IMPLEMENTATION SCIENCE FOR CANCER CONTROL IN AFRICA (ISC2-AFRICA) NETWORK CONFERENCE THEME: IMPLEMENTATION SCIENCE: NUTS AND BOLTS FOR AFRICAN PRACTICE : PART 2
Tracks
STREAM 3
| Saturday, November 6, 2021 |
| 12:00 PM - 5:00 PM |
| STREAM 3 |
Overview
Organized By
African Organization for Research and Training in Cancer (AORTIC)
African Behavioral Research (ABeR) Center
Africa Cancer Research and Control ECHO (Africa Cancer ECHO)
US National Cancer Institute (NCI)
International Cancer Research Partnership (ICRP)
Details
Pre-conference Conference Planning Committee
• Folakemi T. Odedina, PhD – Covener
• Catherine Oladoyinbo, PhD - Co-chair
• Nwamaka Lasebikan, MBBS - Co-chair
• Ernest Kaninjing, DrPH - Member
• Lynne Davies, PhD - Member
• Annet Nakaganda, MBBS - Member
• Jenniffer Kerubo Mabuka-Maroa, PhD - Member
• Mishka Kohli Cira, MPH - Member
• Belmira Rodrigues – Member /AORTIC Liaison
National Cancer Institute Center for Global Health Program Director
• Dr. James Alaro
AGENDA
Implementation Science for Cancer Control in Africa (ISC2-Africa) Network Conference
Theme: Implementation Science: Nuts and Bolts for African Practice
Organized By
African Organization for Research and Training in Cancer (AORTIC)
African Behavioral Research (ABeR) Center
Africa Cancer Research and Control ECHO (Africa Cancer ECHO)
US National Cancer Institute (NCI)
International Cancer Research Partnership (ICRP)
Pre-conference Objectives
1. Learn from lived experiences the urgency and need for Implementation Science (IS) for cancer prevention and control in Africa
2. Introduce and contextualize IS theories, models, frameworks, and study designs for application in Africa
3. Facilitate a global network of African and non-African IS researchers focused on cancer control in Africa.
The Implementation Science for Cancer Control in Africa (ISC2-Africa) Network Conference is funded by the US National Cancer Institute Center for Global Health, Award # CA265019.
Pre-conference Conference Host Instituting
• Mayo Clinic, USA
Pre-conference Conference Planning Committee
• Folakemi T. Odedina, PhD – Covener
• Catherine Oladoyinbo, PhD - Co-chair
• Nwamaka Lasebikan, MBBS - Co-chair
• Ernest Kaninjing, DrPH - Member
• Lynne Davies, PhD - Member
• Annet Nakaganda, MBBS - Member
• Jenniffer Kerubo Mabuka-Maroa, PhD - Member
• Mishka Kohli Cira, MPH - Member
• Belmira Rodrigues – Member /AORTIC Liaison
National Cancer Institute Center for Global Health Program Director
• Dr. James Alaro
Inaugural (ISC2-Africa) Network Conference Agenda
Friday, November 5, 2021: 1:00 PM – 8:15 PM (SAST)
Time Theme Speakers
1:00pm Welcome and Pre-conference Objectives Overview Prof. Folakemi Odedina
1:03pm Opening remarks
AORTIC’s President remarks
Dr. Abubakar Bello
Session I
1:10-2:50pm Moderator: Dr. Nwamaka Lasebikan
1:10pm
Real-life issues and challenges that need to be addressed for successful program implementation (60 mins)
• Universal Health Coverage in Africa – 20mins
• Cancer drug access in Africa – 20mins
• HPV Vaccine role out in Rwanda – 20mins
Dr. Githinji Gitahi (AMREF)
Dr. Uche Nwokwukwu (Nigeria)
Dr. Stephen Rulisa (Rwanda)
2:10pm Slido for lived experiences from the audience (10 mins) Dr. Nwamaka Lasebikan
Ms. Mishka Kohli Cira
Ms. Ruth Agabe
2:20pm Contextualizing and identifying complexities in program implementation (30 mins) Dr. Patti Gravitt
2:50pm Comfort Break (10 mins)
Session II
3:00 – 5:20pm Moderators: Dr. Patti Gravitt and Dr. Gila Neta
3:00pm Breakout Session1: Model building exercise – Focus on understanding the problem (30 mins)
● Breakout group 1 – UHC
● Breakout group 2 – HPV
● Breakout group 3 – Drug access
Dr. Kenneth Sherr & Dr. Juliet Iwelunmor
Dr. Anne Rositch & Dr. Echezona Ezeanolue
