Cervical CancerNCT05952141
Strategies to Close the Gap From Cervical Cancer Diagnosis to Treatment in Botswana
A study testing Clinic Outreach, Enhanced Outreach and Low-Touch Strategy in people with Cervical Cancer, run by Abramson Cancer Center at Penn Medicine at 3 sites in 2 countries.
Trial summary
Investigators will test the effectiveness of adaptive strategies on timely adoption of cervical cancer treatment in Botswana using a pragmatic trial design. Read more about this study
- Who is it for?
- Ages 18 years and older, women only
- Conditions the study is for
- Cervical Cancer
- What is being tested?
- Clinic Outreach, Enhanced Outreach and Low-Touch Strategy
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 610 participants
- Where
- 3 sitesin 2 countries
- Study dates
- 1 Sep 2023to 31 Aug 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- Women only
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Patients will be eligible if they:
- are biological females
- are aged 18 or older
- have pathology-confirmed invasive cervical cancer diagnosis
- have pathology results evaluated at National Health Laboratory in Botswana
- are citizens of Botswana
- have no prior history of invasive cervical cancer
Who cannot join
- Patients will be excluded if they:
- are biological males or otherwise born without a cervix
- are below the age of 18 due to the rarity of cervical cancer in this population
- do not meet study inclusion criteria
Trial locations and contacts
3 sites in 2 countries. Contact the study team or a site near you to ask about taking part.
3 sites in 2 countries
Botswana2 sites, 2 recruiting
- Recruiting
Nyangabgwe Referral Hospital
Francistown, North-East District
Surbhi Grover, MD, 2672076977, surbhi.grover@pennmedicine.upenn.edu
Irene Ramokate, ramokatei@bup.org.bw
- Recruiting
Princess Marina Hospital
Gaborone
Surbhi Grover, MD, MPH, Surbhi.Grover@pennmedicine.upenn.edu
Surbhi Grover, MD, MPH
United States1 site
- Active, not recruiting
University of Pennsylvania
Philadelphia, Pennsylvania, 19104
About this study
Official title: Thibang Diphatlha: Testing Adaptive Strategies to Close the Gap From Cervical Cancer Diagnosis to Treatment in Botswana
Investigators will test the effectiveness of adaptive strategies on timely adoption of cervical cancer treatment in Botswana using a pragmatic trial design.
Read the detailed description
Investigators will test the effectiveness of adaptive strategies on timely adoption of cervical cancer treatment in Botswana using a hybrid (type III) and pragmatic Sequential Multiple Assignment Randomized Trial (SMART) design. The adaptive strategies are designed to target patient- and system-level determinants identified in preliminary data, including delayed communication of results, individual and structural barriers to accessing treatment, and suboptimal care coordination between referring and cancer treatment clinics. The strategies draw upon key principles in behavioral economics and are supported by systematic evidence of the effectiveness of nudge strategies in preventive, HIV, and cancer care. The overarching rationale for the study is that enhancing coordination, communication, and navigation through centralized outreach and nudge strategies will increase timely treatment adoption and be scalable and sustainable in the long-term.
- Conditions
- Cervical Cancer
- Being tested
- Clinic Outreach, Enhanced Outreach, Low-Touch Strategy, High-Touch Strategy
- Keywords
- Screening, Botswana, Treatment, Patient
- Medical subject headings
- Uterine Cervical Neoplasms
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Clinic OutreachBehavioural
A member of the pathology team will contact the referring clinic to communicate the readiness of results.
Enhanced OutreachBehavioural
A member of the pathology team will contact both the referring clinic and the patient directly to communicate the readiness of results.
Low-Touch StrategyBehavioural
Patient will be sent asynchronous text messaging reminders related to the importance of timely care using framed messaging.
High-Touch StrategyBehavioural
Patient will be sent asynchronous text messaging reminders related to the importance of timely care using framed messaging in combination with synchronous telephone-based patient navigation.
| Study group | Role | What they receive |
|---|---|---|
| Stage 1 Clinic Outreach + Stage 2 Low Touch | Experimental | All participants receive direct clinic outreach to communicate readiness of results (stage 1). Participants who do not attend the clinic by 30 days (non-responders) will receive asynchronous text message reminders using framed messaging (stage 2). Receives: Behavioral: Clinic Outreach; Behavioral: Low-Touch Strategy |
| Stage 1 Clinic Outreach + Stage 2 High Touch | Experimental | All participants receive direct clinic outreach to communicate readiness of results (stage 1). Participants who do not attend the clinic by 30 days (non-responders) will receive asynchronous text message reminders using framed messaging in combination with synchronous patient navigation (stage 2). Receives: Behavioral: Clinic Outreach; Behavioral: High-Touch Strategy |
| Stage 1 Enhanced Outreach + Stage 2 Low-Touch | Experimental | All participants receive direct clinic outreach plus enhanced outreach to communicate readiness of results (stage 1). Participants who do not attend the clinic by 30 days (non-responders) will receive asynchronous text message reminders using framed messaging (stage 2). Receives: Behavioral: Enhanced Outreach; Behavioral: Low-Touch Strategy |
| Stage 1 Enhanced Outreach + Stage 2 High-Touch | Experimental | All participants receive direct clinic outreach plus enhanced outreach to communicate readiness of results (stage 1). Participants who do not attend the clinic by 30 days (non-responders) will receive asynchronous text message reminders using framed messaging in combination with synchronous patient navigation. Receives: Behavioral: Enhanced Outreach; Behavioral: High-Touch Strategy |
What is being measured
The primary outcome is the main question the study is designed to answer.
