Using ADAPT-ITT to Adapt and Integrate Cancer Navigation Into HIV Services: The CHAMPS Experience in Botswana
Kaizer Ikgopoleng, Lillian Okui, Robert Moumakwa, Selebaleng Simon Mokonopi, Mpho Zwinila, Megan Mansfield, Manhattan Charurat, Gontse Tshisimogo, Ndwapi Ndwapi, Lynn Tjirare, Bornapate Nkomo, Florence BadaPURPOSE
People living with HIV (PLWH) in Botswana are at a high risk of cancer acquisition and are often diagnosed at an advanced stage of disease. The CHAMPS (Cancer-HIV Care Assistance and Monitoring Using Peers) aimed to adapt a navigation intervention to address gaps in the cancer care continuum for PLWH diagnosed with cancer in Botswana.
METHODS
The Assessment, Decision, Adaptation, Production, Topical Experts-integration, Training, and Testing (ADAPT-ITT) framework guided the formative adaptation process. A CHAMPS working group was established, comprising oncology and HIV program members from the MoH at national, district and facility level. The working group participated in up to 5 workshops in which they defined the navigator role for cancer care within the HIV services, adapted the HIV navigator curriculum to incorporate cancer-specific education and navigation material with input from topical experts, trained navigators and theater tested the adapted intervention in two HIV clinics in Gaborone and Francistown in 2025. Theater testing was conducted with a purposive sample of 20 PLWH co-diagnosed with cancer- 10 in each clinic. FGDs and KIIs with PLHIV and trained navigators, respectively were used to evaluate feasibility and preliminary satisfaction with the adapted intervention.
RESULTS
The CHAMPS working group defined the navigator role in cancer care within HIV services to include education of PLHIV on cancer symptoms, screening and care options, active care coordination for PLWH with suspected cancer, referral tracking, and patient-centered problem-solving for PLWH co-diagnosed with cancer. The adapted intervention was well received during theater testing, with trained navigators indicating that the navigator role’s expansion to include cancer care was feasible within the existing health system. PLWH reported satisfaction with the experienced navigation indicating that navigation supported adherence to both cancer therapy and ART, appointment management, and offered psychosocial support.
CONCLUSION
The adapted cancer navigation intervention within HIV services is a feasible and acceptable strategy to address barriers across the cancer care continuum for PLWH in Botswana. Further research is needed to evaluate effectiveness and implementation outcomes.