# Fidelity and adaptation of breast cancer resource-stratified treatment guidelines in Botswana

> **NIH NIH K01** · UNIVERSITY OF PENNSYLVANIA · 2020 · $137,970

## Abstract

Project Summary
 Breast cancer is the leading cause of cancer mortality among women globally with over
626,000 deaths reported in 2018. Despite substantial reductions in breast cancer mortality in
developed countries, low- and middle- income countries (LMICs) continue to experience a high
fatality rate. The disparity is more pronounced in Sub Saharan Africa (SSA) and in HIV
prevalent regions, where HIV-infected (HIV+) breast cancer patients have a significantly
increased risk of all-cause mortality. The “World Health Organization-Choosing Interventions
that are Cost-Effective” team assessed systemic treatment for breast cancer at 95% coverage in
SSA as cost-effective. Subsequently robust evidence-based resource-stratified guidelines have
been developed to promote high quality breast cancer therapy delivery in SSA. However critical
real-world data are lacking on the treatment fidelity and the implementation of guideline-based
care. These data are critical to understanding whether inferior outcomes are related to the
quality or extent of guideline implementation or other unrelated factors. If interventions that
maximize treatment fidelity and minimize random variability are implemented, targeted
outcomes will likely be achieved.
 The long-term goal is to improve survival outcomes in HIV+ and HIV- breast cancer patients
in SSA by designing targeted interventions to increase high-quality therapy delivery. The
objectives of this application are to allow Dr. Martei to formally train to become an independent
investigator in implementation science in cancer care delivery in SSA, and to obtain practical
skills through the following research aims: 1) compare treatment fidelity between HIV+ and HIV-
breast cancer patients receiving curative intent therapy and identify HIV modifiers of fidelity; 2)
using mixed methods design and a deviance sample of patients with high and low fidelity
identify socioeconomic and cultural modifiers of fidelity; and 3) using the collaborative
intervention planning framework to identify targets for guideline adaptation and develop a menu
of implementation strategies and intervention trials to promote treatment fidelity. This study in
Botswana builds upon 15 years of collaborative research between Botswana and the University
of Pennsylvania, including a multidisciplinary group of US- and Botswana-based senior mentors,
and the strong publicly-funded healthcare system for HIV and breast cancer. This is aligned with
the National Cancer Institute Center for Global health priority areas of “Strengthening Global
Cancer Research and Resource-Appropriate Cancer Control Strategies” to promote cancer
research and control efforts that are evidence-based and sustainable in LMICs.

## Key facts

- **NIH application ID:** 9889663
- **Project number:** 1K01TW011481-01
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Yehoda Marteki Martei
- **Activity code:** K01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $137,970
- **Award type:** 1
- **Project period:** 2020-05-14 → 2024-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9889663

## Citation

> US National Institutes of Health, RePORTER application 9889663, Fidelity and adaptation of breast cancer resource-stratified treatment guidelines in Botswana (1K01TW011481-01). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/9889663. Licensed CC0.

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