Dr. Ernie Kaninjing & Dr. Noreen Mdege
Session III
3:30 – 5:20pm Moderator: Dr. Catherine Oladoyinbo
3:30pm Are we already applying elements of implementation science in projects in Africa? – a real life example Dr. Jemima Kamano & Miriam Schneidman
3:50pm Why implementation science for cancer prevention and control in Africa (connect IS to real-life challenges) (30 mins) Dr. David Chambers
4:20pm Making sense of Implementation Science Theories, Models and Frameworks (60 minutes)
• Introduce IS theories/models/frameworks–Use well established approaches – (30 minutes)
• How does one go about selecting a strategy? - connect approaches with real-life experiences (30 mins)
a. (UHC, HPV vaccination, Drug access)
Dr. Rohit Ramaswamy
Dr. Echezona Ezeanolue
5:20pm Comfort break (10 mins)
Session IV
5:30 – 8:30pm Moderator: Dr. Ernest Kaninjing
5:30pm Implementation Science Study Designs (45 mins) Dr. Donna Shelley
6:15pm Breakout Session 2: Applying IS approaches to addressing the issues/challenges from breakout session 1 (60 mins)
• Setting the stage; articulating the complexities of IS application (5 mins)
Dr. Patti Gravitt and Dr. Gila Neta
6:20pm Breakout Session 2: Applying IS approaches to addressing the issues/challenges from breakout session 1 (60 mins)
Concurrent breakout groups working with assigned experts to explore practical application of IS theories/models/frameworks) above utilizing real-life problem areas above – begin to define fit/ identify limitations (55 mins)
● Breakout group 1– UHC
● Breakout group2 – HPV
● Breakout group 3 - Drug access
Dr. Kenneth Sherr, and Dr. Juliet Iwelunmor
Dr. Anne Rositch and Dr. Echezona Ezeanolue
Dr. Ernie Kaninjing and Dr. Noreen Mdege
7:15pm Report out from breakout session
(Slido audience participation) Breakout Lead: Dr. David Chambers
Dr. Manisha Salinas
8:15pm Closing Day 1 Summary Dr. Nwamaka Lasebikan
Saturday, November 6, 2021: 10:00 AM to 4:30 PM (SAST)
12:00pm
Launch and Business Meeting of New AORTIC Special Interest Group (SIG): AORTIC Implementation Science SIG
Implementation Science Chairs:
Dr. Nwamaka Lasebikan
Dr. Catherine Oladoyinbo
Dr. Ernest Kaninjing
Highlight of Implementation Science Abstracts
Moderator: Dr. Nwamaka Lasebikan
Session V
2:00 – 8:30pm Moderator: Dr. Manisha Salinas
2:00pm Recap of day 1: Question/answer session Dr. Catherine Oladoyinbo
2:20pm Group discussion on Adaptation and Modifications IS theories, models, frameworks, and study designs
● Challenges or weakness with existing IS approaches
● Adaptations/modifications/new approaches for purpose and context in Africa
Dr. Lisa Newman
Dr. Bryan Weiner
3:20pm Moderated open discussion (including audience perspectives)
(Slido audience participation) Dr. Catherine Oladoyinbo
Ms. Parisa Fathi
4:00pm Closing Remarks
African Behavioral Research (ABeR) Center
Africa Cancer Research and Control ECHO (Africa Cancer ECHO)
International Cancer Research Partnership (ICRP)
African Organization for Research and Training in Cancer (AORTIC)
NIH/National Cancer Institute
Mayo Clinic
Dr. Catherine Oladoyinbo
Dr. Nwamaka Lasebikan
Dr. Lynne Davies
Ms. Belmira Rodrigues
Dr. James Alaro
Dr. Folakemi Odedina
4:30pm Adjournment
Speaker
Prof Jean-Pierre Droz
Centre Hospitalier Ouest-Guyane
CROSS-BORDER COMPLEMENTARITY IS NECESSARY WHEN CARE SUPPLY IS INCOMPLETE: THE EXAMPLE OF FRENCH GUIANA AND SURINAME
Abstract
Objective: to analyze the management of the large Surinamese population living in the basin of the Maroni river; radiation therapy is available in Suriname (Academisch Ziekenhuis Paramaribo – AZP) to citizens with minimum state social security coverage. Patients can receive medical treatments at Saint-Laurent du Maroni Hospital (SLMH) as part of urgent care.
