A stigma responsive service delivery model for HPV-based screening among women living with HIV

针对感染艾滋病毒的女性进行基于 HPV 筛查的耻辱响应服务提供模式

• 批准号: 10542876
• 负责人: Megan J. Huchko
• 金额: $ 20.18万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-20 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10542876
• 关键词: Address; Anti-Retroviral Agents; Area; Awareness; Biological; Caring; Cervical Cancer Screening; Characteristics; Clinic; Collection; Communication; Communities; Community Health; County; Data; Diagnosis; Discrimination; Education; Educational Intervention; Educational Materials; Effectiveness; Epidemiology; Focus Groups; Fright; Government; HIV; Health; Health care facility; Healthcare; Human Development; Human Papillomavirus; Individual; Infrastructure; Intervention; Interview; Kenya; Language; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Measurement; Methods; Modeling; Outcome; Outpatients; Pamphlets; Patient-Centered Care; Perception; Persons; Prevalence; Randomized Clinical Trials; Risk; Risk Factors; Screening for cancer; Service delivery model; Sex Behavior; Social support; Stigmatization; Testing; Text Messaging; Training; Woman; Work; World Health Organization; base; cancer risk; care outcomes; cervical cancer prevention; design; effective therapy; effectiveness evaluation; effectiveness testing; follow-up; implementation strategy; infection risk; novel; outreach; peer; prevent; prevention service; programs; response; screening; screening services; service delivery; social stigma; standard of care; success; synergism; therapy design; tool; treatment arm; uptake; volunteer

ABSTRACT Women living with HIV (WLWH) are at increased biologic risk for infection with human papillomavirus (HPV) and development of pre-invasive and invasive cervical cancer. The World Health Organization has recently called for HIV-programs to bolster their efforts to prevent cervical cancer through integrated screening services. Understanding and addressing stigma, including the intersection of HIV, HPV and cervical cancer-related stigma, will be crucial to designing interventions that will facilitate the uptake of cancer screening among WLWH and women in high HIV prevalence settings like western Kenya. Cancer-related stigma negatively influences several determinants of cancer screening uptake, including perception of cancer risk, cancer screening benefit, and acceptability of screening methods. In our prior work to evaluate HPV-based screening in Kenya, we found that lack of education about cervical cancer and low awareness of screening benefits, both of which can potentiate cancer-related stigma, were major barriers to screening uptake. Our team also found that misperceptions and stigma about an HPV diagnosis and cancer were associated with reduced rates of follow-up among women who tested positive for HPV. Our team developed a stigma framework to inform and validate a measurement tool for HPV-, cervical cancer- and HIV-related stigmas. We found that educational messages focused on cancer-related outcomes and HPV epidemiology, including risks related to sexual behavior and HIV, were stigmatizing, while support from social networks and emphasis on the availability of effective treatment reduced stigma and promoted screening uptake. We used this data to develop a stigma-responsive educational intervention which includes simplified scripts for multiple cadres of health workers that provide clear messages about HPV and the benefits of screening and a video aimed at addressing fears and misperceptions from a peer perspective. We propose to incorporate these educational components into “Elimisha HPV,” a multilevel stigma-responsive cervical cancer prevention service delivery model for integration within clinics providing HIV-care in western Kenya. Elimisha HPV, which in Kiswahili means to increase understanding of HPV, will include the following components: HPV-testing via self-collection, simplified scripts and video, peer navigators for women with screening or treatment hesitancy, and the option to receive results and information via text messages. To adapt, implement and test the effectiveness of this model, we will: 1) work with key stakeholders to finalize Elimisha HPV 2) compare cervical cancer prevention outcomes and engagement in HIV care in clinics offering the Elimisha HPV model to clinics providing standard of care outreach, education and screening strategies; and 3) identify individual and institutional factors that moderate the effects of Elimisha HPV on cervical cancer prevention outcomes. If effective, this may represent a new model for HPV-based cervical cancer screening as well as a new paradigm for comprehensive, stigma-responsive service delivery packages for people living with HIV.

抽象的 艾滋病毒（WLWH）的妇女患有人乳头瘤病毒（HPV）和 侵入前和侵入性宫颈癌的发展。世界卫生组织最近呼吁 艾滋病毒计划通过综合筛查服务来加强他们为预防宫颈癌的努力。 了解和解决污名，包括HIV，HPV和宫颈癌相关的污名的交集， 对于设计干预措施至关重要 像肯尼亚西部这样的高艾滋病毒患病率的妇女。与癌症有关的污名对几个 癌症筛查摄取的决定因素，包括对癌症风险的看法，癌症筛查益处和 筛查方法的可接受性。在我们先前评估肯尼亚基于HPV的筛查的工作中，我们发现 缺乏有关宫颈癌的教育和对筛查益处的低认识，这两者都可以潜在 与癌症相关的污名是筛查摄取的主要障碍。我们的团队还发现误解和 关于HPV诊断和癌症的污名与女性的随访率降低有关 测试的HPV呈阳性。我们的团队开发了一个污名框架，以告知和验证一个测量工具 HPV，宫颈癌和与HIV相关的污名。我们发现教育信息的重点是与癌症有关 结局和HPV流行病学，包括与性行为和艾滋病毒有关的风险，污名化，而 社交网络的支持，强调有效治疗的可用性减少了污名和 促进了筛查吸收。我们使用这些数据来开发污名化的教育干预措施， 包括用于多个卫生工作者的简单脚本，提供有关HPV和The的清晰信息 筛选的好处和旨在从同伴角度解决恐惧和误解的视频。我们 将这些教育组件纳入“ Elimisha HPV”的建议，这是一种多层次的污名响应性。 宫颈癌预防服务输送模型，用于在西方提供艾滋病毒护理的诊所内的融合模型 肯尼亚。在基斯瓦希里（Kiswahili）中意味着提高对HPV的理解的Elimisha HPV将包括以下内容 组件：通过自我收集，简化脚本和视频进行HPV测试，女性的同伴导航员 筛查或治疗愈合，以及通过短信接收结果和信息的选项。适应， 实施并测试该模型的有效性，我们将：1）与主要利益相关者合作，以最终确定Elimisha HPV 2）比较宫颈癌的预防结果和诊所中的艾滋病毒护理参与 Elimisha HPV模型向诊所提供了护理标准的外展，教育和筛查策略； 3） 确定调节甲虫HPV对宫颈癌影响的个人和机构因素 预防结果。如果有效，这可能代表基于HPV的宫颈癌筛查的新模型 以及一个新的范式，用于全面，污名化的服务交付套餐 艾滋病病毒。