Thibang Diphatlha: Testing adaptive strategies to close the gap from cervical cancer diagnosis to treatment in Botswana

Thibang Diphatlha：测试适应性策略，以缩小博茨瓦纳从宫颈癌诊断到治疗的差距

• 批准号: 10540624
• 负责人: Surbhi Grover
• 金额: $ 71.02万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-06 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10540624
• 关键词: AIDS related cancer; Address; Adoption; Appointments and Schedules; Area; Behavior; Botswana; Cancer Control; Cancer Control Research; Caring; Cervical Cancer Screening; Cessation of life; Clinic; Clinical; Communication; Complement; Complex; Consolidated Framework for Implementation Research; Country; Data; Developing Countries; Diagnosis; Diagnostic Procedure; Early Diagnosis; Effectiveness; Ensure; Evaluation; Evidence based practice; Evidence based treatment; Failure; Female; Goals; HIV; HIV diagnosis; Health Services Accessibility; High Prevalence; Hybrids; Incidence; Income; Individual; Intervention; Interview; Knowledge; Malignant Female Reproductive System Neoplasm; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Methods; Modeling; Motivation; National Cancer Institute; Newly Diagnosed; Outcome; Pathology; Patients; Persons; Prevention; Preventive; Public Health; Publishing; Randomized; Research; Resource-limited setting; Sequential Multiple Assignment Randomized Trial; Shapes; Surveys; System; Testing; Theoretical model; Time; Touch sensation; Translating; Visit; arm; behavioral economics; cancer care; cancer diagnosis; cancer therapy; care coordination; clinical care; cohort; comparative; contextual factors; design; effectiveness evaluation; effectiveness testing; evidence base; implementation cost; implementation outcomes; implementation strategy; implementation trial; improved; innovation; low and middle-income countries; mortality; outreach; outreach clinics; patient outreach; response; screening; success; system-level barriers; trial design

PROJECT SUMMARY Delays and missed opportunities for timely treatment contribute significantly to disparities in cervical cancer mortality in low- and middle-income countries (LMICs) compared to high-income countries (HICs). Cervical cancer is one of the most common female cancers globally, with approximately 90% of cases and deaths occurring in LMICs, particularly those with high rates of HIV. This global disparity is partly driven by successful efforts in HICs to implement evidence-based practices focused on early detection and timeliness of care. In Botswana, a LMIC with an extremely high prevalence of HIV and cervical cancer, we identified substantial delays in cancer care from diagnosis to treatment, driven by a myriad of individual- and system-level barriers. To date, most of the implementation and cancer control research in Botswana and other LMICs has focused on prevention and screening, with limited focus on treatment following diagnosis of HIV-associated malignancies. As such, there is a critical need to identify effective strategies to ensure timely care, and to understand contextual factors that shape the response to strategies. Without this fundamental knowledge, cervical cancer will remain a public health crisis in Botswana and other LMICs. To help fill this critical gap, this study will test the effectiveness of adaptive strategies on timely treatment adoption using a Sequential Multiple Assignment Randomized Trial (SMART) design and evaluate contextual mechanisms contributing to the success or failure of each adaptive strategy using qualitative comparative analysis. The adaptive strategies are designed to target individual- and system-level determinants identified in our preliminary data, including delayed communication of results, individual and structural barriers to accessing treatment, and suboptimal care coordination between referring and cancer treatment clinics, and are supported by systematic evidence of the effectiveness of nudge strategies in clinical care. The primary implementation outcome will be adoption, defined as the initiation of treatment within 90 days. Secondary implementation outcomes include fidelity (i.e., completion of recommended treatment), reach, acceptability, implementation costs, and cancer and HIV-related clinical outcomes. The rationale for the study is that enhancing coordination, communication, and navigation through centralized outreach will both increase timely treatment adoption and be scalable and sustainable after the project is completed. This innovative study responds directly to the call by the National Cancer Institute to develop and test implementation strategies in cancer control in LMICs. Furthermore, the highly efficient design enables the comparison of different adaptive strategies within one study, helping to advance an understanding of the minimum level of intervention needed to improve and sustain cancer control in lower resource settings. If successful, these strategies can be easily translated to address other areas of cancer control. The long-term goal of this project is to decrease cervical cancer mortality in LMICs by developing and implementing effective and sustainable strategies.

项目摘要 与高收入国家（HICS）相比，低收入和中等收入国家（LMIC）的延迟和错过的及时治疗的机会会导致宫颈癌死亡率的差异。宫颈癌是全球最常见的雌性癌症之一，大约90％的病例和死亡发生在LMIC中，尤其是艾滋病毒率高的病例。这种全球差异的一部分是由HIC成功努力实施循证实践的努力驱动的，这些实践的重点是早期发现和及时的护理。在博茨瓦纳（Botswana），这是一种艾滋病毒和宫颈癌患病率极高的LMIC，我们确定了从诊断到治疗的癌症护理延迟，这是由无数个个人和系统级别的障碍驱动的。迄今为止，博茨瓦纳和其他LMIC的大多数实施和癌症控制研究都集中在预防和筛查上，并且在诊断出与HIV相关的恶性肿瘤后，专注于治疗。因此，迫切需要确定有效的策略以确保及时护理，并了解影响策略反应的上下文因素。没有这些基本知识，宫颈癌将仍然是博茨瓦纳和其他LMIC的公共卫生危机。为了帮助填补这一关键的差距，本研究将使用顺序的多重分配随机试验（智能）设计（智能）设计对适应性策略进行及时采用的​​有效性，并评估上下文机制，从而使用定性比较分析有助于每种适应性策略的成功或失败。自适应策略旨在针对我们的初步数据中确定的个体和系统级别的决定因素，包括延迟的结果沟通，获得治疗的个人和结构性障碍以及参考治疗诊所和癌症治疗诊所之间的次级护理协调，并受到临床护理中Nudge策略有效性的系统性证据。主要的实施结果将是采用，定义为在90天内开始治疗。次要实施成果包括保真度（即建议治疗的完成），覆盖范围，可接受性，实施成本以及癌症以及与HIV相关的临床结果。该研究的理由是，通过集中式外展增强协调，沟通和导航将既可以提高及时的治疗采用，又可以在项目完成后可扩展和可持续。这项创新的研究直接回应了国家癌症研究所在LMIC中制定和测试癌症控制中实施策略的呼吁。此外，高效的设计可以在一项研究中比较不同的自适应策略，从而有助于了解在较低的资源环境中改善和维持癌症控制所需的最低干预水平。如果成功，这些策略很容易被翻译成解决癌症控制的其他领域。该项目的长期目标是通过制定和实施有效和可持续的策略来降低LMIC的宫颈癌死亡率。