Methods: we reviewed the files of patients treated for malignancies from 2015 to 2020 at SLMH and analyzed the information concerning patients treated at AZP. In October 2018, an unconventional cooperation policy was initiated between AZP and SLMH.
Results: until September 2018, 10/299 (3%) patients and from October 2018, 32/274 (12%) patients benefited from contacts between the two institutions. A total of 42 patients were concerned: median age 45 years (14-69); 19 men / 23 women. Surinamese nationality: 39/42 patients. Administrative documents valid in French Guiana: 9, in Suriname: 19, none: 11 patients. Health coverage: full: 7, minimum: 7, none: 28 patients. Nine patients were referred to AZP radiotherapy center (head and neck cancers: 4, uterus: 2, breast, esophagus, anus, one patient each. Two patients had brachytherapy. Seven patients are potentially cured. Fifteen patients were scheduled to receive radiotherapy at AZP without being treated: disease progression: 7, transfer to mainland France: 3, refusal: 2, board decision, no funding lost to follow-up, and ongoing process, one each. Overall, treatments at AZP were diagnostic procedures: 14, radiotherapy: 13, surgery: 10 and chemotherapy: 9 patients, respectively.
Conclusion: more than 12% of cancer patients at SLMH are Surinamese. Since the informal contacts, the number of joint patients has increased, it was possible to organize a coherent curative management of 9 patients, 7 of whom are disease-free. This collaboration deserves to be the subject of a partnership agreement and could serve as an example for other tropics regions of the world.
Methods: we reviewed the files of patients treated for malignancies from 2015 to 2020 at SLMH and analyzed the information concerning patients treated at AZP. In October 2018, an unconventional cooperation policy was initiated between AZP and SLMH.
Results: until September 2018, 10/299 (3%) patients and from October 2018, 32/274 (12%) patients benefited from contacts between the two institutions. A total of 42 patients were concerned: median age 45 years (14-69); 19 men / 23 women. Surinamese nationality: 39/42 patients. Administrative documents valid in French Guiana: 9, in Suriname: 19, none: 11 patients. Health coverage: full: 7, minimum: 7, none: 28 patients. Nine patients were referred to AZP radiotherapy center (head and neck cancers: 4, uterus: 2, breast, esophagus, anus, one patient each. Two patients had brachytherapy. Seven patients are potentially cured. Fifteen patients were scheduled to receive radiotherapy at AZP without being treated: disease progression: 7, transfer to mainland France: 3, refusal: 2, board decision, no funding lost to follow-up, and ongoing process, one each. Overall, treatments at AZP were diagnostic procedures: 14, radiotherapy: 13, surgery: 10 and chemotherapy: 9 patients, respectively.
Conclusion: more than 12% of cancer patients at SLMH are Surinamese. Since the informal contacts, the number of joint patients has increased, it was possible to organize a coherent curative management of 9 patients, 7 of whom are disease-free. This collaboration deserves to be the subject of a partnership agreement and could serve as an example for other tropics regions of the world.
Dr Catherine Kanari
Amref Health Africa
CAPACITY BUILDING OF COMMUNITY HEALTH VOLUNTEERS TO RESPOND TO THE CANCER BURDEN IN MERU COUNTY, KENYA.
