16 Nov 2022

The Ministry of Health (MoH) has launched Thibang Diphatlha, a study that will help improve health services to ensure that cancer patients learn about their condition.

Launching Thibang Diphatlha study in Gaborone on Tuesday, deputy permanent secretary in the ministry, Dr Tshepo Machacha said the study, which encompasses local information, would help patients to start treatment as soon as possible.

He hailed the implementation of the study, saying it would test multiple ways to alert and link cancer diagnosed patients to care in a short time using a special class of Randomised Control Trial design, which he said was the highest standard of research method.

 Dr Machacha noted that delays between diagnosis and treatment had always increased risks for the cancer to spread to other parts of the body, resulting in death if not treated on time and expressed hope that Thibang Diphatlha would help close that gap.

“Delays between diagnosis and treatment remain a major concern, particularly among patients with advanced stage cancers,” he said.

Furthermore, he said the study would also test solutions tailor-made for Botswana’s health system.

“Findings from this study will complement other ongoing research to reducing cancer treatment delays, and other ministry initiatives that strengthen health systems to address treatment delay for cancer and other non-communicable diseases,” he said.

Meanwhile, Dr Machacha said the ministry would co-participate through its continued provision of care to the people, including the screening and referral of patients at local clinics, hospitals and other health facilities across the country.

He further indicated that they prioritised the prevention, diagnosis and treatment of cervical cancer through a cadre of services guided by the National Cervical Cancer Prevention Programme strategy.

He said services included screening and treatment for women at risk of cervical cancer at selected health facilities throughout the country, adding that for women diagnosed with invasive cancer, they provided surgery, radiotherapy, and chemotherapy

Provision of vaccination of girls aged 9-13 years for Human Papilloma Virus (HPV) which he said was the main cause of cervical cancer in Botswana, was also provided.

For her part, Thibang Diphatlha Study Team and Deputy-Dean Prof. Doreen Masire said Thibang Diphatlha entailed testing adaptive strategies to close the gap from cervical cancer diagnosis to treatment in Botswana.

Prof. Masire indicated that cervical cancer was one of the most common cancers affecting females globally, with approximately 90 per cent of cases and deaths occurring in low and middle income countries, particularly those with high rates of HIV.

She said there had been delays and missed opportunities for timely treatment, adding that this contributed significantly to higher rates of cervical cancer mortality.

She said 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. 

Currently the nation has high prevalence of HIV at 18.5 per cent, cervical cancer incidence at 34.4 per 100 000 and mortality at 20.1 per 100 000

Prof. Masire said while several implementation strategies appeared effective for increasing cervical cancer screening in Botswana and other low and medium income countries, no published studies had specifically targeted evidence-based care following diagnosis of HIV-associated malignancies.

“To help fill this critical gap, through 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,” said Prof Masire.

She clarified that the adaptive strategies were designed to target patient and system level determinants identified in preliminary data, including delayed communication of results, individual and structural barriers to accessing treatment, as well as suboptimal care coordination between referring and cancer treatment clinics.

Prof. Masire said the over-arching rationale for the study would enhance coordination, communication, and navigation through centralised outreach and nudge strategies that would increase timely treatment adoption and be scalable and sustainable in the long-term.ENDS