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Abstract：
BACKGROUND: Patients 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.
METHODS: We 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.
RESULTS: We 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.
CONCLUSIONS: We 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.
METHODS: We 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.
RESULTS: We 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.
CONCLUSIONS: We 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.
摘要：
背景：撒哈拉以南非洲（SSA）的乳腺癌患者经历了不成比例的死亡负担。忠实于治疗指南，定义为接受处方治疗的最佳剂量和频率，提高生存。我们试图确定与治疗保真度相关的患者因素，以及HIV（PWH）和乳腺癌患者之间的差异。
方法：我们对博茨瓦纳I-III期乳腺癌患者进行了一项定性研究，对高保真度和低保真度患者进行偏差采样。一对一访谈是使用计划行为理论提供的半结构化指南进行的。样品大小由主题饱和度确定。转录访谈采用综合分析方法进行了双重编码。
结果：我们从2020年8月25日至2020年12月15日注册了15名高保真度和15名低保真度参与者，其中包括10名PWH（4名高，6低保真度)。93%患有III期疾病。治疗忠诚的障碍包括污名，健康的社会决定因素(SDOH)，和卫生系统的障碍。接受和消除污名化，同伴和其他社会支持，增加的知识和自我效能感被确定为促进者。COVID-19大流行放大了现有的社会经济压力源。PWH确定的独特障碍和促进者包括交叉污名，艾滋病和癌症治疗的整合，分别。
结论：我们确定了与保真度相关的多水平可改变的患者和健康系统因素。促进者为利用博茨瓦纳背景下的现有优势提供了机会，以设计实施策略，以增加指南一致的乳腺癌治疗的治疗保真度。然而,PWH经历了独特的障碍，建议解决保真度的干预措施可能需要针对特定的合并症进行调整。
方法：我们对博茨瓦纳I-III期乳腺癌患者进行了一项定性研究，对高保真度和低保真度患者进行偏差采样。一对一访谈是使用计划行为理论提供的半结构化指南进行的。样品大小由主题饱和度确定。转录访谈采用综合分析方法进行了双重编码。
结果：我们从2020年8月25日至2020年12月15日注册了15名高保真度和15名低保真度参与者，其中包括10名PWH（4名高，6低保真度)。93%患有III期疾病。治疗忠诚的障碍包括污名，健康的社会决定因素(SDOH)，和卫生系统的障碍。接受和消除污名化，同伴和其他社会支持，增加的知识和自我效能感被确定为促进者。COVID-19大流行放大了现有的社会经济压力源。PWH确定的独特障碍和促进者包括交叉污名，艾滋病和癌症治疗的整合，分别。
结论：我们确定了与保真度相关的多水平可改变的患者和健康系统因素。促进者为利用博茨瓦纳背景下的现有优势提供了机会，以设计实施策略，以增加指南一致的乳腺癌治疗的治疗保真度。然而,PWH经历了独特的障碍，建议解决保真度的干预措施可能需要针对特定的合并症进行调整。