Abstract
OBJECTIVES
In Kenya, cancer is a major contributor to high mortality approximately 28,092 deaths yearly1. Efforts and interventions to reduce the cancer burden are a priority. Amref using a consortium multifaceted approach, has been implementing an end-to-end NCD pilot program tackling cancer dubbed “Blueprint for innovative access to healthcare”. 20% of the cancer patients seeking medical attention at Kenyatta National Hospital hail from Meru County2. The project aims to improve cancer outcomes, including expanding cancer knowledge and improving the community's health-seeking behaviors. Outcomes expected include reducing cancer morbidity and mortality through early screening for cancer by the Community Health Volunteers (CHVs) and front-line health care workers.
METHODS
1,000 CHVs were trained through M-learning on the Amref leap platform. Leap uses a self-learning approach which has been successful in many health areas but proved difficult for cancer topics. This led to a review of the curriculum and a change in tact, leading to a Trainer of Trainers (TOT) approach, where the TOTs were able to supervise training and carry out support supervision of the CHVs. Performance in training hence became competitive.
RESULTS
The CHVs recorded a pass rate of 85%. CHVs disseminated key messages on cancer prevention & management to their communities through household visits. As a result, over 70,000 households were visited, reaching a population of 130,000. During mass screenings, CHVs participated and have attributed to the over 1,000 cancer patients currently on treatment at the Meru cancer center.
CONCLUSIONS
Capacity building CHVs on cancer using a blended approach and structured supervision has proven effective in increasing community knowledge on cancer and early screening diagnosis and treatment of cancer patients.
REFERENCES
1. Globocan. (2021). Global Cancer Observatory Report.
2. Kobia, Francis, et al. "The state of cancer in Meru, Kenya: a retrospective study." AAS Open Research .167 (2019): 167.
In Kenya, cancer is a major contributor to high mortality approximately 28,092 deaths yearly1. Efforts and interventions to reduce the cancer burden are a priority. Amref using a consortium multifaceted approach, has been implementing an end-to-end NCD pilot program tackling cancer dubbed “Blueprint for innovative access to healthcare”. 20% of the cancer patients seeking medical attention at Kenyatta National Hospital hail from Meru County2. The project aims to improve cancer outcomes, including expanding cancer knowledge and improving the community's health-seeking behaviors. Outcomes expected include reducing cancer morbidity and mortality through early screening for cancer by the Community Health Volunteers (CHVs) and front-line health care workers.
METHODS
1,000 CHVs were trained through M-learning on the Amref leap platform. Leap uses a self-learning approach which has been successful in many health areas but proved difficult for cancer topics. This led to a review of the curriculum and a change in tact, leading to a Trainer of Trainers (TOT) approach, where the TOTs were able to supervise training and carry out support supervision of the CHVs. Performance in training hence became competitive.
RESULTS
The CHVs recorded a pass rate of 85%. CHVs disseminated key messages on cancer prevention & management to their communities through household visits. As a result, over 70,000 households were visited, reaching a population of 130,000. During mass screenings, CHVs participated and have attributed to the over 1,000 cancer patients currently on treatment at the Meru cancer center.
CONCLUSIONS
Capacity building CHVs on cancer using a blended approach and structured supervision has proven effective in increasing community knowledge on cancer and early screening diagnosis and treatment of cancer patients.
REFERENCES
1. Globocan. (2021). Global Cancer Observatory Report.
2. Kobia, Francis, et al. "The state of cancer in Meru, Kenya: a retrospective study." AAS Open Research .167 (2019): 167.
Ms Portia Mamonyowe Motsoeneng
University of Cape Town
BREAST CANCER SURVIVOR EXPERIENCE OF REHABILITATION SERVICES IN SOUTH AFRICA: TOWARDS A CANCER SURVIVORSHIP PLAN
Abstract
Abstract
Purpose Integrated rehabilitation health care pathways are implemented to meet both the physical and clinical needs of breast cancer survivors as they transition from treatment to survivorship. The aim of this study was to assess the current South African upper limb rehabilitation service, provision, and perspectives of these from the health professionals and breast cancer survivors with upper limb disorder.
Methods A sequential mixed-methods design informed this study. Service provision was evaluated via an online survey questionnaire completed by health practitioners working in public and private breast cancer units. Focus groups were conducted with both public health practitioners providing the services and breast cancer survivors accessing the services.
