Francistown

Researchers are evaluating adaptive strategies to improve the timely adoption of cervical cancer treatment in Botswana. This pragmatic trial uses a Sequential Multiple Assignment Randomized Trial SMART design to address patient- and system-level barriers such as delayed communication of results, challenges in accessing treatment, and poor coordination between referring clinics and cancer treatment centers. The strategies are based on behavioral economics principles and nudge techniques proven effective in preventive, HIV, and cancer care settings. The goal is to enhance coordination, communication, and navigation to increase timely treatment adoption in a scalable and sustainable way. Participants receive different combinations of outreach and reminder strategies. Initially, all receive direct clinic outreach to communicate when pathology results are ready. Those who do not attend the clinic within 30 days receive either asynchronous text message reminders alone or combined with telephone-based patient navigation. Some participants receive enhanced outreach, where both the clinic and patient are contacted directly, while others receive standard outreach. These adaptive strategies are tested in four experimental groups combining low-touch and high-touch reminder approaches. Throughout the study, participants attendance and treatment adoption are monitored, focusing on whether they receive treatment within 90 days of randomization. Researchers also assess the fidelity and reach of the interventions at 12 months. The study involves tracking communication effectiveness and care coordination through outreach and reminder methods. This trial is sponsored by the Abramson Cancer Center at Penn Medicine and runs from September 2023 to August 2027.

Researchers are investigating new ways to improve HIV treatment and explore potential cures in children who started treatment early. The study focuses on testing a combination of three broadly neutralizing antibodies bNAbs or a planned break from antiretroviral therapy ART to see how these approaches affect the viral reservoir, immune system function, and the ability to keep the virus under control in children living with HIV in Botswana. The study includes several steps with different treatment approaches. Initially, children receive one of the three bNAbs alone to assess safety, followed by a rotating schedule of all three antibodies alongside their regular ART. Later steps involve stopping ART while continuing bNAbs, or stopping both ART and antibody treatments to observe effects. The study measures how long the virus remains suppressed and monitors immune health during these phases. Participants will have regular visits for safety checks, blood tests to measure viral levels and immune cell counts, and pharmacokinetic assessments to understand how the antibodies behave in the body. Researchers will also monitor the size of the viral reservoir and time to viral rebound if it occurs. Study participation includes up to 48 weeks of treatment and follow-up, with careful monitoring to ensure participant safety throughout.