Tapela, NeoPeluso, Michael J.Kohler, RacquelSetlhako, Irene I.Botebele, KerapetseGabegwe, KemisoNkele, IsaacNarasimhamurthy, MohanMmalane, MompatiGrover, SurbhiBarak, TomerShulman, Lawrence N.Lockman, ShahinDryden-Peterson, Scott2018-07-252018Tapela, N. M., M. J. Peluso, R. E. Kohler, I. I. Setlhako, K. Botebele, K. Gabegwe, I. Nkele, et al. 2018. “A Step Toward Timely Referral and Early Diagnosis of Cancer: Implementation and Impact on Knowledge of a Primary Care-Based Training Program in Botswana.” Frontiers in Oncology 8 (1): 187. doi:10.3389/fonc.2018.00187. http://dx.doi.org/10.3389/fonc.2018.00187.http://nrs.harvard.edu/urn-3:HUL.InstRepos:37298454Introduction: Health system delays in diagnosis of cancer contribute to the glaring disparities in cancer mortality between high-income countries and low- and middle-income countries. In Botswana, approximately 70% of cancers are diagnosed at late stage and median time from first health facility visit for cancer-related symptoms to specialty cancer care was 160 days (IQR 59–653). We describe the implementation and early outcomes of training targeting primary care providers, which is a part of a multi-component implementation study in Kweneng-East district aiming to enhance timely diagnosis of cancers. Methods: Health-care providers from all public facilities within the district were invited to participate in an 8-h intensive short-course program developed by a multidisciplinary team and adapted to the Botswana health system context. Participants’ performance was assessed using a 25-multiple choice question tool, with pre- and post-assessments paired by anonymous identifier. Statistical analysis with Wilcoxon signed-rank test to compare performance at the two time points across eight sub-domains (pathophysiology, epidemiology, social context, symptoms, evaluation, treatment, documentation, follow-up). Linear regression and negative binomial modeling were used to determine change in performance. Participants’ satisfaction with the program was measured on a separate survey using a 5-point Likert scale. Results: 176 participants attended the training over 5 days in April 2016. Pooled linear regression controlling for test version showed an overall performance increase of 16.8% after participation (95% CI 15.2–18.4). Statistically significant improvement was observed for seven out of eight subdomains on test A and all eight subdomains on test B. Overall, 71 (40.3%) trainees achieved a score greater than 70% on the pretest, and 161 (91.5%) did so on the posttest. Participants reported a high degree of satisfaction with the training program’s content and its relevance to their daily work. Conclusion: We describe a successfully implemented primary health care provider-focused training component of an innovative intervention aiming to reduce health systems delays in cancer diagnosis in sub-Saharan Africa. The training achieved district-wide participation, and improvement in the knowledge of primary health-care providers in this setting. Clinical Trial Registration www.ClinicalTrials.gov, identifier NCT02752061.en-UScancer early diagnosishealth system delaysprimary careprimary care providersBotswanasub-Saharan AfricatrainingJournal Article2018-07-2510.3389/fonc.2018.00187