Results This study has revealed a dearth of rehabilitation services for breast cancer survivors in the public health sector of South Africa. Data reveal an overstretched, understaffed, and poorly trained public health sector, unable to deliver adequate upper limb services to breast cancer survivors. Focus group data suggests that this is due to financial austerity rather than poor recognition of the need. Poor patient education is driving poor upper limb outcomes and barriers to exercise behavior.
Conclusion The current South African upper limb rehabilitation services does not cater to the needs of breast cancer survivors leading to poor health outcomes.
Purpose Integrated rehabilitation health care pathways are implemented to meet both the physical and clinical needs of breast cancer survivors as they transition from treatment to survivorship. The aim of this study was to assess the current South African upper limb rehabilitation service, provision, and perspectives of these from the health professionals and breast cancer survivors with upper limb disorder.
Methods A sequential mixed-methods design informed this study. Service provision was evaluated via an online survey questionnaire completed by health practitioners working in public and private breast cancer units. Focus groups were conducted with both public health practitioners providing the services and breast cancer survivors accessing the services.
Results This study has revealed a dearth of rehabilitation services for breast cancer survivors in the public health sector of South Africa. Data reveal an overstretched, understaffed, and poorly trained public health sector, unable to deliver adequate upper limb services to breast cancer survivors. Focus group data suggests that this is due to financial austerity rather than poor recognition of the need. Poor patient education is driving poor upper limb outcomes and barriers to exercise behavior.
Conclusion The current South African upper limb rehabilitation services does not cater to the needs of breast cancer survivors leading to poor health outcomes.
Dr Mamsau Ngoma
Ocean Road Cancer Institute
EVALUATION OF A MULTI-COMPONENT STRATEGY FOR CANCER TREATMENT GUIDELINE IMPLEMENTATION AT A NATIONAL REFERRAL HOSPITAL IN TANZANIA.
Abstract
Objectives: To promote uptake of Tanzania’s new National Cancer Treatment Guidelines, a theory-driven implementation strategy was employed. This was facilitated through three phases: 1) guideline dissemination; 2) training; and 3) ongoing reinforcement of guideline-concordant practice. We aimed to evaluate implementation outcomes of this multi-component strategy through analyses of feasibility, acceptability, and fidelity.
Methods: We conducted a process evaluation using a mixed methods approach with direct observation, pre- and post-intervention surveys, and a qualitative focus group discussion to evaluate the experiences of Implementation Champions.
Results: Several components of the implementation strategy were completed with fidelity: guideline distribution via hard copies and a new smartphone application; a publicity campaign; and reinforcement by Implementation Champions. Others required modifications: a planned meeting for guideline training was reduced in length and scope; implementation of clinical treatment planning forms was disrupted by delayed conversion from paper to electronic versions. Pre-intervention surveys were completed by 54 oncology clinicians, and post-intervention surveys were completed by 22. A higher proportion of respondents reported utilization of national guidelines in post-intervention surveys, as compared to pre-intervention surveys. In the post-intervention survey, respondents were overall satisfied with their performance using the guidelines. The focus group found that Implementation Champions felt positively about being agents of change, education, and capacity building. Ward rounds, outpatient clinics, and departmental meetings were listed as conducive environments for guideline promotion. The main barrier to guideline uptake was resistance to change from physicians, as reported predominantly by nurses. Audit and feedback for completion of clinical forms was emphasized as a critical yet challenging responsibility of Champions.
Conclusion: Overall, the implementation strategy was feasible and acceptable but required some modifications. With recent increases in new cancer treatment guidelines developed for resource-constrained settings, our lessons learned from this approach may serve to inform strategies to promote guideline implementation.
Methods: We conducted a process evaluation using a mixed methods approach with direct observation, pre- and post-intervention surveys, and a qualitative focus group discussion to evaluate the experiences of Implementation Champions.
