PROJECT SUMMARY This application is being submitted in response to the Notice of Special Interest (NOSI) identified as NOT-CA- 21-058. The number of cancer survivors living in low- and middle-income countries (LMICs) is expected to grow rapidly over the next decade driven in part by global advances in early detection and treatment, yet very little is known about the long-term needs of cancer survivors or delivery of survivorship care in LMICs. This supplement application will help to fill this critical research gap by quantitatively and qualitatively evaluating care outcomes and contextual determinants of survivorship care among women diagnosed with cervical cancer in Botswana. Cervical cancer is one of the leading cancers among women globally with 600,000 new cases and 340,000 deaths annually per 2020 estimates. Cervical cancer is an acquired immunodeficiency syndrome (AIDS)-defining malignancy, and countries with high rates of human immunodeficiency virus (HIV) have higher incidence of cervical cancer. Due to high HIV-infection rates and suboptimal screening uptake, most of the burden of cervical cancer incidence, morbidity, and mortality falls on LMICs particularly in sub-Saharan Africa, with many women presenting with advanced disease. Botswana, a sub-Saharan African country, has high rates of cervical cancer (incidence rate of 34.4 per 100,000) and HIV (18.5% prevalence), and a high rate of mortality due to cervical cancer (20.1 per 100,000) among women. To date, the majority of cancer research in Botswana and other LMICs has focused on early detection or treatment, with limited research evaluating the long-term physical or psychosocial outcomes in survivorship or how survivorship care may impact these outcomes. Furthermore, even less is known regarding which approaches may be most impactful and sustainable to deliver survivorship care in LMICs. As such, there is a critical need to understand the current state of survivorship in LMICs and to identify effective strategies to ensure that all women receive optimal survivorship care. The objectives of this project are to: 1) quantitatively describe a) patterns in post-treatment survivorship care and b) long-term physical and psychosocial sequelae of cervical cancer using an existing cohort of patients at Princess Marina Hospital in Gaborone, Botswana; and 2) qualitatively assess contextual determinants (e.g., quality of life, access to resources, care delivery strategies) shaping patient experiences and adherence to survivorship care. In combination, these data will be used to develop and/or adapt survivorship care interventions to target the specific contextual determinants in Botswana and other LMICs. The results of this project will advance scientific understanding of survivorship care and sequelae in LMICs and how these experiences may or may not differ from the experiences and needs of cancer survivors in high-income countries. This project will also generate fundamental evidence needed to ...