- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05364138
Evaluating Scaleup of an Adapted Breast Cancer Early Diagnosis Program in Rwanda
Breast cancer incidence is increasing in low- and middle-income countries (LMICs) and breast cancer mortality is high in these regions largely due to late stage diagnoses. This is true in the low-income East African country of Rwanda, where there are no national protocols in place to guide evaluation and referral of breast symptoms at primary health facilities.
This study will use quantitative and qualitative methods to examine implementation of the Women's Cancer Early Detection Program (WCEDP) in order to understand optimal strategies to scale and sustain breast cancer early diagnosis in Rwanda and other limited-resource settings. The WCEDP is an adaptation of a prior intervention in Burera District, which focused on building community awareness of breast symptoms, improving clinicians' clinical breast assessment (CBA) skills, and implementing weekly breast clinics at the primary health care center and hospital levels. The Burera intervention was associated with improvements in health care workers' knowledge and skills, increases in care-seeking and receipt of care by women with breast symptoms, and an increase in early-stage breast cancer diagnoses.
Study Overview
Status
Conditions
Detailed Description
Despite the Burera trial's promising results it was clear adaptations would be needed for real-world scaleup. The Burera intervention focused on breast health in isolation, hindering scalability in a limited-resource health system. In addition, it benefited from intensive patient tracking, feasible with the study's resources and implementation in a single district. Rwanda Biomedical Centre (RBC) is now scaling up breast cancer early diagnosis using the Burera training program with two key adaptations. First, in an effort to expand reach and increase efficiency, breast cancer early diagnosis services are offered together with cervical cancer screening in a combined initiative, the Women's Cancer Early Detection Program. The WCEDP combines these services through: 1)Combined provider trainings; 2)Community awareness-raising about both cancers; and 3)Weekly district hospital (DH) and HC clinics for women eligible for cervical cancer screening and CBA. RBC's second adaptation, an effort to facilitate patient tracking and linkage to care at scale, is a tablet-based EMR that allows clinicians to share information across facilities, identify missed visits, and document patient phone calls. These adaptations address priorities of the WHO's Global Breast Cancer Initiative: integrating early diagnosis into primary care services and building systems to facilitate referrals. By examining these adaptations in a real-world setting, this research will contribute to global efforts to identify evidence-based implementation strategies to address breast cancer in LMICs.
This study will leverage a longstanding partnership between RBC, Partners In Health (PIH), and Brigham and Women's Hospital (BWH) to pursue the following Specific Aims:
Aim 1. Use the RE-AIM framework to examine implementation and impact of Rwanda's adaptation and scale-up of breast cancer early diagnosis within the WCEDP, in 3 districts with 52 HCs.
1a. Evaluate the WCEDP's reach using interrupted time series analysis to examine its impact on the number of patients receiving CBA at HCs, and engagement of older women and those with breast symptoms.
1b. Examine program effectiveness, adoption and implementation by assessing timely linkage to care, loss-to-follow-up, service delivery, and EMR use.
Aim 2. Use patient and provider interviews, guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, to elicit contextual factors related to successes and challenges of scaleup, including the WCEDP's fit and acceptability for communities, clinicians, and facilities.
Study Type
Enrollment (Estimated)
Contacts and Locations
Study Contact
- Name: Lydia Pace, MD, MPH
- Phone Number: 4154657223
- Email: lpace@bwh.harvard.edu
Study Locations
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-
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Butaro, Rwanda
- Recruiting
- Partners in Health (Inshuti Mu Buzima)
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Contact:
- Vincent Cubaka, MD
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
Sampling Method
Study Population
Description
Inclusion Criteria:
- All individuals who are evaluated for a breast concern or receive breast cancer screening through implementation of the nationally-led early detection programs
Exclusion Criteria:
- None
Study Plan
How is the study designed?
Design Details
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Number of patients presenting to health centers for CBA per week (Reach)
Time Frame: 12 months
|
The primary analysis will be interrupted time series (ITS) Poisson regression to compare the number of patients presenting for CBA to health centers each week in the months before and after initiation of the WCEDP
|
12 months
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Age of patients received (Reach)
Time Frame: 18 months
|
The investigators will examine the median age of individuals presenting before and after WCEDP
|
18 months
|
Proportion of patients receiving CBA who had breast symptoms (Reach)
Time Frame: 18 months
|
Investigators will examine the proportion of patients evaluated at health centers with CBA who had symptoms
|
18 months
|
Proportion of patients evaluated with CBA at health centers who also had cervical cancer screening (Reach)
Time Frame: 18 months
|
Proportion of patients evaluated with CBA at health centers who also had cervical cancer screening (Reach)
|
18 months
|
WCEDP Effectiveness - HCs
Time Frame: 12 months
|
Number and percentage of women seen at health centers for CBA who are referred to district hospitals (and seen within 1 month of DH visit)
|
12 months
|
WCEDP Effectiveness - DHs
Time Frame: 12 months
|
Number and percentage of women seen at district hospitals for CBA who are referred to referral facilities (and seen within 1 month of DH visit)
|
12 months
|
WCEDP Adoption - CHWs
Time Frame: 12 months
|
Number and percentage of community health workers (CHWs) trained
|
12 months
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WCEDP Adoption - Clinicians
Time Frame: 12 months
|
Number and percentage of clinicians trained in the program and in electronic medical record
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12 months
|
WCEDP Implementation - Clinics
Time Frame: 6 and 12 months
|
Number and percentage of weeks that clinics are held at each health center and district hospital (and the average percentage per district)
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6 and 12 months
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WCEDP Implementation - CHWs
Time Frame: 6 and 12 months
|
Number of days/ month that CHWs hold community awareness events or do home visits (and average percentage per district)
|
6 and 12 months
|
WCEDP Implementation - electronic medical record
Time Frame: 6 and 12 months
|
Proportion of weeks in which electronic medical record missed-visit reports are run in each district hospital
|
6 and 12 months
|
WCEDP Implementation - Phone calls
Time Frame: 6 and 12 months
|
Of patients who have missed district hospital visits, percentage with phone call documented in the electronic medical record
|
6 and 12 months
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Lydia Pace, MD, MPH, Brigham and Women's Hospital
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Skin Diseases
- Neoplasms
- Urogenital Neoplasms
- Neoplasms by Site
- Uterine Neoplasms
- Genital Neoplasms, Female
- Uterine Cervical Diseases
- Uterine Diseases
- Female Urogenital Diseases
- Female Urogenital Diseases and Pregnancy Complications
- Urogenital Diseases
- Genital Diseases
- Genital Diseases, Female
- Uterine Cervical Neoplasms
- Breast Neoplasms
- Breast Diseases
- Fibrocystic Breast Disease
Other Study ID Numbers
- 2021P002943
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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