# A multilevel intervention (Potlako+) to improve timely cancer detection and treatment initiation

> **NIH NIH R01** · BRIGHAM AND WOMEN'S HOSPITAL · 2021 · $479,108

## Abstract

Project Summary/Abstract
The HIV pandemic has intensified the growing burden of cancer in low- and middle-income countries (LMICs),
where nearly three-quarters of all cancer deaths occur. The majority of patients in LMICs have advanced cancer
stage and limited opportunity for survival. Meaningful improvements in cancer mortality in LMICs will require
prompt diagnosis and efficient linkage to care, however research identifying effective strategies has not been
conducted. Botswana has key resources in place— free-of-charge medical care including comprehensive cancer
care, accessible primary clinics, and an internationally-emulated ART program— yet large gaps in timely
cancer care and thus provides a key opportunity to innovate strategies to detect cancer earlier and engage
patients in care. The Potlako pilot trial (ORBIT phase IIa), evaluating an intervention targeting diagnostic and
pre-treatment intervals in a single district (27 communities) in Botswana, has successfully increased the
number of patients entering cancer care and number treated with curative intent compared to historical
controls. As a next step, the Potlako+ trial— a community-randomized (26 geographically diverse rural
communities, 1:1), pragmatic, ORBIT phase IIb, type 1 hybrid effectiveness-implementation trial— will assess a
complex, theory-informed intervention to promote earlier clinic presentation with symptoms suggestive of
cancer, enable efficient diagnosis, and facilitate prompt initiation of oncologic treatment. The Potlako+ trial
targets high burden cancers accounting for 60% of cancer deaths (breast, cervix, anus, penis, vulva, and head
and neck) which are typically curable with early detection of symptoms. We utilize cancer stage at time of
treatment initiation, incidence of curative intent treatment, and the duration of Models of Pathways to
Treatment intervals as primary effectiveness endpoints. Implementation will be evaluated using the RE-AIM
framework. The project will achieve three aims: 1) Assess the effectiveness of cancer symptom awareness
intervention with rural residents (persons living with HIV and HIV-uninfected) aged 30 years and older in
decreasing time to presentation with moderate and high probability cancer syndromes, 2) Assess impact of a
comprehensive cancer patient navigation platform on reducing time to diagnosis and initiation of cancer
treatment (diagnostic and pre-treatment intervals), and 3) Evaluate whether the combined multilevel
intervention improves early stage treatment and cumulative incidence of curative intent treatment.
Understanding the impact and implementation of these interventions will inform strategies of care for LMIC
populations at increasing risk of cancer death and contribute to developing models of primary care in resource-
constrained environments.

## Key facts

- **NIH application ID:** 10242834
- **Project number:** 5R01CA236546-03
- **Recipient organization:** BRIGHAM AND WOMEN'S HOSPITAL
- **Principal Investigator:** Scott Dryden-Peterson
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $479,108
- **Award type:** 5
- **Project period:** 2019-09-19 → 2024-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10242834

## Citation

> US National Institutes of Health, RePORTER application 10242834, A multilevel intervention (Potlako+) to improve timely cancer detection and treatment initiation (5R01CA236546-03). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10242834. Licensed CC0.

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