abstract: 'Introduction: Health 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.

  Methods: Health-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.

  Results: 176 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\% 01

  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.

  Conclusion: We 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.'
affiliation: 'Tapela, NM (Corresponding Author), Botswana Harvard AIDS Inst Partnership,
  Gaborone, Botswana.

  Tapela, NM (Corresponding Author), Brigham \& Womens Hosp, Div Global Hlth Equ,
  75 Francis St, Boston, MA 02115 USA.

  Tapela, Neo M.; Botebele, Kerapetse; Gabegwe, Kemiso; Nkele, Isaac; Mmalane, Mompati;
  Barak, Tomer; Lockman, Shahin; Dryden-Peterson, Scott, Botswana Harvard AIDS Inst
  Partnership, Gaborone, Botswana.

  Tapela, Neo M.; Peluso, Michael J., Brigham \& Womens Hosp, Div Global Hlth Equ,
  75 Francis St, Boston, MA 02115 USA.

  Peluso, Michael J., Brigham \& Womens Hosp, Dept Med, 75 Francis St, Boston, MA
  02115 USA.

  Kohler, Racquet E., Dana Farber Canc Inst, Ctr Community Based Res, Harvard TH Chan
  Sch Publ Hlth, Dept Social \& Behav Sci, Boston, MA 02115 USA.

  Setlhako, Irene I., Princess Marina Hosp, Minist Hlth \& Wellness, Gaborone, Botswana.

  Narasimhamurthy, Mohan, Univ Botswana, Fac Med, Dept Pathol, Gaborone, Botswana.

  Grover, Surbhi, Univ Penn, Philadelphia, PA 19104 USA.

  Grover, Surbhi, Botswana Upenn Partnership, Gaborone, Botswana.

  Barak, Tomer, Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA 02215 USA.

  Shulman, Lawrence N., Univ Penn, Abramson Canc Ctr, Ctr Global Canc Med, Philadelphia,
  PA 19104 USA.

  Lockman, Shahin; Dryden-Peterson, Scott, Harvard TH Chan Sch Publ Hlth, Boston,
  MA USA.

  Lockman, Shahin; Dryden-Peterson, Scott, Brigham \& Womens Hosp, Div Infect Dis,
  75 Francis St, Boston, MA 02115 USA.'
article-number: '187'
author: Tapela, Neo M. and Peluso, Michael J. and Kohler, Racquet E. and Setlhako,
  Irene I. and Botebele, Kerapetse and Gabegwe, Kemiso and Nkele, Isaac and Narasimhamurthy,
  Mohan and Mmalane, Mompati and Grover, Surbhi and Barak, Tomer and Shulman, Lawrence
  N. and Lockman, Shahin and Dryden-Peterson, Scott
author-email: ntapela@gmail.com
author_list:
- family: Tapela
  given: Neo M.
- family: Peluso
  given: Michael J.
- family: Kohler
  given: Racquet E.
- family: Setlhako
  given: Irene I.
- family: Botebele
  given: Kerapetse
- family: Gabegwe
  given: Kemiso
- family: Nkele
  given: Isaac
- family: Narasimhamurthy
  given: Mohan
- family: Mmalane
  given: Mompati
- family: Grover
  given: Surbhi
- family: Barak
  given: Tomer
- family: Shulman
  given: Lawrence N.
- family: Lockman
  given: Shahin
- family: Dryden-Peterson
  given: Scott
da: '2023-09-28'
doi: 10.3389/fonc.2018.00187
files: []
issn: 2234-943X
journal: FRONTIERS IN ONCOLOGY
keywords: 'cancer early diagnosis; health system delays; primary care; primary care

  providers; Botswana; sub-Saharan Africa; training'
keywords-plus: 'BREAST-CANCER; ORAL-CANCER; DELAYS; INDIA; CHALLENGES; PATHOLOGY;

  SERVICES; ONCOLOGY; WORKERS; ACCESS'
language: English
month: MAY 29
number-of-cited-references: '42'
orcid-numbers: 'Dryden-Peterson, Scott/0000-0002-8487-9731

  Tapela, Neo/0000-0002-2048-3973'
papis_id: 67f20cf58a42dcf87059ee7b372f9d0f
ref: Tapela2018steptimely
researcherid-numbers: 'narasimahmurthy, mohan/AAM-8077-2021

  '
times-cited: '12'
title: 'A Step Toward Timely Referral and Early Diagnosis of Cancer: Implementation
  and Impact on Knowledge of a Primary Care-Based Training Program in Botswana'
type: article
unique-id: WOS:000433304500001
usage-count-last-180-days: '0'
usage-count-since-2013: '4'
volume: '8'
web-of-science-categories: Oncology
year: '2018'