Developing and Implementing a Colorectal Cancer Screening Program in Uganda: Stakeholder Perceived Barriers and Opportunities.

Introduction: Colorectal cancer (CRC) incidence is increasing in Uganda. Despite this, and the disproportionately high burden of early onset and late-stage CRC cases, no CRC screening program exists in Uganda. To guide and inform future CRC prevention efforts, interviews with key stakeholders were undertaken to better understand the perceived barriers and opportunities relevant to the development and implementation of a CRC screening program in Uganda.

Methods: Semi-structured key informant interviews were conducted with key stakeholders in cancer prevention, screening and policy/programming (n = 11, 6 medically qualified and 5 non-medical), who were recruited across Uganda using maximum variation sampling between March and April 2022. Interviews were audio recorded, transcribed, coded and later analysed using a deductive thematic analysis approach guided by the social ecological model.

Results: Major barriers included lack of government priority for CRC prevention programs, lack of resources/funding for CRC screening (policy level), inadequate screening facilities and equipment, limited training/knowledge of CRC and capacity of the health workforce (health system level), challenges in the delivery of CRC awareness messages (community level), emotions associated with CRC screening and poor awareness of CRC and its symptoms (individual level). Major opportunities included the existence of a draft national cancer control plan (policy level), existence of less costly CRC screening alternatives, less costly primary prevention measures (health system level), existence of community leadership and structures (community level), likely acceptability of the faecal occult blood test and peer support (individual level).

Conclusion: There are substantive barriers to CRC screening program development and implementation in Uganda. However, there are signs, like the development of a cancer control plan, that suggest a shift towards strategic planning and allocation of resources at a population level for addressing the issues of cancer prevention and care, including CRC. In the meantime, efforts should prioritise primary prevention interventions such as mass education to promote CRC awareness.