Evaluation of a Breast Cancer Early Detection Curriculum Among Nurses Working in 5 Antiretroviral Clinics in Eswatini

Abstract

PURPOSE Breast cancer (BC) incidence is rising in sub-Saharan Africa, and approximately 75% of cases are diagnosed at stages III and IV. Women living with HIV, who are surviving longer with antiretroviral use, are also increasingly affected. Survey data suggest that primary care providers often fail to recognize early-stage BC. We trained nurses from 5 antiretroviral clinics in Eswatini to assess breast abnormalities and evaluated our curriculum’s effectiveness in improving BC knowledge and skills. METHODS The 2-day curriculum covered breast physiology, benign pathology, and BC. Clinical breast exam and management were taught using mannequins and standardized patient scenarios, with emphasis on prompt referral for biopsy. After training, mentoring was provided every 2 to 4 weeks at each study clinic. A written examination of BC knowledge (maximum score, 23 points) and an observed examination of practical clinical skills (maximum score, 28 points) were administered before training, immediately after training, and 90 days after training. Pre- and post-training scores were compared using Wilcoxon signed-rank tests. RESULTS Forty-four nurses, with a median of 10 years of experience, underwent training; only 5 nurses (11%) reported prior BC education. All nurses completed the pre- and immediate post-training exams, and 38 completed the 90-day post-training exams. Median scores on pre-, immediate post-, and 90-day post-training knowledge exams were 17.5 (interquartile range [IQR], 16-19), 20 (IQR, 19-21), and 20 (IQR, 19-21), respectively. Median scores on pre-, immediate post-, and 90-day post-training practical exams were 10 (IQR, 7-11), 23 (IQR, 21.5-25), and 23 (IQR, 22-24), respectively. Compared with pretraining scores, immediate post- and 90-day post-training scores on both exams were significantly improved ( P < .0001 for all comparisons). CONCLUSION Our curriculum produced a sustained improvement in nurses’ BC-related knowledge and clinical skills, including identification of possible early cancers. Our results resemble those among similarly trained Rwandan nurses, suggesting that the curriculum may generally benefit front-line health care providers and patients in sub-Saharan Africa.