{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T07:02:58Z","timestamp":1777532578405,"version":"3.51.4"},"reference-count":33,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2022,8,26]],"date-time":"2022-08-26T00:00:00Z","timestamp":1661472000000},"content-version":"vor","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000054","name":"National Cancer Institute","doi-asserted-by":"publisher","award":["1RO1CA172050"],"award-info":[{"award-number":["1RO1CA172050"]}],"id":[{"id":"10.13039\/100000054","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2022,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Most Zimbabweans access medical care through tiered health systems. In 2013, HIV care was decentralized to primary care clinics; while oncology care remained centralized. Most persons in Zimbabwe with Kaposi sarcoma (KS) are diagnosed late in their disease, and the prognosis is poor. Little is known about whether educational interventions could improve KS outcomes in these settings.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Interventions to improve KS detection and management were evaluated at eight Zimbabwe primary care sites (four rural\/four urban) that provided HIV care. Interventions included a standardized KS clinical evaluation tool, palliative care integration, standardized treatment and improved consultative services. Interventions were implemented between February 2013 and January 2016 using a randomized stepped\u2010wedge cluster design. Sites were monitored for KS diagnosis rates and KS outcomes, including early diagnosis (T0 vs. T1 tumour stage), participant retention and mortality. Analyses controlled for within\u2010clinic correlations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 1102 persons with suspected KS (96% HIV positive) were enrolled: 47% incident (new diagnosis), 20% prevalent (previous diagnosis) and 33% determined as not KS. Early (T0) diagnosis increased post\u2010intervention, though not significant statistically (adjusted odds ratio [aOR] = 1.48 [95% confidence interval (95% CI): 0.66\u20133.79], <jats:italic>p<\/jats:italic> = 0.37). New KS diagnosis rates increased 103% (95% CI: 11\u2013273%), <jats:italic>p<\/jats:italic> = 0.02) post\u2010intervention; although paired with an increased odds of incorrectly diagnosing KS (aOR = 2.08 [95% CI: 0.33\u20133.24], <jats:italic>p<\/jats:italic> = 0.001). Post\u2010intervention, non\u2010significant decreases in 90\u2010day return rates (adjusted hazard ratio [aHR] = 0.69 [95% CI: 0.38\u20131.45], <jats:italic>p<\/jats:italic> = 0.21) and survival (aHR = 1.36 [95% CI: 0.85\u20132.20], <jats:italic>p<\/jats:italic> = 0.20) were estimated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>KS training interventions at urban and rural Zimbabwe decentralized primary care clinics significantly increased overall and incorrect KS diagnosis rates, but not early KS diagnosis rates, 90\u2010day return rates or survival.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25998","type":"journal-article","created":{"date-parts":[[2022,8,27]],"date-time":"2022-08-27T03:37:50Z","timestamp":1661571470000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Evaluation of a training intervention to improve cancer care in Zimbabwe: Strategies to Improve Kaposi Sarcoma Outcomes (SIKO), a prospective community\u2010based stepped\u2010wedge cluster randomized trial"],"prefix":"10.1002","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6147-9196","authenticated-orcid":false,"given":"Katherine R.","family":"Sabourin","sequence":"first","affiliation":[{"name":"University of Colorado School of Medicine  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Margaret","family":"Borok","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences University of Zimbabwe  Harare Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samantha","family":"Mawhinney","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maxwell","family":"Matimba","sequence":"additional","affiliation":[{"name":"University of Zimbabwe Clinical Research Centre  Harare Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francis","family":"Jaji","sequence":"additional","affiliation":[{"name":"University of Zimbabwe Clinical Research Centre  Harare Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suzanne","family":"Fiorillo","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dickson D.","family":"Chifamba","sequence":"additional","affiliation":[{"name":"Island Hospice and Healthcare  Harare Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudios","family":"Muserere","sequence":"additional","affiliation":[{"name":"University of Zimbabwe Clinical Research Centre  Harare Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Busisiwe","family":"Mashiri","sequence":"additional","affiliation":[{"name":"Island Hospice and Healthcare  Harare Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chenjerai","family":"Bhodheni","sequence":"additional","affiliation":[{"name":"Island Hospice and Healthcare  Harare Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia","family":"Gambiza","sequence":"additional","affiliation":[{"name":"University of Zimbabwe Clinical Research Centre  Harare Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachael","family":"Mandidewa","sequence":"additional","affiliation":[{"name":"University of Zimbabwe Clinical Research Centre  Harare Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mercia","family":"Mutimuri","sequence":"additional","affiliation":[{"name":"University of Zimbabwe Clinical Research Centre  Harare Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivy","family":"Gudza","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences University of Zimbabwe  Harare Zimbabwe"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Mulvahill","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camille M.","family":"Moore","sequence":"additional","affiliation":[{"name":"National Jewish Health  Denver Colorado USA"},{"name":"Colorado School of Public Health  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean S.","family":"Kutner","sequence":"additional","affiliation":[{"name":"University of Colorado School of Medicine  Aurora Colorado USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric A. 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