Improving early diagnosis in Uganda through training on patient navigation

Uganda Women’s Cancer Support Organisation (UWOCASO) – Uganda

As part of the Breast Cancer programme, this project was awarded a grant for early detection of breast cancer in October 2022.

Project objectives

The objective of this project was to improve early diagnosis of breast cancer by providing education to three different groups: village health team (VHT) volunteers, UWOCASO volunteers, and health workers, with training on general breast health and patient navigation, and ultimately connecting women with breast complaints to the breast clinic for imaging diagnosis and biopsy.

Project description

The education and training materials were developed in conjunction with the Uganda Cancer Institute, helping to ensure that they were aligned with and could be endorsed by the MoH.

The team trained 25 VHT volunteers coming from seven health facilities in a train-the-trainer model. This group of volunteers were trained on the evaluation of breast complaints and referral pathways to expedite diagnosis. Notably, although VHT volunteers often have knowledge on health topics such as HIV/AIDS, malaria, immunisation, maternal health and family planning, they often have not been exposed to information about cancer. In a similar train-the-trainer model, and with a focused curriculum on patient navigation, 20 additional volunteers from UWOCASO were trained. Additionally, 149 primary health care providers were trained to identify early signs and symptoms of breast cancer as well as on the referral process.

Following the training, VHT volunteers have integrated breast cancer awareness into their routine community health mobilisation and sensitisation activities, which to date has resulted in 93 women in their communities with suspicious breast cancer symptoms being referred to the clinic for clinical breast examination (CBE). UWOCASO navigation services then supported 73 women to receive definitive diagnosis and finally 5 women to receive treatment.

The project also developed and printed a breast health card for women to use through the referral pathways. Health workers in the seven health facilities were trained on how to use the card, in addition to receiving quarterly continuous medical education (CMEs).

The project received ethical approval from the Uganda National Council for Science and Technology.

Key numbers

194 health care professionals trained (149 primary health care providers, 25 VHTs and 20 patient navigators) trained on breast health and patient navigation

93 women identified by VHTs with suspicious breast symptoms referred to clinic to receive CBE

73 women referred for further imaging and biopsy and supported with navigation services

5 women identified with positive diagnosis requiring treatment

Impact

Since the end of the grant, there have been 40 additional referrals of women with breast problems, showing that VHTs continue to provide information on breast health during community outreaches and that health workers are identifying early signs and making timely referrals. Among these, 26 women have received a breast cancer diagnosis and are now integrated into UWOCASO’s navigation programme.