10 Nov 2022

The University of Botswana will on November 15, 2022, launch a study titled Thibang Diphatlha which basically entails testing adaptive strategies to close the gap from cervical cancer diagnosis to treatment in Botswana.

Cervical cancer is one of the most common female cancers globally, with approximately 90% of cases and deaths occurring in Low- and-Middle-Income-Countries (LMICs), particularly those with high rates of HIV.

Delays and missed opportunities for timely treatment contribute significantly to higher rates of cervical cancer mortality.

In Botswana, a nation with a particularly high prevalence of HIV (18.5%), and cervical cancer incidence (34.4 per 100,000) and mortality (20.1 per 100,000), prior research identified substantial delays in cervical cancer care from diagnosis to treatment in a cohort of nearly 1,000 patients, driven by myriad individual- and system-level barriers. While several implementation strategies appear effective for increasing cervical cancer screening in Botswana and other LMICs, no published studies have specifically targeted evidence-based care following diagnosis of HIV-associated malignancies.

To help fill this critical gap, through a collaboration between the University of Botswana, Ministry of Health, the University of Pennsylvania and Botswana-UPenn Partnership, investigators will test the effectiveness of adaptive strategies on timely treatment adoption using a hybrid (type III) and pragmatic Sequential Multiple Assignment Randomized Trial (SMART) design, complemented by an evaluation using mixed-methods.

The adaptive strategies are designed to target patient- and system-level determinants identified in our preliminary data, including delayed communication of results, individual and structural barriers to accessing treatment, and suboptimal care coordination between referring and cancer treatment clinics.

The strategies draw upon key principles in behavioral economics and are supported by systematic evidence of the effectiveness of nudge strategies in preventive, HIV, and cancer care. Ends