ArticleThe oncologist2023
Stigma and Social Determinants of Health Associated With Fidelity to Guideline-Concordant Therapy in Patients With Breast Cancer Living With and Without HIV in Botswana.
Article in The oncologist, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Stage at Diagnosis and Molecular Subtype Distribution of Breast Cancer in Sub-Saharan Africa: A Systematic Review.Cancer reports (Hoboken, N.J.) · 2026Pooled it
- Organization and Integration of Care in the HIV-Non-Communicable Disease Syndemic: A Rapid Scoping Review.International journal of environmental research and public health · 2026Article
- Quality of life among non-metastatic breast cancer survivors in Botswana.Journal of cancer survivorship : research and practice · 2025Article
- Baseline Distress and Effectiveness of Survivor Video Narratives on Cancer-Associated Distress in Botswana: A Pilot Study.JCO global oncology · 2025Article
- Real-world breast cancer treatment patterns and guideline-concordant treatment completion among Malawian women.BMC women's health · 2025Article
- Access to and Utilization of Endocrine Therapy Among Breast Cancer Survivors in Botswana.JCO global oncology · 2024Article
- Review
- Treatment delays for cancer patients in Sub-Saharan Africa: South Africa as a microcosm.Ecancermedicalscience · 2024Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
backgroundPatients with breast cancer in sub-Saharan Africa (SSA) experience a disproportionate burden of mortality. Fidelity to treatment guidelines, defined as receiving optimal dose and frequency of prescribed treatments, improves survival. We sought to identify patient factors associated with treatment fidelity and how this may differ for people with HIV (PWH) and breast cancer.
methodsWe conducted a qualitative study of women who initiated outpatient treatment for stages I-III breast cancer in Botswana, with deviance sampling of high- and low-fidelity patients. One-on-one interviews were conducted using semi-structured guides informed by the Theory of Planned Behavior. The sample size was determined by thematic saturation. Transcribed interviews were double coded with an integrated analytic approach.
resultsWe enrolled 15 high- and 15 low-fidelity participants from August 25, 2020 to December 15, 2020, including 10 PWH (4 high, 6 low fidelity). Ninety-three percent had stage III disease. Barriers to treatment fidelity included stigma, social determinants of health (SDOH), and health system barriers. Acceptance and de-stigmatization, peer and other social support, increased knowledge and self-efficacy were identified as facilitators. The COVID-19 pandemic amplified existing socioeconomic stressors. Unique barriers and facilitators identified by PWH included intersectional stigma, and HIV and cancer care integration, respectively.
conclusionWe identified multilevel modifiable patient and health system factors associated with fidelity. The facilitators provide opportunities for leveraging existing strengths within the Botswana context to design implementation strategies to increase treatment fidelity to guideline-concordant breast cancer therapy. However, PWH experienced unique barriers, suggesting that interventions to address fidelity may need to be tailored to specific comorbidities.
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