Evaluating a community-driven cervical cancer prevention model in western Kenya

评估肯尼亚西部社区驱动的宫颈癌预防模式

• 批准号: 8762661
• 负责人: Megan J. Huchko
• 金额: $ 55.33万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-19 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8762661
• 关键词: Address; Adoption; Africa South of the Sahara; Aftercare; Cancer Burden; Cancer Control; Caring; Cervical Cancer Screening; Cessation of life; Clinic; Communities; Community Health; Cost Measures; Country; Coupled; Cytology; Developing Countries; Development; Diagnosis; Dimensions; Disease; District Hospitals; Equipment; Government; HIV; HPV-High Risk; Health; Health Campaign; Health Services Accessibility; Health care facility; Healthcare; Human Papillomavirus; Incidence; Intervention; Kenya; Link; Maintenance; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Measures; Modeling; Outcome; Outpatients; Patients; Pelvic Examination; Phase; Population; Prevention Protocols; Prevention program; Prevention strategy; Preventive; Protocols documentation; Provider; Public Health; Randomized; Research Design; Research Infrastructure; Resources; Rural; Services; Site; Specimen; Techniques; Technology; Testing; Transportation; Visit; Woman; Work; World Health Organization; abstracting; arm; base; burden of illness; cervical cancer prevention; cost; cost effective; cost effectiveness; disability-adjusted life years; evidence base; follow-up; improved; mortality; outreach; population health; programs; public health relevance; randomized trial; rural area; scale up; screening; standard care; standard of care; success; treatment site; uptake

DESCRIPTION (provided by applicant): Abstract for R01: Evaluating a community- driven cervical cancer prevention model in western Kenya Cervical cancer impacts over half a million women globally each year. While cervical cancer control in wealthy countries is one of the public health success stories of the past century, the disease remains a significant threat for women in developing countries where almost 90% of cases occur. Although effective screening technologies have been developed for use in low-resource settings, there are complicated, context-specific barriers to their implementation as part of a complete cervical cancer prevention strategy. In addition to employing evidence-based screening and treatment techniques, the overall population impact of cervical cancer screening depends on two main factors: (1) community-wide access to screening and (2) successful linkage to treatment or follow-up for women who screen positive. Strategies to address these factors must also be acceptable, relatively easy to implement, and cost-effective to be sustainable. Our formative work in western Kenya, a country with a high cervical cancer burden, uncovered tangible barriers and facilitators to these key steps in the "cervical cancer prevention cascade" and has led to a strategy that will increase women's uptake of cervical cancer prevention activities. Based on this work, we have developed the following hypotheses: (1) cervical cancer screening with self-collected human papillomavirus (HPV) specimens will reach more women when offered through community health campaigns versus government clinics; and (2) community-developed strategies will successfully link more women to treatment than the current standard of care (i.e., referral to treatment sites). To test these hypotheses, we propose a two- phase cluster-randomized trial of implementation strategies for a Ministry of Health and WHO-recommended cervical cancer prevention protocol in western Kenya. During Phase 1, communities will be randomized to HPV-testing in either community-health campaigns or in clinics, with standard referral for treatment of HPV+ women to government facilities. We will use the RE-AIM framework, a framework used to evaluate implementation strategies, (Reach, Efficacy, Adoption, Implementation consistency and costs, and Maintenance) to assess the key outcomes; we will then work in partnership with the community to develop a strategy for enhanced linkage to care. In Phase 2, all communities will offer community-based testing with enhanced linkage to care. Conducting this cluster-randomized trial will enable us to assess the proportion of women in each community who get cervical cancer screening, the gain in treatment access with enhanced linkage to care, and the cost-effectiveness of the two interventions. The RE-AIM framework will allow us to measure and refine the context-specific dimensions of the project to produce a "toolkit" for scale-up within ths region and implementation into similar settings.

描述（由申请人提供）： R01的摘要：评估肯尼亚西部宫颈癌的社区驱动的宫颈癌预防模型每年影响超过50万妇女。虽然富裕国家的宫颈癌控制是过去一个世纪的公共卫生成功案例之一，但这种疾病仍然是近90％发生病例的发展中国家妇女的重大威胁。尽管已经开发出有效的筛查技术用于低资源环境，但作为完整的宫颈癌预防策略的一部分，它们实施的复杂，特定于上下文的障碍。除了采用基于证据的筛查和治疗技术外，宫颈癌筛查的总体总体影响取决于两个主要因素：（1）范围内访问筛查的访问以及（2）筛查阳性的妇女的治疗或随访的成功联系。解决这些因素的策略也必须是可以接受的，相对易于实施，并且具有成本效益才能可持续。我们在肯尼亚西部的形成性工作是一个具有较高的宫颈癌负担的国家，在“预防宫颈癌预防级联”中发现了这些关键步骤，并揭示了有形的障碍和促进者，并导致了一项策略，该策略将增加妇女对宫颈癌预防活动的吸收。基于这项工作，我们已经制定了以下假设：（1）通过自我收集的人乳头瘤病毒（HPV）标本进行宫颈癌筛查，当通过社区健康运动与政府诊所提供的提供时，将吸引更多女性； （2）社区发展的策略将成功将更多的女性与当前护理标准（即转介到治疗地点）联系起来。为了检验这些假设，我们提出了针对卫生部的实施策略的两相聚类试验，并在肯尼亚西部推出了谁推荐的宫颈癌预防方案。在第1阶段，社区将在社区健康运动或诊所中随机进行HPV测试，并将标准转诊用于将HPV+妇女治疗给政府设施。我们将使用RE-AIM框架，该框架是一种用于评估实施策略（触及，功效，采用，实施一致性和成本以及维护）的框架来评估关键结果；然后，我们将与社区合作，制定一项策略，以加强关怀联系。在第2阶段，所有社区都将提供基于社区的测试，并加强与Care的联系。进行这项集群随机试验将使我们能够评估每个社区中接受宫颈癌筛查的妇女比例，治疗访问的增益并增强了护理的联系以及两种干预措施的成本效益。 RE-AIM框架将使我们能够衡量和完善项目的特定上下文维度，以生成一个“工具包”，以扩大到THS区域内的扩展并实现相似的设置。