Grant Number:	5R34CA283483-03 Interpret this number
Primary Investigator:	Katz, Ingrid
Organization:	Brigham And Women'S Hospital
Project Title:	Multi-Level Shared Decision-Making Intervention to Prevent Cancer in South Africa
Fiscal Year:	2025

Cancer prevention remains one of the most pressing public health challenges worldwide. Cancers of the cervix, anogenital tract, and oropharynx disproportionately affect people in low-resource settings, and South Africa carries one of the heaviest burdens due to the intersection of high HIV prevalence with elevated rates of infection-related cancers in young people. Cervical cancer is the leading cause of cancer-related mortality among women in South Africa. In 2014, the National Department of Health launched a national, school-based program to reduce future cancer burden. While initial implementation was promising, completion rates declined substantially after 2014, with fewer than four in ten girls receiving effective cancer prevention strategies in 2021. These declines reflect prior service interruptions, challenges in delivery, and reduced confidence in health systems. Important access gaps also remain for boys and for adolescents outside the public school system. Addressing these gaps is critical for effective cancer prevention. The overall objective of this project is to refine and evaluate a school-based, multi-level education and communication strategy that supports parents and caregivers in making informed decisions, equips teachers and schools with effective materials, and ensures shared decision-making through accessible and trusted channels. The project will be conducted in partnership with the Department of Health and schools in Gauteng Province, a region with high burden of preventable cancers. Investigators from the United States and South Africa bring expertise in cancer prevention, health communication, participatory design, and community engagement to pursue two specific aims: (1) to refine components of a multi-level education strategy to strengthen informed parental choice and shared decision-making for effective cancer prevention strategies for girls and boys; and (2) to evaluate feasibility, early outcomes, and criteria necessary to advance to a full-scale trial. Our systems-focused approach leverages established partnerships with schools that serve diverse populations not always reached by traditional health services. Education and parental engagement will be central, integrating the voices of communities living in low-resource settings to identify and reduce barriers to cancer prevention. This proposal is directly responsive to NCI’s call for cancer prevention and control clinical trials planning grants (PAR-22-173) through its emphasis on active stakeholder engagement and its focus on engaging a diverse, scientifically appropriate study population.





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