Adoption
Defined as the initiation of cervical cancer treatment within 90 days of randomization.
Measured: Within 90 days of randomization
Secondary outcomes (5)
Fidelity
Defined as completion of evidence-based cancer treatment according to international guidelines and measured using medical record data.
Measured: 12 months after randomization
Reach: First Appointment
Defined by the proportion of patients who complete an initial treatment visit divided by those randomized
Measured: 12 months after randomization
Reach: First Stage
Defined by the proportion of patients who complete an enhanced outreach phone call divided by those contacted.
Measured: 12 months after randomization
Reach: Second Stage
Defined by the proportion of patients who complete a patient navigation phone call (high touch strategy) divided by those contacted.
Measured: 12 months after randomization
Reach: Results
Defined by the proportion of patients with confirmation of results received divided by those randomized.
Measured: 12 months after randomization
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted19 Jul 2023
- Study start1 Sep 2023
- Primary completion31 Dec 2026 (estimated)
- Study completion31 Aug 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (1)Papers the sponsor has linked to this study.
- Other trials for Cervical CancerStudies of the same condition, open and under way.
- More trials run by Abramson Cancer Center at Penn MedicineThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Sequential
- Model description
- Pragmatic Sequential Multiple Assignment Randomized Trial (SMART). This study uses a sequential randomization design in which all eligible participants will be randomized into one of two interventions at Stage 1 and then participants that do not respond to Stage 1 interventions will be randomized to receive Stage 2 interventions
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 610 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Abramson Cancer Center at Penn Medicine
- Sponsor type
- University, hospital or other
- Collaborators
- National Cancer Institute (NCI), University of Botswana
- Responsible party
- Principal investigator, Katharine Rendle, Abramson Cancer Center at Penn Medicine
- Investigators
- Katharine Rendle, PhD,MSW,MPH, Principal investigator, University of PennsylvaniaSurbhi Grover, MD, MPH, Principal investigator, University of Pennsylvania
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT05952141
- Sponsor's protocol ID
- UPCC 23822
- Other IDs
- U01CA275032-01
- Status last verified
- Jul 2026
- First submitted
- 11 Jul 2023
- Last updated
- 22 Jul 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Rendle KA, Ramogola-Masire D, Grover S; Thibang Diphatlha Collective. Thibang Diphatlha: a sequential multiple assignment randomized trial designed to increase timely adoption of cervical cancer treatment in Botswana. Implement Sci Commun. 2024 Nov 12;5(1):128. doi: 10.1186/s43058-024-00659-9.
PubMed 39533437
Study at a glance
From the registry record, last updated by the sponsor on 22 Jul 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Thibang Diphatlha: Testing Adaptive Strategies to Close the Gap From Cervical Cancer Diagnosis to Treatment in Botswana
- ClinicalTrials.gov ID
- NCT05952141
- Acronym / sponsor ID
- UPCC 23822
- Conditions
- Cervical Cancer
- Keywords
- Screening, Botswana, Treatment, Patient
- Study type
- Interventional
- Recruitment status
- Recruiting
- Enrolment
- 610 participants (estimated)
- Lead sponsor
- Abramson Cancer Center at Penn MedicineUniversity, hospital or other
- Collaborators
- National Cancer Institute (NCI), University of Botswana
- Study start
- 1 Sep 2023 (actual)
- Primary completion
- 31 Dec 2026 (estimated)
- Study completion
- 31 Aug 2027 (estimated)
- First posted
- 19 Jul 2023 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Investigators will test the effectiveness of adaptive strategies on timely adoption of cervical cancer treatment in Botswana using a pragmatic trial design.
Detailed description
Investigators will test the effectiveness of adaptive strategies on timely adoption of cervical cancer treatment in Botswana using a hybrid (type III) and pragmatic Sequential Multiple Assignment Randomized Trial (SMART) design. The adaptive strategies are designed to target patient- and system-level determinants identified in preliminary data, including delayed communication of results, individual and structural barriers to accessing treatment, and suboptimal care coordination between referring and cancer treatment clinics. The strategies draw upon key principles in behavioral economics and are supported by systematic evidence of the effectiveness of nudge strategies in preventive, HIV, and cancer care. The overarching rationale for the study is that enhancing coordination, communication, and navigation through centralized outreach and nudge strategies will increase timely treatment adoption and be scalable and sustainable in the long-term.
