Evaluating the Impact of Intersectional Stigma on Linkage to Cancer Care in HIV-Associated Kaposi's Sarcoma in East Africa

评估东非艾滋病毒相关卡波西肉瘤中交叉耻辱与癌症护理的影响

• 批准号: 10406121
• 负责人: Andrew Ddungu Kambugu
• 金额: $ 19.81万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-13 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10406121
• 关键词: AIDS related cancer; Address; Administrative Supplement; Africa; Africa South of the Sahara; Area; Award; Cancer Control; Caring; Characteristics; Clinic; Clinic Visits; Clinical; Diagnosis; Early Diagnosis; Evaluation; Failure; Future; General Population; Goals; HIV; HIV Infections; HIV diagnosis; Health; Healthcare; High Prevalence; Individual; Intervention; Interview; Investigation; Kaposi Sarcoma; Kenya; Label; Laboratories; Link; Malignant Neoplasms; Measurement; Newly Diagnosed; Oncology; Parents; Pathway interactions; Patients; Persons; Population; Prevalence; Prevention; Provider; Research; Resources; Structure; Time; United States; Work; cancer care; career development; chemotherapy; comparative; experience; follow-up; instrument; interest; intersectionality; lens; mortality; parent grant; participant enrollment; response; skin disorder; social; social stigma; treatment planning; virus related cancer

This application is being submitted in response to the Notice of Special Interest (NOSI) identified as "NOT- CA-21-026”. In sub-Saharan Africa, Kaposi’s sarcoma (KS) remains one of the most common HIV-related cancers and — by virtue of the high prevalence of HIV infection in the region — one of the commonest in the general population. Not only is KS common in Africa, but it is also frequently fatal; two-year mortality following KS diagnosis is as high as 45%. Reasons for poor survival are diverse, but one potentially modifiable cause is failure to promptly link patients to cancer care following diagnosis. In one setting in Kenya, for example, only 50% of patients with KS clinically eligible for chemotherapy actually received it. Stigma occurs when individuals are recognized, labeled as “other”, and discriminated against because of socially undesirable characteristics. In resource-rich settings, the health consequences of stigma, including amongst persons with cancer, have been recognized for over 50 years. In resource-limited settings, stigma has been most intensely studied amongst persons with HIV infection. There has been comparatively scant investigation of stigma amongst patients with cancer in resource-limited settings, but where it has been studied, manifestations are similar to resource-rich settings. HIV-associated KS in Africa has the potential to confer three co-occurring forms of stigma: cancer-related stigma, skin disease-related stigma, and HIV-related stigma. As such, this cancer provides a unique lens to study stigma in resource-limited settings. If present amongst patients with HIV-associated KS, these three “intersecting” forms of stigma may impact healthcare engagement at many levels, including the crucial initial linkage to cancer care after diagnosis. As an administrative supplement to U54 CA254571, our overarching goal is to study the magnitude and impact of stigma on linkage to care in patients with HIV-associated KS in East Africa. Our specific aims are: Aim 1. Describe intersectional stigma in patients with newly diagnosed HIV-associated KS. Using semi-structured interviews and quantitative instruments, we will describe the prevalence and relationship between 3 forms of stigma: a) cancer-related, b) skin disease-related; and c) HIV-related. Aim 2. Assess the impact of stigma on linkage to cancer care in HIV-associated KS. Among patients with newly-diagnosed HIV-associated KS in western Kenya, we will evaluate the impact of the 3 stigma types on linkage to cancer care, defined as time to a) first Oncology Clinic visit, b) first evaluation by an oncology provider at the clinic qualified to make a treatment plan, and c) initial chemotherapy use. To address these aims, we will study stigma in an already-existing population laboratory for the investigation of HIV-associated KS in the AMPATH network in western Kenya, supported by parent grant U54 CA254571. Findings from this work are expected to expand our understanding of stigma and its impact on linkage to care in patients with KS and inform future stigma reduction interventions for all cancers in sub-Saharan Africa.

该申请是为了响应特殊利益通知（NOSI）而提交 CA-21-026”。在撒哈拉以南非洲，卡波西的肉瘤（KS）仍然是最常见的HIV相关的人之一 癌症，以及该地区艾滋病毒感染的高流行率，是最常见的一种 普通人群。 KS不仅在非洲常见，而且经常是致命的。两年死亡率 遵循KS诊断高达45％。生存差的原因是潜水员，但有可能 可修改的原因是诊断后无法迅速将患者与癌症护理联系起来。在一个环境中 例如，肯尼亚实际上只有50％的KS患者有资格接受化学疗法。 当个人被认可，标记为“其他”并歧视时，就会发生污名 社会上不受欢迎的特征。在资源丰富的环境中，污名的健康后果，包括 在患有癌症的人中，已被认可了50多年。在资源有限的设置中，污名 在艾滋病毒感染的人中，一直是最激烈的研究。相对较少 在资源有限的环境中对癌症患者中污名的调查，但 Studiod，表现形式类似于资源丰富的设置。非洲与HIV相关的KS具有潜力 会议三种同时存在的污名形式：与癌症相关的污名，与皮肤疾病相关的污名和 与HIV相关的污名。因此，这种癌症为研究资源有限设置的污名提供了独特的镜头。 如果在与HIV相关的KS患者中存在，则这三种“相交”形式的污名可能会影响 许多层面的医疗保健参与，包括诊断后与癌症护理的至关重要联系。 作为U54 CA254571的行政补充，我们的总体目标是研究规模和 污名对东非与HIV相关KS患者的护理联系的影响。我们的具体目的是： AIM 1。描述新诊断为HIV相关KS的患者的交叉污名。使用 半结构化访谈和定量工具，我们将描述流行率和关系 在三种形式的污名之间：a）与癌症有关的，b）与皮肤疾病有关的；和C）与HIV有关的。 AIM 2。评估污名对与HIV相关的KS中癌症护理联系的影响。之中 在肯尼亚西部与新诊断的HIV相关KS的患者，我们将评估3种影响 与癌症护理联系的污名类型，定义为a）首次肿瘤学诊所，b）首次评估 由诊所的肿瘤学提供者有资格制定治疗计划，c）最初的化学疗法使用。 为了解决这些目标，我们将研究已经存在的人口实验室的污名 在肯尼亚西部的Ampath网络中与HIV相关的KS的支持，由父母Grant U54 CA254571支持。 期望这项工作的发现将扩大我们对污名的理解及其对联系的影响 在KS患者中，并为撒哈拉以南非洲所有癌症的未来污名降低干预措施提供了信息。