Global Breast and Cervical Cancer Control: Implementing a Bundled Screening Approach in a Resource Limited Setting - ABSTRACT In Sub-Saharan Africa, 75% of women diagnosed with breast or cervical cancer are already in late-stage disease, a much more dire figure than women in high income countries. One reason for this is a lack of programs for cancer screening and early detection, which could be remedied by bundling breast and cervical cancer screening, an innovative approach that is known to improve access to preventative cancer care and yield an earlier cancer diagnosis, thereby decreasing its morbidity and mortality. Clinical Breast Exam (CBE) and the “screen-and-treat” approach for cervical cancer via visual inspection with acetic acid (VIA) are effective screening modalities and often the top choice in resource-limited settings. However, there is a critical gap in knowledge of how to effectively implement and optimize these bundled interventions. The Cameroon Baptist Convention Health Services (CBCHS) runs the largest and most comprehensive breast (CBE) and cervical cancer screening (VIA and HPV testing) program in Cameroon by bundling both screenings into a single service. Through a long- established collaboration between CBCHS and UAB researchers, there is now an opportunity to conduct implementation science-driven research to optimize the screening program, improve the screening to diagnosis to treatment cascade, and to effectively disseminate the program, thereby maximizing its public health impact. Guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) robust implementation science framework, the proposed career development award aims to 1) establish the reach and effectiveness of the bundled women’s cancer screening program and compare these metrics across stationary and mobile clinics, 2) identify the implementation outcomes of acceptability (patient level), appropriateness (provider level), and cost (organization level) along with barriers and facilitators to program maintenance (organization level), and 3) conduct implementation mapping via stakeholder (patients, providers, organizational leaders, Ministry of Health personnel) engagement to devise a patient-centered multi-level implementation strategy(s) to enhance and disseminate two bundled evidence-based cancer screening interventions into new clinic sites in the public health system in Cameroon. To successfully complete the project, the PI will receive mentorship from a team of experienced clinicians and researchers of health services, implementation science, and health economics. The PI will also gain focused training via a personalized dynamic learning plan in implementation science, mixed methods research, economic evaluation, and science of sustainability and scale. She will also participate in grant writing workshops over the award period in order to prepare follow-on grant proposals to further her work in the optimization of cancer control programs. Successful completion of the proposed research and training will position the PI as an independent, NIH-funded surgeon-scientist focused on enhancing equitable global cancer control by implementing innovative, scalable, and evidence-based interventions.
