{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T17:46:41Z","timestamp":1777398401151,"version":"3.51.4"},"reference-count":43,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"8","content-domain":{"domain":["ascopubs.org"],"crossmark-restriction":true},"short-container-title":["JCO Global Oncology"],"published-print":{"date-parts":[[2022,11]]},"abstract":"<jats:sec><jats:title>PURPOSE<\/jats:title><jats:p> Cervical cancer is the leading cause of cancer death for women in Botswana. Barriers in access to cancer care can lead to later stages at diagnosis and increased mortality. This study evaluated access, defined as travel time from a patient's residential village to a multidisciplinary team clinic in Gaborone, with stage of cervical cancer at presentation. In addition, because of the high HIV prevalence in Botswana, we explored the association between travel time and HIV status. <\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p> Eligible patients with cervical cancer presenting to the multidisciplinary team between 2015 and 2020 were included. Data were abstracted from questionnaires and hospital records. Google Maps was used to calculate travel time. Multinomial regression was used to examine travel time and cancer stage, and multivariable logistic regression was used to investigate travel time and HIV status. <\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p> We identified 959 patients with cervical cancer of which 70.1% were women living with HIV. The median travel time was approximately 2 hours. Using a reference group of stage I disease and a travel time of &lt; 1 hour, the odds of presenting with stage II increased for patients traveling 3-5 hours (adjusted odds ratio [OR], 2.00; 95% CI, 1.14 to 3.52) and &gt; 5 hours (OR, 2.19; 95% CI, 1.15 to 4.19). There were no significant associations for stage III. For stage IV disease, the odds were increased for patients traveling 3-5 hours (OR, 2.93; 95% CI, 1.26 to 6.79) and &gt; 5 hours (adjusted OR, 4.05; 95% CI, 1.62 to 10.10). In addition, the odds of patients presenting living with HIV increased with increasing travel time (trend test = 0.004). <\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSION<\/jats:title><jats:p> This study identified two potential factors, travel time and HIV status, that influence access to comprehensive cervical cancer care in Botswana. <\/jats:p><\/jats:sec>","DOI":"10.1200\/go.22.00183","type":"journal-article","created":{"date-parts":[[2022,11,17]],"date-time":"2022-11-17T20:59:40Z","timestamp":1668718780000},"update-policy":"https:\/\/doi.org\/10.1200\/crossmark","source":"Crossref","is-referenced-by-count":5,"title":["Distance to Multidisciplinary Team Clinic in Gaborone, Botswana, and Stage at Cervical Cancer Presentation for Women Living With and Without HIV"],"prefix":"10.1200","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3726-9527","authenticated-orcid":false,"given":"Tara M.","family":"Friebel-Klingner","sequence":"first","affiliation":[{"name":"Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA"},{"name":"Botswana-University of Pennsylvania Partnership, Gaborone, Botswana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6170-1084","authenticated-orcid":false,"given":"Lisa","family":"Bazzett-Matabele","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana"},{"name":"Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, CT"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9624-8366","authenticated-orcid":false,"given":"Doreen","family":"Ramogola-Masire","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barati","family":"Monare","sequence":"additional","affiliation":[{"name":"Botswana-University of Pennsylvania Partnership, Gaborone, Botswana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1150-3722","authenticated-orcid":false,"given":"Tlotlo B.","family":"Ralefala","sequence":"additional","affiliation":[{"name":"Department of Oncology, Princess Marina Hospital, Gaborone, Botswana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Seiphetlheng","sequence":"additional","affiliation":[{"name":"University of Botswana, Gaborone, Botswana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaobakwe","family":"Ramontshonyana","sequence":"additional","affiliation":[{"name":"Botswana-University of Pennsylvania Partnership, Gaborone, Botswana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Vuylsteke","sequence":"additional","affiliation":[{"name":"University of Botswana, Gaborone, Botswana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7714-3910","authenticated-orcid":false,"given":"Nandita","family":"Mitra","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas J.","family":"Wiebe","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA"},{"name":"Botswana-University of Pennsylvania Partnership, Gaborone, Botswana"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4799-1900","authenticated-orcid":false,"given":"Timothy R.","family":"Rebbeck","sequence":"additional","affiliation":[{"name":"Dana-Farber Cancer Institute and Harvard TH Chan School of Public Health, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne