Abstract 1: A Learning Collaborative Model to Empower Rural Rwandan Health Centers to Improve the Quality of Screening for Women’s Cancers
Authors: Dusengimana Jean-Marie Vianney , Uwihaye Jean de Dieu , Fata Amanda , Tuyisenge David , Ndayisaba Aphrodis , Rugema Vestine , Uwineza Marie Louise , Shulman Lawrence N. , Shyirambere Cyprien , Pace Lydia E. 
Published: June 2023

Abstract
Purpose: Screening and early detection initiatives for breast and cervical cancer are public health priorities in sub-Saharan Africa, but sustainable strategies to monitor screening quality in rural health facilities are not well-described. We sought to empower rural primary care clinicians to monitor and improve screening quality and integrate quality improvement (QI) into routine practice through a learning collaborative in 8 health facilities participating in a breast and cervical cancer screening initiative in Burera district, Rwanda. We evaluated the model’s impact on participant knowledge/attitudes and QI projects’ success.
Methods: Two-day didactic sessions in March 2022 addressed quality measurement and QI implementation. QI knowledge/attitudes were assessed before and after training using a brief written survey and compared using paired t-tests. Participants (all nurses) then identified a cancer screening problem at their health facility that could be solved using QI methods and planned projects. All health center (HC) trainees focused on increasing the proportion of eligible women screened for cervical cancer in their sectors, via educational campaigns. District hospital (DH) team members aimed to reduce missed referral visits. At subsequent meetings, teams discussed projects and next steps.
Results: Three clinicians from each of 7 HCs and 2 from the DH (n=23) participated in training; 22 took pre- and post-training surveys. Baseline mean knowledge scores (66.5%,SD 11.8) improved following training (82.4%,SD 12.0,p&lt;0.001). After training, 22(100%) reported interest in being more engaged in QI. In the 6 months following project implementation, HCs saw a 4.8-fold increase in the mean number of patients screened across 7 HCs (35.4,SD 17.1) compared to 6 months prior (7.5,SD 2.6). Efforts to reduce missed visits could not be assessed due to inability of the cancer screening electronic medical record to track patients across facilities.
Conclusion: A learning collaborative model engaged rural primary care clinicians in evaluating and improving cancer screening practices. QI knowledge improved and HCs met initial project goals. Though projects focused on patient volume, future initiatives should examine other critical quality measures i.e., referral completion and time to cancer diagnosis. Improving data collection systems is essential to facilitate availability of follow-up data and patient tracking and empower clinicians to monitor care quality.
Citation Format: Jean-Marie Vianney Dusengimana, Jean de Dieu Uwihaye, Amanda Fata, David Tuyisenge, Aphrodis Ndayisaba, Vestine Rugema, Marie Louise Uwineza, Lawrence N. Shulman, Cyprien Shyirambere, Lydia E. Pace. A Learning Collaborative Model to Empower Rural Rwandan Health Centers to Improve the Quality of Screening for Women’s Cancers [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 1.