%A Tapela,Neo M.
%A Peluso,Michael J.
%A Kohler,Racquel E.
%A Setlhako,Irene I.
%A Botebele,Kerapetse
%A Gabegwe,Kemiso
%A Nkele,Isaac
%A Narasimhamurthy,Mohan
%A Mmalane,Mompati
%A Grover,Surbhi
%A Barak,Tomer
%A Shulman,Lawrence N.
%A Lockman,Shahin
%A Dryden-Peterson,Scott
%D 2018
%J Frontiers in Oncology
%C
%F
%G English
%K Cancer,early diagnosis,Early detection,health system delays,Primary Care,primary care providers,Health Workforce,Botswana,sub-Saharan Africa,training
%Q
%R 10.3389/fonc.2018.00187
%W
%L
%M
%P
%7
%8 2018-May-29
%9 Original Research
%#
%! Implementation and impact of a primary care-based training program in Botswana
%*
%<
%T A Step Toward Timely Referral and Early Diagnosis of Cancer: Implementation and Impact on Knowledge of a Primary Care-Based Training Program in Botswana
%U https://www.frontiersin.org/articles/10.3389/fonc.2018.00187
%V 8
%0 JOURNAL ARTICLE
%@ 2234-943X
%X IntroductionHealth system delays in diagnosis of cancer contribute to the glaring disparities in cancer mortality between high-income countries and low- and middle-income countries. In Botswana, approximately 70% of cancers are diagnosed at late stage and median time from first health facility visit for cancer-related symptoms to specialty cancer care was 160 days (IQR 59–653). We describe the implementation and early outcomes of training targeting primary care providers, which is a part of a multi-component implementation study in Kweneng-East district aiming to enhance timely diagnosis of cancers.MethodsHealth-care providers from all public facilities within the district were invited to participate in an 8-h intensive short-course program developed by a multidisciplinary team and adapted to the Botswana health system context. Participants’ performance was assessed using a 25-multiple choice question tool, with pre- and post-assessments paired by anonymous identifier. Statistical analysis with Wilcoxon signed-rank test to compare performance at the two time points across eight sub-domains (pathophysiology, epidemiology, social context, symptoms, evaluation, treatment, documentation, follow-up). Linear regression and negative binomial modeling were used to determine change in performance. Participants’ satisfaction with the program was measured on a separate survey using a 5-point Likert scale.Results176 participants attended the training over 5 days in April 2016. Pooled linear regression controlling for test version showed an overall performance increase of 16.8% after participation (95% CI 15.2–18.4). Statistically significant improvement was observed for seven out of eight subdomains on test A and all eight subdomains on test B. Overall, 71 (40.3%) trainees achieved a score greater than 70% on the pretest, and 161 (91.5%) did so on the posttest. Participants reported a high degree of satisfaction with the training program’s content and its relevance to their daily work.ConclusionWe describe a successfully implemented primary health care provider-focused training component of an innovative intervention aiming to reduce health systems delays in cancer diagnosis in sub-Saharan Africa. The training achieved district-wide participation, and improvement in the knowledge of primary health-care providers in this setting.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier NCT02752061.