Strengthening Primary Healthcare Clinics to Reduce Delays in Cancer Care: Findings from Kenya  
Abstract for the IARC 60 Conference submission (Word limit 500 words)
Background
Delays in cancer care contribute to poor outcomes in Sub-Saharan Africa, including Kiambu County, Kenya. These delays occur at multiple levels, including late presentation, delayed diagnosis, inefficient referrals, and limited treatment readiness at primary healthcare facilities. Strengthening primary healthcare clinics is a key strategy to improve early detection, timely referrals, and continuity of care, ultimately reducing cancer-related morbidity and mortality.
Objectives
Overall, this study aimed to develop, implement, and assess the feasibility and acceptability of a multi-component intervention combining clinic strengthening and patient navigation. Findings from this work will inform the design of a larger-scale trial to evaluate the effectiveness of the intervention across diverse healthcare settings in reducing delays in cancer diagnosis and treatment. 
Methods
We developed and implemented a multi-component intervention targeted 25 primary healthcare facilities. The facilities included 1 polyclinic, 6 large public health centers, 6 small public health centers, 6 large private clinics, and 6 small private clinics. The intervention had the following components i) Referral registers were introduced to systematically document suspected cases and track referral outcomes, ii)facility mapping to provide  linkages with higher-level facilities were established to reduce delays, iii)SMS reminders and phone calls from facilities to patients to help remind them to take up their referral, iv) patient information leaflets to enhance adherence and v) peer navigators were trained and deployed to support referred patients and respond to inquiries along the referral pathway.
Results
The study was done between August and November of 2025 and a total of 21 facilities (84%) completed the program, with four private clinics dropping out. Approximately 10,300 patients were seen monthly across all facilities. Across the participating facilities, 243 patients were referred and referrals recorded in the referral registers, of these, 125 patients were suspected cancer cases and six patients received peer navigation support to facilitate referral completion and address barriers. The introduction of referral registers improved documentation and accountability. SMS reminders, phone follow-up, and peer navigation support helped reduce missed appointments.
Conclusion
This work presents preliminary findings that will inform the scaling up into a larger study. Overall, the intervention demonstrated both fidelity and acceptability, suggesting that, if implemented more broadly, it could enhance early detection and continuity of care at the primary healthcare level. Expanding integrated clinic-strengthening interventions across public, private, and polyclinic facilities could play a crucial role in reducing delays in cancer care.