Grant Details
Grant Number: |
5R01CA269472-03 Interpret this number |
Primary Investigator: |
Subramanian, Sujha |
Organization: |
Implenomics Llcs |
Project Title: |
An Integrated Community-Clinic Model of Optimized Implementation Strategies to Increase Early Detection of Breast and Cervical Cancers in Kenya |
Fiscal Year: |
2024 |
Abstract
PROJECT SUMMARY/ABSTRACT
Kenya has a high incidence of breast and cervical cancers, and most women are diagnosed with late-
stage disease. Implementing effective programs to screen and detect these cancers at an early stage could
substantially decrease the high mortality. Kenya has been increasing access to cancer screening, but less
than one-sixth of eligible women have ever received breast and cervical cancer screening.
The goal of the study is to assess the effectiveness and cost-effectiveness of multicomponent strategies
to increase the uptake of breast and cervical cancer screeening. A key gap that perpetuates the low
screening rates in Kenya is the lack of community–clinic linkages. There is evidence that women are often
unaware of the screening services offered in facilities, and, even among those who are aware, there is lack
of motivation, anticipated or perceived stigma, and reduced self-efficacy to undergo screening. We will
conduct a pragmatic cluster randomized trial to evaluate the screening outcomes, including screening
uptake, diagnostic test completion, and treatment initiation and implementation outcomes to support scale-
up. We will test two multicomponent packages of strategies: (1) Cancer Community–Clinic Linkage (C3Link)
Core: Community health volunteer (CHV)-delivered group education for women and family members to
increase screening uptake in the community setting and practice facilitation to improve the screening
process and develop team-based care with CHV participation in the clinic setting; (2) C3Link Plus: C3Link
Core strategies along with a sequential series of individual strategies that increase in intensity at 3-month
intervals; women who remain unscreened will first receive one-on-one education; second, motivational
interviewing; and, finally, navigation to address specific barriers.
We will implement the study across 27 communities in Kenya to address the following three specific
aims: Aim 1: Conduct a cluster randomized trial to assess short-term (intervention implementation phase)
and longer-term impacts (maintenance phase) of the two packages of multicomponent strategies on breast
and cervical cancer screening outcomes along the continuum of care compared to enhanced standard of
care (communities receiving a messaging campaign only); Aim 2: Use a mixed-methods approach to assess
and compare multilevel implementation outcomes of the package of strategies focusing on acceptability,
feasibility, appropriateness, fidelity, and sustainability; Aim 3: Perform cost-effectiveness and return-on-
investment analysis to support scale-up of an effective package of implementation strategies across Kenya
and other sub-Saharan African countries. The Kenyan Ministry of Health can use the findings from this study
to design optimal approaches and plan investments in screening infrastructure to scale up implementation of
guideline recommendations. The lessons learned can be applied to other sub-Saharan African settings.
Publications
None