Evaluation of a training intervention to improve cancer care in Zimbabwe: strategies to improve kaposi sarcoma outcomes (SIKO), a prospective community-based stepped-wedge cluster randomized trial
Open accessAbstract
INTRODUCTION: Most Zimbabweans access medical care through tiered health systems. In 2013, HIV care was decentralized to primary care clinics; while oncology care remained centralized. Most persons in Zimbabwe with Kaposi sarcoma (KS) are diagnosed late in their disease, and the prognosis is poor. Little is known about whether educational interventions could improve KS outcomes in these settings. METHODS: Interventions to improve KS detection and management were evaluated at eight Zimbabwe primary care sites (four rural/four urban) that provided HIV care. Interventions included a standardized KS clinical evaluation tool, palliative care integration, standardized treatment and improved consultative services. Interventions were implemented between February 2013 and January 2016 using a randomized stepped-wedge cluster design. Sites were monitored for KS diagnosis rates and KS outcomes, including early diagnosis (T0 vs. T1 tumour stage), participant retention and mortality. Analyses controlled for within-clinic correlations. RESULTS: A total of 1102 persons with suspected KS (96% HIV positive) were enrolled: 47% incident (new diagnosis), 20% prevalent (previous diagnosis) and 33% determined as not KS. Early (T0) diagnosis increased post-intervention, though not significant statistically (adjusted odds ratio [aOR] = 1.48 [95% confidence interval (95% CI): 0.66-3.79], p = 0.37). New KS diagnosis rates increased 103% (95% CI: 11-273%), p = 0.02) post-intervention; although paired with an increased odds of incorrectly diagnosing KS (aOR = 2.08 [95% CI: 0.33-3.24], p = 0.001). Post-intervention, non-significant decreases in 90-day return rates (adjusted hazard ratio [aHR] = 0.69 [95% CI: 0.38-1.45], p = 0.21) and survival (aHR = 1.36 [95% CI: 0.85-2.20], p = 0.20) were estimated. CONCLUSIONS: KS training interventions at urban and rural Zimbabwe decentralized primary care clinics significantly increased overall and incorrect KS diagnosis rates, but not early KS diagnosis rates, 90-day return rates or survival.
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Within blocks, sites in Sabourin et al. 2022 were randomized to obtain the order for implementation of the Intervention Package.
“Within blocks, sites were then randomized to obtain the order for implementation of the Intervention Package.”
From Applications and implementation considerations for stepped-wedge designs in sub-Saharan Africa: a systematic review (2026) · cites this paper as [70]
The intervention order for urban and rural sites in Sabourin et al. 2022 was block randomized.
“The intervention order for urban and rural sites was block randomized.”
From Applications and implementation considerations for stepped-wedge designs in sub-Saharan Africa: a systematic review (2026) · cites this paper as [70]
The stepped-wedge design in Sabourin et al. 2022 ensured that urban and rural sites had a similar number of weeks in the pre-intervention and intervention periods.
“This design ensured that urban and rural sites had a similar number of weeks in the pre-intervention and intervention periods.”
From Applications and implementation considerations for stepped-wedge designs in sub-Saharan Africa: a systematic review (2026) · cites this paper as [70]
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- Authors
- Sabourin, K. R., Borok, M., Mawhinney, S., Matimba, M., Jaji, F., Fiorillo, S., Chifamba, D. D., Muserere, C., Mashiri, B., Bhodheni, C., Gambiza, P., Mandidewa, R., Mutimuri, M., Gudza, I., Mulvahill, M., Moore, C. M., Kutner, J. S., Simões, E. A. F., & Campbell, T. B.
- Affiliations
- University of Colorado Anschutz (US)
- University of Zimbabwe (ZW)
- Island Hospice and Healthcare Harare Zimbabwe
- Colorado School of Public Health (US)
- Corresponding author
- Campbell, Thomas B.
- ORCID
- Venue
- Journal of the International AIDS Society
- Publisher
- Wiley
- Published
- 2022-08
- Volume
- 25
- Issue
- 8
- Pages
- e25998-e25998
- ISSN
- 1758-2652 (ISSN-L)
- PMC
- PMC9418419
- OpenAlex
- W4293511057
- Cited by
- 4
- References
- 28
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2
- FWCI
- 0.31
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of the International AIDS Society (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (1RO1CA172050)
- Topics
- Health Sciences › Medicine › Oncology › Viral-associated cancers and disorders
- Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Keywords
- Kaposi's sarcoma, cancer care, health professions education, AIDS-related Kaposi's sarcoma, early diagnosis, primary health centers, palliative care integration, oncology services, patient retention, survival, Zimbabwe, clinical assessment tools, rural and urban health services
- MeSH terms
- Humans, Prospective Studies, Sarcoma, Kaposi, Zimbabwe, HIV Infections, Early Detection of Cancer
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