Thibang Diphatlha: Testing adaptive strategies to close the gap from cervical cancer diagnosis to treatment in Botswana

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This application is being submitted in response to the Notice of Special Interest (NOSI) identified as “NOT-CA-23-025”. Cervical cancer is the leading cause of cancer-related death in Botswana. About half of the women with cervical cancer in Botswana do not receive timely treatment, increasing their risk of greater morbidity and mortality. Stigma and fear surrounding cervical cancer present significant barriers to care in this cultural context, as cancer and its treatment are often paired with negative associations, concerns over impaired reproductive health, and self-blame. While prior studies have explored the impact of stigma on cervical cancer screening in low- and middle-income countries (LMIC), there is limited knowledge regarding how cancer stigma manifests during the subsequent stages of post-diagnosis care and survivorship. This proposed study builds upon its parent project “Thibang Diphatlha” (U01CA275032), which tests adaptive strategies to close the gap from cervical cancer diagnosis to treatment initiation in Botswana. In this supplemental study, we propose to conduct additional qualitative assessments to understand how cervical cancer stigma impacts survivors at multiple levels throughout the care cascade, and how other intersectional factors, such as HIV status, manifest in the stigma process. Through engagement with different stakeholder groups, we will also co-produce an intervention logic model and pre- test individual intervention components to inform development of an efficient, parsimonious anti- stigma intervention for cervical cancer survivors in Botswana. The proposed research will advance our understanding of culture salient experiences of stigma among invasive cervical cancer survivors, to inform the development, optimization, and pre-testing of a targeted intervention to reduce stigma and facilitate resilience and recovery among this highly vulnerable population in Botswana and other LMIC contexts.