Evaluating scaleup of an adapted breast cancer early diagnosis program in Rwanda

项目摘要 乳腺癌的负担在低收入和中等收入国家（LMIC）迅速上升，其中大多数妇女 乳腺癌患者被诊断为晚期疾病。由于后期的演示， 尽管撒哈拉以南非洲地区的乳腺癌年龄标准化发病率较低，但该地区的乳腺癌发病率 死亡率高于美国。我们以前研究过一种干预措施， 在卢旺达的一个区（Burera区）进行乳房症状评估， 接受乳房症状评估的妇女和增加的早期诊断。然而，有效 在资源有限的初级卫生保健中扩大乳腺癌早期诊断计划的战略 护理系统还没有得到很好的理解。扩展早期诊断的具体挑战包括整合 临床乳房评估与其他初级保健服务，并促进及时，可靠的联系，病人 将乳腺检查结果提交给更高级别的护理。本研究项目的目的是研究 卢旺达生物医学中心扩大Burera项目的实施成功和挑战 干预其他地区。为了促进规模扩大，RBC已经调整了该计划， 提高对有症状妇女的认识和评估，将其纳入宫颈癌筛查倡议， 利用基于平板电脑的电子医疗记录来促进患者跟踪。该项目将评估 执行这一经过调整的扩大规模举措的情况，以及成功执行的促进因素和障碍。 在目标1中，我们将使用RE-AIM框架来回顾性地检查WCEDP的覆盖范围、有效性， 采用和设施的实施保真度在该计划的第一年。在目标2中，我们将使用定性 在探索、准备、实施和维持（EPIS）框架的指导下， 卫生工作者对WCEDP的适合性、可行性和可接受性以及内部和外部背景的看法 影响成功的因素。我们还将通过WCEDP采访被诊断患有乳腺癌的妇女 探索适合性、可接受性和参与障碍和促进因素。理解实施 这种适应模型的成功和挑战将为进一步的适应提供信息，可以在更大的范围内进行研究。 研究项目，并与长期成果挂钩。该项目与国家癌症 研究所特别关注与中低收入国家癌症控制有关的实施研究， 致力于在全球癌症控制中追求公平。

PROJECT SUMMARY The burden of breast cancer is rising rapidly in low- and middle-income countries (LMICs), where most women with breast cancer are diagnosed with advanced-stage disease. Largely because of late-stage presentations, despite lower age-standardized incidence of breast cancer in sub-Saharan Africa, the region’s breast cancer mortality rates are higher than the United States’. We previously studied an intervention to facilitate timely evaluation of breast symptoms in a single Rwandan district (Burera District) which increased the number of women receiving evaluation for breast symptoms and increased early-stage diagnoses. However, effective strategies to scale-up breast cancer early diagnosis programs in resource-constrained primary health care systems are not well-understood. Particular challenges for scaling early diagnosis include integration of clinical breast assessment with other primary care services and facilitating timely, reliable linkage of patients with concerning breast findings to higher levels of care. The objective of this research project is to study implementation successes and challenges of Rwanda Biomedical Centre’s (RBC’s) scale-up of the Burera intervention to other districts. To facilitate scaleup, RBC has adapted the program to integrate breast cancer awareness-raising and evaluation of symptomatic women into a cervical cancer screening initiative and is utilizing a tablet-based electronic medical record to facilitate patient tracking. This project will evaluate implementation of this adapted scaleup initiative, and facilitators of and barriers to successful implementation. In Aim 1 we will use the RE-AIM framework to retrospectively examine the WCEDP’s reach, effectiveness, adoption and facilities’ implementation fidelity over the program’s first year. In Aim 2, we will use qualitative methods guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to identify health workers’ perceptions of fit, feasibility and acceptability of the WCEDP and inner and outer context factors influencing success. We will also interview women diagnosed with breast cancer through the WCEDP to explore fit, acceptability, and participation barriers and facilitators. Understanding the implementation successes and challenges of this adapted model will inform further adaptations that can be studied in a larger research project and linked to longer-term outcomes. This project aligns with the National Cancer Institute’s special interest in implementation research related to cancer control in LMICs and its commitment to pursuing equity in global cancer control.