Efstathiou J.A.,Harvard University |
Heunis M.,Stellenbosch University |
Karumekayi T.,Gaborone Private Hospital |
Makufa R.,Gaborone Private Hospital |
And 11 more authors.
Journal of Clinical Oncology | Year: 2016
There is a global cancer crisis, and it is disproportionately affecting resource-constrained settings, especially in low- and middle-income countries (LMICs). Radiotherapy is a critical and cost-effective component of a comprehensive cancer control plan that offers the potential for cure, control, and palliation of disease in greater than 50% of patients with cancer. Globally, LMICs do not have adequate access to quality radiation therapy and this gap is particularly pronounced in sub-Saharan Africa. Although there are numerous challenges in implementing a radiation therapy program in a low-resource setting, providing more equitable global access to radiotherapy is a responsibility and investment worth prioritizing. We outline a systems approach and a series of key questions to direct strategy toward establishing quality radiation services in LMICs, and highlight the story of private-public investment in Botswana from the late 1990s to the present. After assessing the need and defining the value of radiation, we explore core investments required, barriers that need to be overcome, and assets that can be leveraged to establish a radiation program. Considerations addressed include infrastructure; machine choice; quality assurance and patient safety; acquisition, development, and retention of human capital; governmental engagement; public-private partnerships; international collaborations; and the need to critically evaluate the program to foster further growth and sustainability. © Copyright 2016 American Society of Clinical Oncology. All rights reserved. Source
Massele A.,University of Botswana |
Tiroyakgosi C.,Ministry of Health |
Matome M.,Managed Care |
Desta A.,WHO Regional Office for Africa |
And 9 more authors.
Expert Review of Pharmacoeconomics and Outcomes Research | Year: 2016
There is a need to improve the rational use of antibiotics across continents including Africa. This has resulted in initiatives in Botswana including treatment guidelines and the instigation of Antibiotic Stewardship Programs (ASPs). The next steps involve a greater understanding of current antibiotic utilization and resistance patterns (AMR). This resulted in a 2-day meeting involving key stakeholders principally from Botswana to discuss key issues including AMR rates as well as ASPs in both the public and private sectors. Following this, the findings will be used to plan future studies across Africa including point prevalence studies. The findings will be presented in July 2016 at the next Medicines Utilization Research in Africa meeting will ideally serve as a basis for planning future pertinent interventional studies to enhance the rational use of antibiotics in Botswana and wider. © 2016 Informa UK Limited, trading as Taylor & Francis Group Source
Brown C.A.,Botswana Harvard AIDS Institute |
Suneja G.,University of Utah |
Tapela N.,University of Botswana |
Mapes A.,Botswana Harvard AIDS Institute |
And 16 more authors.
Oncologist | Year: 2016
Background. Three-quarters ofcancerdeathsoccur inresourcelimited countries, and delayed presentation contributes to poor outcome. In Botswana,wheremore than half of cancers arise in HIV-infected individuals, we sought to explore predictors of timely oncology care and evaluate the hypothesis that engagement in longitudinal HIV care improves access. Methods. Consenting patients presenting for oncology care from October 2010 to September 2014 were interviewed and their records were reviewed. Cox and logistic models were used to examine the effect of HIV and other predictors on time to oncology care and presentation with advanced cancer (stage III or IV). Results. Of the 1,146 patients analyzed, 584 (51%) had HIV and 615 (54%) had advanced cancer. The initial clinic visit occurred a mean of 144 days (median 29, interquartile range 0-185) after symptom onset, but subsequent mean time to oncology care was 406 days (median 160, interquartile range 59-653). HIV status was not significantly associated with time to oncology care (adjusted hazard ratio [aHR] 0.91, 95% confidence interval [CI] 0.79-1.06). However, patients who reported using traditional medicine/healers engaged in oncology care significantly faster (aHR 1.23, 95% CI 1.09-1.40) and those with advanced cancer entered care earlier (aHR 1.48, 95% CI 1.30-1.70). Factors significantly associated with advanced cancer included income,$50 permonth (adjusted odds ratio [aOR] 1.35, 95% CI 1.05-1.75), male sex (aOR 1.45, 95% CI 1.12-1.87), and pain as the presenting symptom(aOR 1.39, 95% CI 1.03-1.88). Conclusion. Longitudinal HIV care did not reduce the substantial delay to cancer treatment. Research focused on reducing health system delay through coordination and navigation is needed. © AlphaMed Press 2016. Source
Efstathiou J.A.,Massachussetts General Hospital |
Bvochora-Nsingo M.,Gaborone Private Hospital |
Gierga D.P.,Massachussetts General Hospital |
Alphonse Kayembe M.K.,National Health Laboratory |
And 20 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2014
Botswana has experienced a dramatic increase in HIV-related malignancies over the past decade. The BOTSOGO collaboration sought to establish a sustainable partnership with the Botswana oncology community to improve cancer care. This collaboration is anchored by regular tumor boards and on-site visits that have resulted in the introduction of new approaches to treatment and perceived improvements in care, providing a model for partnership between academic oncology centers and high-burden countries with limited resources. © 2014 Elsevier Inc. All rights reserved. Source
Grover S.,University of Pennsylvania |
Grover S.,University of Botswana |
Raesima M.,National Cervical Cancer Prevention Programme |
Bvochora-Nsingo M.,Gaborone Private Hospital |
And 29 more authors.
Frontiers in Oncology | Year: 2015
Botswana has a high burden of cervical cancer due to a limited screening program and high HIV prevalence. About 60% of the cervical cancer patients are HIV positive; most present with advanced cervical disease. Through initiatives by the Botswana Ministry of Health and various strategic partnerships, strides have been made in treatment of pre-invasive and invasive cancer. The See and Treat program for cervical cancer is expanding throughout the country. Starting in 2015, school-going girls will be vaccinated against HPV. In regards to treatment of invasive cancer, a multidisciplinary clinic has been initiated at the main oncology hospital to streamline care. However, challenges remain such as delays in treatment, lack of trained human personnel, limited follow-up care, and little patient education. Despite improvements in the care of pre-invasive and invasive cervical cancer patients, for declines in cervical cancer-related morbidity and mortality to be achieved, Botswana needs to continue to invest in decreasing the burden of disease and improving patient outcomes of patients with cervical cancer. © 2015 Grover, Raesima, Bvochora-Nsingo, Chiyapo, Balang, Tapela, Balogun, Kayembe, Russell, Monare, Tanyala, Bhat, Thipe, Nchunga, Mayisela, Kizito, Ho-Foster, Gaolebale, Gaolebale, Efstathiou, Dryden-Peterson, Zetola, Hahn, Robertson, Lin, Morroni and Ramogola-Masire. Source