%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.