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To address these issues, we plan to develop, pilot, and evaluate a set of implementation strategies to integrate provider-initiated clinical breast examination (CBE) and PN into routine clinical practice to support timely breast cancer diagnosis and treatment initiation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We will conduct a pragmatic implementation pilot study in the four sub-Saharan African countries that make up the Network for Oncology Research in Africa (NORA) consortium: Ethiopia, South Africa, Nigeria, and Tanzania. The study will follow the implementation mapping (IM) process, drawing on theory, evidence, and stakeholders\u2019 input to develop and evaluate a set of implementation strategies. Our target evidence-based intervention will be provider driven breast cancer screening via opportunistic, clinic-based CBE for all eligible patients and subsequent PN support for women with abnormal exams through diagnosis evaluation and initiation of treatment. All four countries will begin by conducting independent mixed-methods needs assessments structured according to the Consolidated Framework for Implementation Research to identify contextual barriers and implementation determinants. Working with local stakeholders, defined performance objectives and identified determinants will be used to select evidence-based implementation strategies. The set of strategies will then be implemented and iteratively evaluated in two phases, guided by the RE-AIM framework. Our primary implementation outcomes will address reach (the proportion of CBE uptake) and secondary implementation outcomes will address adoption by providers and implementation fidelity. Preliminary effectiveness outcomes will include stage distribution of newly diagnosed breast cancers and diagnostic and treatment intervals. Data sources will include existing medical records, internal study clinical records, structured facility resource surveys, patient and provider surveys, observational checklists, and qualitative interviews and focus group discussions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>This multi-country implementation study protocol demonstrates a structured, theory-informed approach to develop, pilot, and evaluate implementation strategies for breast cancer screening in diverse health care settings. If the intervention succeeds, findings from this pilot will inform design of future hybrid effectiveness\u2013implementation studies, readiness for potential national scale-up, and adaptation to similar low and middle-income settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Protocol registration number<\/jats:title>\n                    <jats:p>\n                      The protocol is registered at clinicaltrials.gov: NCT07023198: registered 01 April, 2026,\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT07023198\" ext-link-type=\"uri\">https:\/\/clinicaltrials.gov\/study\/NCT07023198<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s43058-026-01029-3","type":"journal-article","created":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T08:54:51Z","timestamp":1784969691000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Provider-initiated screening clinical breast examination and patient navigation in sub-Saharan Africa: protocol for an implementation mapping-based pilot study"],"prefix":"10.1186","volume":"7","author":[{"given":"Aragaw","family":"Tesfaw","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elima Jedy","family":"Agba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edom","family":"Seife","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Debebe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eyerusalem","family":"Getachew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muluken","family":"Gizaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen","family":"Joffe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adamu","family":"Addissie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Mremi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blandina Theophil","family":"Mmbaga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva Johanna","family":"Kantelhardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel S.","family":"O\u2019Neil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sefonias","family":"Getachew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,25]]},"reference":[{"key":"1029_CR1","doi-asserted-by":"crossref","unstructured":"Bray F, Laversanne M, Sung H. 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We notified the selected hospitals through a support letter, and institutional permission was obtained from each of the selected hospitals after a detailed explanation of the purpose of the study. Each participant will provide written informed consent after complete information about the study purpose, procedures, risks, and benefits is clearly provided. We will ensure confidentiality by anonymising personal data and storing it securely on password-protected computers. 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