Integrated delivery of cancer control interventions for adolescents and young adults living with HIV in Zambia

为赞比亚艾滋病毒感染者提供综合癌症控制干预措施

基本信息

批准号：
10540828
负责人：
CATHERINE KASONGO MWABA
金额：
$ 77.97万
依托单位：
RESEARCH TRIANGLE INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-02 至 2023-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10540828
关键词：
AIDS related cancer Address Adherence Administrator Adolescent and Young Adult Adult African Age-Years CD4 Lymphocyte Count Cancer Burden Cancer Center Cancer Control Cancer Model Cancer Patient Caring Cervical Cancer Screening Childhood Communities Consultations Continuity of Patient Care Cost Analysis Country Data Data Set Diagnostic Services Diagnostic tests Disease Early Diagnosis Early Intervention Education Ensure Face Feedback Goals Guidelines HIV HIV diagnosis Health Policy Health Services Health care facility Healthcare Healthcare Systems Hospitals Incidence Individual Intervention Investments Kaposi Sarcoma Knowledge Learning Link Malignant Childhood Neoplasm Malignant Neoplasms Malignant neoplasm of cervix uteri Mediating Methods Modeling Morbidity - disease rate Non-Hodgkin&apos s Lymphoma Nurses Oncology Outcome Pamphlets Patients Persons Physicians Policies Policy Maker Premature Mortality Prevalence Preventive service Primary Health Care Process Professional counselor Provider Province Rapid diagnostics Reporting Research Resource-limited setting Risk Role Self Efficacy Services Signs and Symptoms Specialist Testing Time Vulnerable Populations Work Zambia antiretroviral therapy base cancer care cancer diagnosis cancer referral center cancer risk cancer therapy care delivery cohort cost effectiveness cost-effectiveness evaluation design economic evaluation effectiveness evaluation evidence base experience future implementation implementation efforts implementation evaluation implementation outcomes implementation science implementation trial improved incremental cost-effectiveness individual patient learning network member mortality peer peer learning peer support peri-urban policy implication premature programs randomized trial rural area scale up service uptake simulation survivorship theories treatment as usual treatment optimization treatment planning treatment program tv watching unethical

项目摘要

PROJECT SUMMARY/ABSTRACT Zambia is a global epicenter for HIV with a large number of adolescents and young adults living with HIV (AYAHIV). Compared with their uninfected peers, AYAHIV are at increased risk of developing cancer, most frequently Kaposi sarcoma (KS), non-Hodgkin’s lymphoma (NHL), and cervical cancer (CC). To reduce this premature mortality, evidence-based strategies should be implemented to both diagnose cancers at an earlier stage and help AYAHIV complete recommended cancer treatment. We will use theory-informed multilevel strategies to create the AYAHIV Role-based Responsibilities for Oncology-focused Workforce (ARROW) program to increase uptake of services for early diagnosis and improve compliance with cancer treatment for KS, NHL, and CC. Our overall approach is based on the evidence-based strategy of peer support for engagement and learning. At the individual level, we will address barriers by embedding peer counselors to support AYAHIV. At the provider level, we will create a peer-to-peer learning network to build linkages between those specializing in pediatric and adult HIV treatment and cancer care. At the health care system level, we will bring together health care administrators and Zambian Ministry of Health policy makers to review barriers and to develop and implement collaborative solutions. We will use implementation science methods to evaluate effectiveness, implementation outcomes, and cost-effectiveness of the ARROW program compared with a one-time education campaign by pursuing the following aims: Aim 1. Conduct randomized trials to compare the ARROW program with the one-time education campaign in increasing services received by AYAHIV to facilitate early diagnosis (physical exam for KS and NHL, CC screening, and timely diagnostic testing) and in improving adherence to cancer treatment. Aim 2. Use mixed methods to assess implementation outcomes of the ARROW program compared with one- time education based on acceptability, feasibility, appropriateness, fidelity, and sustainability. Aim 3. Perform economic evaluations to assess cost-effectiveness and return-on-investment scenarios. Successful completion of these aims will yield a set of data-driven strategies that can be scaled up to reduce premature cancer mortality among AYAHIV. To support future implementation efforts, we will generate incremental cost-effectiveness estimates, conduct policy simulations, evaluate implementation outcomes, and assess challenges and facilitators to optimize the ARROW program. The model tested in Zambia can serve as a blueprint for other Sub-Saharan African countries to ensure AYAHIV receive optimal services to facilitate early diagnosis and ensure completion of guideline-recommended treatments. The ARROW program will also provide a framework for implementing expanded services, such as preventive services and survivorship care, to further reduce the burden of cancer AYAHIV face.

项目摘要/摘要赞比亚是艾滋病毒的全球震中（ayahiv）。与未感染的同龄人相比，Ayahiv患癌症的风险增加，大多数 Kaposi肉瘤（KS），非霍奇金淋巴瘤（NHL）和宫颈癌（CC）经常。为了减少这一点应在一个诊断癌症的两种诊断癌症中实施过早死亡率，基于证据的策略较早的阶段并帮助Ayahiv完全建议癌症治疗。我们将使用理论信息多层次的策略来创建以肿瘤学为中心的劳动力的基于AYAHIV角色的责任（箭头）计划增加服务的吸收早期诊断并提高对癌症的依从性 KS，NHL和CC的治疗。我们的整体方法基于同伴的基于证据的策略支持参与和学习。在个人层面，我们将通过嵌入同伴来解决障碍算是支持Ayahiv。在提供商级别，我们将创建一个点对点学习网络来构建专门从事小儿和成人艾滋病毒治疗与癌症护理的人之间的联系。在医疗保健系统级别，我们将召集医疗保健管理人员和赞比亚卫生部政策制定者审查障碍并开发和实施协作解决方案。我们将使用实施科学评估箭头的有效性，实施结果和成本效益的方法计划与一次性教育运动相比，通过追求以下目的：目标1。进行随机试验以将箭头计划与一次性教育活动进行比较 Ayahiv收到的促进早期诊断的服务增加（KS和NHL的体格检查，CC 筛查，及时的诊断测试）以及改善对癌症治疗的依从性。 AIM 2。使用混合方法来评估箭头计划的实施结果基于可接受性，可行性，适当性，忠诚和可持续性的时间教育。目标3。进行经济评估以评估成本效益和投资回报方案。这些目标的成功完成将产生一系列数据驱动的策略，可以扩展以减少 Ayahiv中的癌症死亡率过早。为了支持未来的实施工作，我们将产生增量的成本效益估计，进行政策模拟，评估实施结果，并评估挑战和促进者以优化箭头计划。在赞比亚测试的模型可以作为其他撒哈拉以南非洲国家的蓝图，以确保Ayahiv获得最佳服务促进早期诊断，并确保完成指南征用的治疗方法。箭头计划还将提供一个用于实施扩展服务的框架，例如预防服务和生存护理，以进一步减少Ayahiv脸的燃烧。