Study design
- Primary purpose
- Health services research
- Allocation
- Randomised
- Intervention model
- Sequential
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 4
- Model description
- Pragmatic Sequential Multiple Assignment Randomized Trial (SMART). This study uses a sequential randomization design in which all eligible participants will be randomized into one of two interventions at Stage 1 and then participants that do not respond to Stage 1 interventions will be randomized to receive Stage 2 interventions
| Arm | Type | Receives |
|---|---|---|
| Stage 1 Clinic Outreach + Stage 2 Low Touch | Experimental | Behavioral: Clinic Outreach, Behavioral: Low-Touch StrategyAll participants receive direct clinic outreach to communicate readiness of results (stage 1). Participants who do not attend the clinic by 30 days (non-responders) will receive asynchronous text message reminders using framed messaging (stage 2). |
| Stage 1 Clinic Outreach + Stage 2 High Touch | Experimental | Behavioral: Clinic Outreach, Behavioral: High-Touch StrategyAll participants receive direct clinic outreach to communicate readiness of results (stage 1). Participants who do not attend the clinic by 30 days (non-responders) will receive asynchronous text message reminders using framed messaging in combination with synchronous patient navigation (stage 2). |
| Stage 1 Enhanced Outreach + Stage 2 Low-Touch | Experimental | Behavioral: Enhanced Outreach, Behavioral: Low-Touch StrategyAll participants receive direct clinic outreach plus enhanced outreach to communicate readiness of results (stage 1). Participants who do not attend the clinic by 30 days (non-responders) will receive asynchronous text message reminders using framed messaging (stage 2). |
| Stage 1 Enhanced Outreach + Stage 2 High-Touch | Experimental | Behavioral: Enhanced Outreach, Behavioral: High-Touch StrategyAll participants receive direct clinic outreach plus enhanced outreach to communicate readiness of results (stage 1). Participants who do not attend the clinic by 30 days (non-responders) will receive asynchronous text message reminders using framed messaging in combination with synchronous patient navigation. |
Who may qualify
- Ages
- 18 years and older
- Sex
- Female only
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (7 listed)
- are biological females
- are aged 18 or older
- have pathology-confirmed invasive cervical cancer diagnosis
- have pathology results evaluated at National Health Laboratory in Botswana
- are citizens of Botswana
Key exclusion criteria (4 listed)
- are biological males or otherwise born without a cervix
- are below the age of 18 due to the rarity of cervical cancer in this population
- do not meet study inclusion criteria
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Clinic OutreachA member of the pathology team will contact the referring clinic to communicate the readiness of results. | Behavioural | Stage 1 Clinic Outreach + Stage 2 High Touch, Stage 1 Clinic Outreach + Stage 2 Low Touch |
| Enhanced OutreachA member of the pathology team will contact both the referring clinic and the patient directly to communicate the readiness of results. | Behavioural | Stage 1 Enhanced Outreach + Stage 2 High-Touch, Stage 1 Enhanced Outreach + Stage 2 Low-Touch |
| Low-Touch StrategyPatient will be sent asynchronous text messaging reminders related to the importance of timely care using framed messaging. | Behavioural | Stage 1 Clinic Outreach + Stage 2 Low Touch, Stage 1 Enhanced Outreach + Stage 2 Low-Touch |
| High-Touch StrategyPatient will be sent asynchronous text messaging reminders related to the importance of timely care using framed messaging in combination with synchronous telephone-based patient navigation. | Behavioural | Stage 1 Clinic Outreach + Stage 2 High Touch, Stage 1 Enhanced Outreach + Stage 2 High-Touch |
Primary outcome
Adoption
Time frame: Within 90 days of randomization
Defined as the initiation of cervical cancer treatment within 90 days of randomization.
5 secondary outcomes
Fidelity
Time frame: 12 months after randomization
Reach: First Appointment
Time frame: 12 months after randomization
Reach: First Stage
Time frame: 12 months after randomization
Reach: Second Stage
Time frame: 12 months after randomization
Reach: Results
Time frame: 12 months after randomization
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 22 Jul 2026.
- Derived from this study: PubMed 39533437Rendle KA, Ramogola-Masire D, Grover S; Thibang Diphatlha Collective. Thibang Diphatlha: a sequential multiple assignment randomized trial designed to increase timely adoption of cervical cancer treatment in Botswana. Implement Sci Commun. 2024 Nov 12;5(1):128. doi: 10.1186/s43058-024-00659-9.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Katharine Rendle, PhD,MSW,MPH principal investigator
University of Pennsylvania
Surbhi Grover, MD, MPH principal investigator
University of Pennsylvania
3 sites in 2 countries: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Clinic Outreach, Enhanced Outreach and Low-Touch Strategy in people with Cervical Cancer, run by Abramson Cancer Center at Penn Medicine at 3 sites in 2 countries.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 7 inclusion and 4 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: looking for participants now, as of the sponsor's last update on 22 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 3 sites in Botswana, United States. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Katharine Rendle, PhD,MSW,MPH (215-349- 5442, katharine.rendle@pennmedicine.upenn.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Adoption (time frame: Within 90 days of randomization). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT05952141, which also lists 1 linked publication.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 22 Jul 2026.