Background
Fragmentation across the cancer care continuum remains a major barrier to effective cancer prevention, early detection, and timely treatment in low- and middle-income countries (LMICs). In Ethiopia, weak referral systems, limited follow-up mechanisms, and insufficient information exchange between levels of care contribute to delayed diagnosis and loss to follow-up for women with breast abnormalities and those treated for cervical precancerous lesions. Digital health solutions offer potential to strengthen coordination and continuity of care, yet evidence from real-world implementation within primary healthcare systems remains limited.
To address these gaps, we established a multidisciplinary research group focusing on digital support of the cancer care continuum and developed a context-adapted digital platform facilitating patient flow from opportunistic primary healthcare–level screening to higher-level diagnostic services, including re-appointments.

Objectives
To describe the development, implementation, and ongoing evaluation of a digital platform designed to support the cancer care continuum for breast and cervical cancer between primary and secondary healthcare settings in Ethiopia, and to outline its role within pragmatic implementation research and capacity-building efforts.

Methods
We developed the DINKNESH (Developing an INternational research CollaboratioN in Ethiopia to Support oncology at primary Health care level) platform through an iterative, stakeholder-driven process involving the Ministry of Health, regional health authorities, healthcare providers, and technical partners. DINKNESH is an Android-based application with a server-supported backend enabling patient registration, digital referrals, bidirectional communication between facilities, and automated short message service (SMS) reminders for patients and health workers.
The platform is currently embedded within two ongoing implementation trials. For breast cancer, a cluster-randomised controlled trial evaluates eHealth-supported referral for women with breast-related abnormalities identified through clinical breast examination at primary healthcare facilities, linked to referral hospitals across multiple Ethiopian regions. For cervical cancer, a pragmatic cluster-randomised controlled trial assesses digital and community-supported follow-up strategies for women treated for precancerous cervical lesions in primary care. Both studies are conducted under routine service conditions and include quantitative and qualitative components to assess feasibility, fidelity, and implementation processes. Capacity building is integrated through local leadership, embedded doctoral training, and sustained partnerships with Ethiopian academic and health system institutions.

Results
The DINKNESH platform has been successfully developed and implemented within routine primary healthcare workflows and referral pathways for breast and cervical cancer services. Health professionals across participating facilities have been trained, and digital registration, referral, and follow-up processes have been operationalised. Ongoing evaluations focus on referral completion, follow-up adherence, timeliness of care, and implementation outcomes. Outcome analyses are underway and will be reported separately upon study completion.

Conclusions / Implications
Our work demonstrates the feasibility of establishing a digitally supported cancer care continuum within resource-constrained primary healthcare systems. By embedding a context-adapted digital platform into pragmatic implementation research, this programme contributes evidence on how digital health can strengthen referral coordination, follow-up, and continuity of cancer care in LMICs. The approach highlights the importance of long-term partnerships, capacity building, and system integration, and provides a scalable foundation for future digital innovations in cancer control.

Digital Support of the Breast and Cervical Cancer Care Continuum in Ethiopia