Botswana Harvard AIDS Institute Partnership (BHP) conducted community randomization on June 04,2020 for the Potlako Plus study. Potlako Plus is a multi intervention study to improve timely cancer detection, diagnosis and treatment initiation in Botswana.This is a five year pair-matched randomized study in Twenty rural/peri-urban communities in Botswana sponsored by the National Cancer Institute. Ten communities shall be randomized to receive the intervention with the other ten receiving standard-of-care.
The study aims to develop a multi component intervention that is feasible in a resource limited setting and to evaluate the interventions impact on time from symptoms to presentation to health care facility, and time from presentation at the health care facility to cancer treatment initiation. The study also seeks to assess the proportion of cancers treated in early stage.
Because the study will rely on community engagement and participation, to ensure community leadership and participation, the Paramount Chief of Balete, Kgosi Mosadi Seboko and Bishop Raphael Habibo of the Assemblies of God Botswana were requested to participate in the community randomization. Ministry of Health and Wellness (MOHW) officials, Dr Gontse Tshisimogo, Non Communicable Disease (NCD) Programme Manager and NCD Officer, Dr Lame Seema, assisted the two community leaders. The randomization was conducted following a candle lighting ceremony in remembrance of those who have lost their lives to cancer and recently to the COVID-19 global pandemic.
In his welcome remarks at the event, BHP Chief Executive (CEO) Dr Joseph Makhema described cancer as a very insidious disease, which often by the time it is diagnosed, it would have already caused significant harm. “It is time we go to the communities to educate, detect cancer early and link patients to care. We have to do the research and share the data of proven impactful research interventions with policy makers for implementation and transformation of policy to improve our health system,” said Dr Makhema.
Giving an overview of the study, BHP Deputy CEO, Dr Mompati Mmalane revealed that cancers in Botswana and the region are diagnosed late resulting in avoidable deaths and inefficient use of resources. “Potlako Plus will rigorously evaluate an innovative cancer early diagnosis intervention that has potential to save lives and strengthen health systems in Botswana and elsewhere,” he said.
The study will enroll Batswana citizens aged 30 years and above residing in the study communities. The anticipated sample size is 1500 cancer suspects and 400 diagnosed cancers.
Dr Mmalane revealed that interventions will include oncology training, standardized referral algorithm, pathology results follow ups, appointment bookings, community awareness campaigns, phone based navigation, short message (sms) visit reminders, defaulter tracing and provision of transport for the vulnerable. These interventions will be employed only in the communities in the intervention arm while those in the Standard of Care arm will receive the usual health care services.
Bishop Raphael Habibo expressed his appreciation for taking part in the randomization exercise. He also pointed out that his involvement as a Pastor indicates that there is no conflict between the Church and medical health care. Some patients are said to be avoiding medical assistance saying that it is against their religious believes but Bishop Habibo said his participation was a show of partnership and support to save lives.
For her part, Kgosi Mosadi Seboko also appreciated having taken part in the randomization, indicating that part of Dikgosi’s job is to look after the welfare of the communities. She pointed out the need for BHP to request for a slot to introduce the study to Dikgosi at the next sitting of Ntlo ya Dikgosi (House of Chiefs).
“Bringing us, Bogosi and Pastors together is an indication of your resolve to bring communities together as evidenced by your proposed community interventions to save lives. We will win the fight against all ills if we work together,” she said.
In her remarks, Potlako plus Project Coordinator Kutlo Manyake thanked Kgosi Seboko, Bishop Habibo and the Ministry of Health and Wellness officials for being part of this important exercise that ensures the integrity of the study. She promised the community leaders utmost cooperation and respect, as they will be in their respective communities conducting the study.
The randomization of the 10 community pairs is as follows;