Results: Several components of the implementation strategy were completed with fidelity: guideline distribution via hard copies and a new smartphone application; a publicity campaign; and reinforcement by Implementation Champions. Others required modifications: a planned meeting for guideline training was reduced in length and scope; implementation of clinical treatment planning forms was disrupted by delayed conversion from paper to electronic versions. Pre-intervention surveys were completed by 54 oncology clinicians, and post-intervention surveys were completed by 22. A higher proportion of respondents reported utilization of national guidelines in post-intervention surveys, as compared to pre-intervention surveys. In the post-intervention survey, respondents were overall satisfied with their performance using the guidelines. The focus group found that Implementation Champions felt positively about being agents of change, education, and capacity building. Ward rounds, outpatient clinics, and departmental meetings were listed as conducive environments for guideline promotion. The main barrier to guideline uptake was resistance to change from physicians, as reported predominantly by nurses. Audit and feedback for completion of clinical forms was emphasized as a critical yet challenging responsibility of Champions.
Conclusion: Overall, the implementation strategy was feasible and acceptable but required some modifications. With recent increases in new cancer treatment guidelines developed for resource-constrained settings, our lessons learned from this approach may serve to inform strategies to promote guideline implementation.
Mrs Laura Prakash
Clinical Monitoring Research Program Directorate (CMRPD), Frederick National Laboratory for Cancer Research
IMPLEMENTATION SCIENCE RESEARCH FUNDED BY THE U.S. NATIONAL CANCER INSTITUTE: AN ANALYSIS OF GRANTS WITH INTERNATIONAL COLLABORATORS
Abstract
OBJECTIVE: The U.S. National Cancer Institute (NCI) funds implementation science, the study of methods to promote the adoption and integration of evidence into practice, both domestically and globally. We analyzed NCI’s implementation science portfolio to examine international grants and identify research opportunities.
METHODS: NCI-funded grants (2000-2020) with foreign principal investigators or collaborators were identified using NIH databases. A text search was conducted, and six coders reviewed abstracts to determine which awards included implementation science aims. Grants were categorized by collaborating countries, content area, cancer sites studied, and cancer care continuum. Analyses were conducted in Microsoft Excel.
RESULTS: Thirty-four NCI-funded grants met the criteria for inclusion. Twenty-four awards were to investigators collaborating with scientists in LMICs, 13 of which were in Africa, including, Kenya (n=4), South Africa (n=4), Botswana (n=3), Malawi (n=2), Rwanda (n=2), and Uganda (n=2). All 13 Africa-based grants studied HIV-associated malignancies; over half focused on HPV/cervical cancer screening (n=7) and four on breast cancer. Africa-based grants spanned the cancer control continuum: prevention (n=3), screening (n=8), treatment (n=6), and survivorship (n=2).
Outside of Africa, collaborating countries included Australia (n=4), Canada (n=4), and those in Asia (n=9), Europe (n=8), and Latin America (n=5). Across all 34 grants, the top research content areas were HPV/cervical cancer screening (n=10) and tobacco control (n=7). In addition to cervix (n=10) and lung (n=7), other cancer sites studied included breast (n=4) and colorectal (n=3). Grants spanned the cancer control continuum but most focused on prevention (n=19) and screening (n=15).
CONCLUSIONS: NCI’s current portfolio of global cancer implementation science grants is growing but still limited in number and scope. This analysis helps highlight gaps and identify opportunities for future research.
METHODS: NCI-funded grants (2000-2020) with foreign principal investigators or collaborators were identified using NIH databases. A text search was conducted, and six coders reviewed abstracts to determine which awards included implementation science aims. Grants were categorized by collaborating countries, content area, cancer sites studied, and cancer care continuum. Analyses were conducted in Microsoft Excel.
RESULTS: Thirty-four NCI-funded grants met the criteria for inclusion. Twenty-four awards were to investigators collaborating with scientists in LMICs, 13 of which were in Africa, including, Kenya (n=4), South Africa (n=4), Botswana (n=3), Malawi (n=2), Rwanda (n=2), and Uganda (n=2). All 13 Africa-based grants studied HIV-associated malignancies; over half focused on HPV/cervical cancer screening (n=7) and four on breast cancer. Africa-based grants spanned the cancer control continuum: prevention (n=3), screening (n=8), treatment (n=6), and survivorship (n=2).
