Implementing breast cancer screening using clinical breast exam in the primary health centers of Abuja, Nigeria

Yale University, New Haven CT

Investigators

Abstract

The primary goal of this research proposal is to provide Dr. O’Neil with four years of training and research experience in implementation science and mixed-methods research techniques to support his transition to being an independent researcher focused on improving the early detection of breast cancer and breast cancer care more broadly in low- and middle-income countries (LMICs). Breast care patients from LMICs face far higher mortality that patients from the USA, in part because a lack of screening mammography results in more than 50% being diagnosed with stage III or IV cancer. Breast cancer screening using clinical breast exam has been shown it to be nearly as effective at detecting early BC as mammography and capable of decreasing BC stage at diagnosis and mortality. However, screening CBE (sCBE) has not been widely implemented in LMICs, including Nigeria. Dr. O’Neil proposes to use the Implementation Mapping process to collaboratively design and pilot a set of strategies for implementing sCBE in the primary health centers (PHCs) of Abuja, Nigeria. In Aim 1, he will engage with provider and patient stakeholders at two participating PHCs to conduct a baseline needs assessment, identify determinants of implementation with change objectives, select applicable strategies, and then produce implementation materials. Determinant and strategy selection will be organized using the COM-B and behavioral wheel of change frameworks. In Aim 2, Dr. O’Neil will conduct a feasibility pilot study of sCBE implementation in the same two PHCs, using the strategies developed in Aim 1. This study will allow for refinement of the strategies, and the primary outcome will compare receipt of sCBE among eligible women before and after implementation. These results and other secondary results from the RE-AIM framework will provide preliminary data supporting an R01 proposal for a large-scale hybrid trial measuring the effectiveness and implementation success of the sCBE implementation package developed here. Dr. O’Neil has substantial experience studying breast cancer care quality and barriers to care in sub-Saharan Africa. His training plan adds to that foundation by emphasizing new skills essential to actually improving care, with formal instruction in the theories and methods of implementation science and mixed-methods research. His mentoring team includes experts in breast cancer clinical research, implementation science, and global oncology, who are uniquely qualified to supervise Dr. O’Neil’s research program and to help him expand his academic global oncology network. Dr. O’Neil will also be leveraging a partnership with breast cancer researchers at the Institute of Human Virology Nigeria / International Research Center of Excellence in Abuja, Nigeria, who will be enthusiastic collaborators in the proposed work and provide vital support. This work will the first step towards scaling-up and studying breast cancer screening throughout Nigeria and other LMICs, a public health goal with the potential to decrease global breast cancer mortality. It will also position Dr. O’Neil for a successful career as an independent global oncology implementation scientist.