Strategies to Close the Gap From CC Diagnosis to Treatment in Botswana

Thibang Diphatlha: Testing Adaptive Strategies to Close the Gap From Cervical Cancer Diagnosis to Treatment in Botswana

Investigators will test the effectiveness of adaptive strategies on timely adoption of cervical cancer treatment in Botswana using a pragmatic trial design.

Investigators will test the effectiveness of adaptive strategies on timely adoption of cervical cancer treatment in Botswana using a hybrid (type III) and pragmatic Sequential Multiple Assignment Randomized Trial (SMART) design. The adaptive strategies are designed to target patient- and system-level determinants identified in preliminary data, including delayed communication of results, individual and structural barriers to accessing treatment, and suboptimal care coordination between referring and cancer treatment clinics. The strategies draw upon key principles in behavioral economics and are supported by systematic evidence of the effectiveness of nudge strategies in preventive, HIV, and cancer care. The overarching rationale for the study is that enhancing coordination, communication, and navigation through centralized outreach and nudge strategies will increase timely treatment adoption and be scalable and sustainable in the long-term.

Pragmatic Sequential Multiple Assignment Randomized Trial (SMART). This study uses a sequential randomization design in which all eligible participants will be randomized into one of two interventions at Stage 1 and then participants that do not respond to Stage 1 interventions will be randomized to receive Stage 2 interventions

A member of the pathology team will contact the referring clinic where the patient had the diagnostic procedure to communicate positive results and provide an appointment at a gynecological cancer treatment clinic.

A member of the pathology team will contact the referring clinic where the patient had the diagnostic procedure to communicate positive results and provide an appointment at a gynecological cancer treatment clinic. In the enhanced outreach arm, the patient will also be contacted directly by the pathology team and informed that their results are ready.

Individuals who do not complete an initial visit at the cancer treatment clinic within 30 days of randomization (non-responders) will be randomized to receive asynchronous text message reminders using framed messaging alone.

Individuals who do not complete an initial visit at the cancer treatment clinic within 30 days of randomization (non-responders) will be randomized to receive asynchronous text message reminders using framed messaging in combination with synchronous patient navigation.

Asynchronous text message reminders using framed messaging in combination with synchronous patient navigation.

Defined as completion of evidence-based cancer treatment according to international guidelines and measured using medical record data.

Defined by the proportion of patients who complete an initial treatment visit divided by those randomized

Defined by the proportion of patients who complete an enhanced outreach phone call divided by those contacted.

Defined by the proportion of patients who complete a patient navigation phone call (high touch strategy) divided by those contacted.

Defined by the proportion of patients with confirmation of results received divided by those randomized.

Defined by the stage at diagnosis, type of cancer treatment the patient received (e.g., CRT, surgery) measured using medical record data.

Inclusion Criteria: Patients will be eligible if they: are biological females are aged 18 or older have pathology-confirmed invasive cervical cancer diagnosis have pathology results evaluated at National Health Laboratory in Botswana Exclusion Criteria: Patients will be excluded if they: are biological males or otherwise born without a cervix are below the age of 18 due to the rarity of cervical cancer in this population do not meet study inclusion criteria