Outside of Africa, collaborating countries included Australia (n=4), Canada (n=4), and those in Asia (n=9), Europe (n=8), and Latin America (n=5). Across all 34 grants, the top research content areas were HPV/cervical cancer screening (n=10) and tobacco control (n=7). In addition to cervix (n=10) and lung (n=7), other cancer sites studied included breast (n=4) and colorectal (n=3). Grants spanned the cancer control continuum but most focused on prevention (n=19) and screening (n=15).
CONCLUSIONS: NCI’s current portfolio of global cancer implementation science grants is growing but still limited in number and scope. This analysis helps highlight gaps and identify opportunities for future research.
Dr Yared Tilahun
Clinton Health Access Initiative (chai)
EXPANSION OF BREAST CANCER TREATMENT TO SIX REGIONAL HOSPITALS IN ETHIOPIA: IMPACT ON TOTAL NUMBER OF BREAST CANCER PATIENTS INITIATING CHEMOTHERAPY
Abstract
OBJECTIVE:
Ethiopia faces a high breast cancer (BC) burden. Until 2016, cancer patients could only seek treatment at Black Lion Hospital (BLH), Addis Ababa, which faced a large patient backlog. There is also a national shortage of oncology specialists.
To address these challenges, the MOH expanded BC treatment services to six regional hospitals in 2016, by training general medical practitioners to provide breast cancer diagnosis, surgery, and chemotherapy, and nurses to administer chemotherapy. By 2020, this model expanded to twelve regional hospitals.
The study objective is to measure the increase of BC patients initiating chemotherapy in regional hospitals between 2018 and 2020.
METHODS:
Study outcomes were measured by collecting and comparing 2018 and 2020 patient registration data from hospital registers, at twelve regional hospitals and BLH.
RESULTS:
In 2018, 515 BC patients initiated chemotherapy across six regional hospitals, while 2,676 patients initiated treatment at BLH. In 2020, the number of patients in the same six regional hospitals increased by 59% percent to 818, while the number of patients at BLH decreased by 59% to 1,089. In 2020, an additional 420 BC patients were treated at six other regional hospitals that started offering chemotherapy after 2018.
The total number of BC patients starting chemotherapy in public hospitals in Ethiopia decreased by 27% between 2018 and 2020, going from 3,191 to 2,327. The overall share of patients treated at regional hospitals vs BLH increased from 16% to 53%.
CONCLUSIONS:
The program increased the number of BC patients starting chemotherapy in regional hospitals, thus reducing travel barriers to care. The overall decrease in number of BC patients in 2020 is attributable to care disruptions at BLH caused by COVID19. We will update study results with forthcoming data on the number of cycles completed by BC patients in regional hospitals.
Ethiopia faces a high breast cancer (BC) burden. Until 2016, cancer patients could only seek treatment at Black Lion Hospital (BLH), Addis Ababa, which faced a large patient backlog. There is also a national shortage of oncology specialists.
To address these challenges, the MOH expanded BC treatment services to six regional hospitals in 2016, by training general medical practitioners to provide breast cancer diagnosis, surgery, and chemotherapy, and nurses to administer chemotherapy. By 2020, this model expanded to twelve regional hospitals.
The study objective is to measure the increase of BC patients initiating chemotherapy in regional hospitals between 2018 and 2020.
METHODS:
Study outcomes were measured by collecting and comparing 2018 and 2020 patient registration data from hospital registers, at twelve regional hospitals and BLH.
RESULTS:
In 2018, 515 BC patients initiated chemotherapy across six regional hospitals, while 2,676 patients initiated treatment at BLH. In 2020, the number of patients in the same six regional hospitals increased by 59% percent to 818, while the number of patients at BLH decreased by 59% to 1,089. In 2020, an additional 420 BC patients were treated at six other regional hospitals that started offering chemotherapy after 2018.
The total number of BC patients starting chemotherapy in public hospitals in Ethiopia decreased by 27% between 2018 and 2020, going from 3,191 to 2,327. The overall share of patients treated at regional hospitals vs BLH increased from 16% to 53%.
