and treatment resources, including screening infrastructure, surgical and locoregional capacity, systemic treatment availability, and access to supportive care, 2) Implement a national virtual liver cancer tumor board to strengthen multidisciplinary care and coordination, and 3) Develop contextualized and resource-specific treatment guidelines for liver cancer in Tanzania with assessment of impact using a retrospective patient cohort. Nation liver cancer care capacity assessments will be performed at all major public medical centers to identify available physical and human resources. The virtual tumor board will be distributed nationwide for optimal provider engagement, with implementation success measured by participation and effect on care recommendations. Resource-specific treatment guidelines for liver cancer in Tanzania will be developed on expert consensus. This proposal is part of a larger effort to improve cancer care in SSA and will provide valuable baseline data leading to future capacity building and intervention-driven research.