NIHR Global Research Group on Advancing Early Diagnosis of Cancer in Southern Africa By 2030, about 24 million people worldwide will develop cancer each year. Most cases will occur in low- and middle-income (LMIC) countries, which may be attributed to aging societies, high prevalence of cancer risk behaviours, as well as the epidemiologic transition and socio-economic inequalities. While more people are getting cancer, services to diagnose and to treat cancer are often not widely available, and there are huge differences in care-seeking and quality of care. Cancer outcomes can be improved by early detection and timely diagnosis. 

Our team includes researchers from Queen Mary University London, University of Cape Town in South Africa, University of Zimbabwe and Kings College London. We aim to advance the early diagnosis of cancer in Southern Africa by developing and evaluating e-Tools to improve care-seeking and reduce healthcare delays in two countries: Zimbabwe and South Africa. 

We will focus on cervical and breast cancer in women and colorectal cancer in men and women as these are common cancers and have relatively easy methods for detecting and treating the cancers, especially in the early stages. This research programme will run for 4 years from October 2021.

The research aims to answer important questions about how to encourage appropriate help-seeking among people with possible cancer symptoms and how to deliver high-quality, accessible and equitable cancer referral and diagnosis services in lower level facilities. It will be undertaken mainly in local clinics and secondary health facilities that are the first place that people go for health services in these countries. Studies will include materials in local languages to increase awareness and access to the services. We will also have a major focus on quality training for junior researchers.

The questions to be answered include: 
Can we improve timely symptom appraisal and help-seeking among people with possible symptoms of cancer? Can we develop and evaluate an effective digital e-Tool for local primary care workers which will support their service, including patient management and referrals? Can we provide an acceptable and user-friendly e-Tool for patients to promote early diagnosis of breast, cervical and colorectal cancer?
To answer these questions we will map current primary care and hospital services for breast, cervical and colorectal cancer in the two Southern African countries. We will then identify key factors influencing patient pathways, from symptom awareness through to referral and diagnosis, and develop two interventions. One will be a symptom assessment and management e-Tool for primary care providers and the other a symptom appraisal and help-seeking e-Tool for the public. We will evaluate the feasibility, acceptability and effectiveness (including cost-effectiveness) of these e-interventions.
Importantly, we will draw on community engagement and involvement at all stages of the research, and emphasize interventions that are affordable and socio-culturally acceptable to African women and men and local healthcare providers.
This research will help health authorities plan how new approaches can be integrated into existing health services in countries like Zimbabwe and South Africa. It will demonstrate which resources are needed to provide accessible, good quality, cost effective services that successfully help people to have a more timely diagnosis of breast, cervical and colorectal cancer. To advance early diagnosis of breast, cervical and colorectal cancer cancers in Southern Africa we will:
1.	In Workstream 1, assess the current time intervals from breast, cervical and colorectal cancer symptom awareness to referral and diagnosis and the factors influencing these intervals among adult (age 18 and over) men and women in Zimbabwe (low-income country) and South Africa (upper middle-income country) representing Southern African countries at different levels of economic development;
2.	In Workstream 2, develop two e-Tools that promote more timely presentation and referral for breast, cervical and colorectal cancer:
i.	A symptom assessment and management e-Tool for primary care providers to enable efficient diagnosis
ii.	A symptom appraisal and help-seeking e-Tool for the public;
3.	In Workstream 3, evaluate the e-Tools across local settings in Zimbabwe and South Africa, to ensure that they are operationally and economically feasible and equitable, socio-culturally acceptable and support timely referral.