CONCLUSIONS:
The program increased the number of BC patients starting chemotherapy in regional hospitals, thus reducing travel barriers to care. The overall decrease in number of BC patients in 2020 is attributable to care disruptions at BLH caused by COVID19. We will update study results with forthcoming data on the number of cycles completed by BC patients in regional hospitals.
Miss Josephin Trabitzsch
PATHWAYS AND REFERRAL OF CANCER PATIENTS IN RURAL ETHIOPIA
Abstract
OBJECTIVE:
Streamlined pathways of cancer patients are essential in Sub-Saharan Africa, where specialized care is only available in few facilities per country. Research on cancer patient pathways has mainly been conducted at tertiary hospitals, missing out on patients who never reached them. In this study, we describe pathways and referral patterns of cancer patients diagnosed at primary and secondary level hospitals in Ethiopia.
METHODS:
This cross-sectional study was set at two primary and six secondary level hospitals in the South-West of Ethiopia. We conducted structured telephone interviews with patients diagnosed with cancer between July 2017 and June 2020. The primary outcome was successful referral - this was achieved when the intended diagnostic or treatment procedure had been initiated at the referral institution.
RESULTS:
Of 365 patients included, more than 80% had entered the healthcare system on the primary level. From the study sites, most patients were referred to private clinics for pathology services or to tertiary cancer centres. The median time from symptom recognition to non-surgical treatment initiation was 160 days. Referrals for diagnostics were successful in 96% of all cases, referrals for treatment in 73%. Being referred for diagnostics (versus being referred for treatment) was the only predictor associated with successful referral on a 95% confidence level (odds ratio 13.3; confidence interval 4.12 – 42.92; p-value < 0.01). Overall, 21% of all patients remained without any therapy, ranging from 14% at secondary referral hospitals to 40 % at primary hospitals.
CONCLUSIONS:
Pathways and referral of cancer patients in rural Ethiopia appear to largely follow coherent patterns. However, time to treatment initiation is unacceptably long and many patients remain without treatment. Expanded pathology services on the primary and secondary healthcare level could reduce the number of referrals and therefore decrease time to treatment initiation for cancer patients in rural Ethiopia.
Streamlined pathways of cancer patients are essential in Sub-Saharan Africa, where specialized care is only available in few facilities per country. Research on cancer patient pathways has mainly been conducted at tertiary hospitals, missing out on patients who never reached them. In this study, we describe pathways and referral patterns of cancer patients diagnosed at primary and secondary level hospitals in Ethiopia.
METHODS:
This cross-sectional study was set at two primary and six secondary level hospitals in the South-West of Ethiopia. We conducted structured telephone interviews with patients diagnosed with cancer between July 2017 and June 2020. The primary outcome was successful referral - this was achieved when the intended diagnostic or treatment procedure had been initiated at the referral institution.
RESULTS:
Of 365 patients included, more than 80% had entered the healthcare system on the primary level. From the study sites, most patients were referred to private clinics for pathology services or to tertiary cancer centres. The median time from symptom recognition to non-surgical treatment initiation was 160 days. Referrals for diagnostics were successful in 96% of all cases, referrals for treatment in 73%. Being referred for diagnostics (versus being referred for treatment) was the only predictor associated with successful referral on a 95% confidence level (odds ratio 13.3; confidence interval 4.12 – 42.92; p-value < 0.01). Overall, 21% of all patients remained without any therapy, ranging from 14% at secondary referral hospitals to 40 % at primary hospitals.
CONCLUSIONS:
Pathways and referral of cancer patients in rural Ethiopia appear to largely follow coherent patterns. However, time to treatment initiation is unacceptably long and many patients remain without treatment. Expanded pathology services on the primary and secondary healthcare level could reduce the number of referrals and therefore decrease time to treatment initiation for cancer patients in rural Ethiopia.
Bryan Weiner
Group discussion on Adaptation and Modifications IS theories, models and frameworks
Dr Catherine Oladoyinbo
Federal University of Agriculture Abeokuta
Recap of day 1
Dr Lisa Newman
Weill Cornell Medicine
Group discussion on Adaptation and Modifications IS theories, models and frameworks