Marie","family":"McCarthy","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7443-5937","authenticated-orcid":false,"given":"Surbhi","family":"Grover","sequence":"additional","affiliation":[{"name":"Botswana-University of Pennsylvania Partnership, Gaborone, Botswana"},{"name":"Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"233","reference":[{"key":"b1","volume-title":"AFCRN: African Cancer Registry Network. Botswana National Cancer Registry"},{"key":"b2","doi-asserted-by":"publisher","DOI":"10.1038\/s41597-019-0142-2"},{"key":"b3","unstructured":"UNAIDS: United Nations Programme on HIV\/AIDS. Country fact sheets, Botswana, 2021. https:\/\/www.unaids.org\/en\/regionscountries\/countries\/botswana"},{"key":"b4","doi-asserted-by":"publisher","DOI":"10.1200\/JGO.2015.001701"},{"key":"b5","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2016.67.9613"},{"key":"b6","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e3182426227"},{"key":"b7","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0229086"},{"key":"b8","doi-asserted-by":"publisher","DOI":"10.1200\/JGO.2016.006577"},{"key":"b9","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.18.221424"},{"key":"b11","volume-title":"Statistics Botswana: Guide to the Villages of Botswana. Private Bag 0024, Gaborone Botswana, 2021"},{"key":"b12","doi-asserted-by":"publisher","DOI":"10.1200\/JGO.2016.006353"},{"key":"b13","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32470-X"},{"key":"b14","first-page":"1","volume":"4","author":"Anakwenze C","year":"2018","journal-title":"J Glob Oncol"},{"key":"b15","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2015-0387"},{"key":"b16","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2017-0643"},{"key":"b17","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-013059"},{"key":"b18","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.28861"},{"key":"b19","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-019-6638-z"},{"key":"b20","doi-asserted-by":"publisher","DOI":"10.1186\/s12905-021-01402-5"},{"key":"b21","volume-title":"United States Census Bureau: Subnational Population by Sex, Age, and Geographic Area. Gaborone, Botswana","author":"USCB","year":"2019"},{"key":"b23","volume-title":"Identifying location of residential village and MDT\/PMH in Gaborone, Botswana. Google Maps","author":"Google"},{"key":"b24","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czab099"},{"key":"b25","volume-title":"Maps for Travel Distance and Travel Time From Villages to Princess Marina Hospital, Gaborone. Google Maps","author":"Google"},{"key":"b26","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.12749"},{"key":"b27","volume-title":"National AIDS Coordinating Agency. Botswana AIDS Impact Survey IV 2013. Gaborone, Botswana","author":"Statistics Botswana, NACA"},{"key":"b28","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21660"},{"key":"b29","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.33400"},{"key":"b30","doi-asserted-by":"publisher","DOI":"10.1200\/EDBK_175251"},{"key":"b31","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31392-7"},{"key":"b32","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-016-1658-5"},{"key":"b33","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-198102000-00001"},{"key":"b34","doi-asserted-by":"publisher","DOI":"10.1097\/JNC.0000000000000194"},{"key":"b35","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0205425"},{"key":"b36","doi-asserted-by":"publisher","DOI":"10.1097\/IGC.0b013e318249470a"},{"key":"b37","first-page":"4","volume":"12","author":"Zapka JG","year":"2003","journal-title":"Cancer Epidemiol Biomarkers Prev"},{"key":"b38","doi-asserted-by":"publisher","DOI":"10.1016\/j.canep.2018.01.014"},{"key":"b39","first-page":"125S","volume":"19","author":"Vorobiof DA","year":"2001","journal-title":"J Clin Oncol"},{"key":"b40","doi-asserted-by":"publisher","DOI":"10.1002\/pon.1767"},{"key":"b41","doi-asserted-by":"publisher","DOI":"10.1258\/jhsrp.2011.010113"},{"key":"b42","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(20)30459-9"},{"key":"b43","doi-asserted-by":"publisher","DOI":"10.1158\/1940-6207.CAPR-19-0348"},{"key":"b44","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0218094"},{"key":"b45","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwz121"}],"container-title":["JCO Global Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ascopubs.org\/doi\/pdfdirect\/10.1200\/GO.22.00183","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,11,17]],"date-time":"2022-11-17T20:59:49Z","timestamp":1668718789000},"score":1,"resource":{"primary":{"URL":"https:\/\/ascopubs.org\/doi\/10.1200\/GO.22.00183"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,11]]},"references-count":43,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2022,11]]}},"alternative-id":["10.1200\/GO.22.00183"],"URL":"https:\/\/doi.org\/10.1200\/go.22.00183","relation":{},"ISSN":["2687-8941"],"issn-type":[{"value":"2687-8941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,11]]},"assertion":[{"value":"2022-05-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-07-20","order":1,"name":"revised","label":"Revised","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-09-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-11-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e2200183"}}