PL03 Presentation Time: 2:00 PM

Purpose

Cervical cancer is the most common cancer treated in Botswana, and the number one cause of cancer related deaths. Curative treatment consists of concurrent chemoradiation with brachytherapy boost . Until 2011, the absence of brachytherapy services in Botswana necessitated patient referrals to South Africa following external beam radiation. Our objective was to establish and consistently deliver high-quality radiation therapy within Botswana to enhance treatment outcomes. A significant challenge was the shortage of locally experienced personnel in High Dose Rate (HDR) brachytherapy, prompting us to engage global experts throughout the endeavor. This study aims to assess the sustainance and advancement of brachytherapy utilization in Botswana over a 12-year period since its implementation, and evaluate the impact of global collaboration on its integration into the country's healthcare system.

Materials and Methods

A retrospective analysis was conducted utilizing healthcare records, collaborative initiatives, and interviews with key stakeholders involved in brachytherapy provision. Quantitative data and qualitative insights were combined to understand the evolution of brachytherapy services in Botswana.

Results

Brachytherapy services commenced in Botswana in 2012, following the establishment of local government support, private-public partnerships, and vendor training in 2011. To date, over 6000 successful implants have been done on at least 2000 patients. Collaborative efforts, particularly through Massachusetts General Hospital faculty under the BOTSOGO (Botswana Global Oncology Outreach) initiative, and Botswana-Upenn partnership, led to significant progress, beginning with the introduction of 2D and eventually 3D CT-guided to interstitial brachytherapy techniques. The pivotal on-site training session conducted by a multidisciplinary team from MGH in February 2012, comprising expert oncologists, physicists, therapists, and managers, laid the foundation for future collaborations and instilled confidence within the local team. Further collaborations included bilateral exchanges, support with data collection, presentation at conferences and continuing education. Figure 1 illustrates the increase in brachytherapy utilization over the 12-year period, and the input from collaborators.

Conclusions

Collaborative efforts between local and international stakeholders have significantly advanced brachytherapy utilization in Botswana, progressing from zero provision to advanced CT-guided techniques. This progress is attributed to sustained global collaboration efforts, including enhanced training programs, infrastructure development, and resource allocation. Continued collaboration builds confidence in the local team with construed peer review and upskilling. Positive patient outcomes and increased healthcare access have been observed as a result of these collaborative endeavors. Ongoing studies aim to evaluate the effects on survival rates for cervical cancer.