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 摘要：评估肯尼亚西部社区驱动的宫颈癌预防模式 宫颈癌每年影响全球超过 50 万女性。虽然富裕国家的宫颈癌控制是上个世纪公共卫生方面的成功故事之一，但该疾病仍然对发展中国家的妇女构成重大威胁，而发展中国家几乎 90% 的病例都发生在这些国家。尽管已经开发出有效的筛查技术用于资源匮乏的环境，但作为完整的宫颈癌预防策略的一部分，其实施仍存在复杂的、具体情况的障碍。除了采用基于证据的筛查和治疗技术外，宫颈癌筛查对总体人口的影响取决于两个主要因素：(1) 社区范围内获得筛查的机会；(2) 成功将患有以下疾病的女性与治疗或随访联系起来：屏幕正极。解决这些因素的策略还必须是可接受的、相对容易实施且具有成本效益才能可持续。我们在肯尼亚西部这个宫颈癌负担较高的国家开展的工作，发现了“宫颈癌预防级联”中这些关键步骤的切实障碍和促进因素，并制定了一项战略，以提高妇女对宫颈癌预防活动的参与度。基于这项工作，我们提出了以下假设：（1）与政府诊所相比，通过社区健康活动提供的自采集人乳头瘤病毒（HPV）样本宫颈癌筛查将覆盖更多女性； (2) 社区制定的策略将比目前的护理标准（即转诊到治疗地点）成功地让更多的妇女接受治疗。为了检验这些假设，我们建议对肯尼亚西部卫生部和世卫组织推荐的宫颈癌预防方案的实施策略进行两阶段整群随机试验。在第一阶段，社区将在社区健康活动或诊所中随机接受 HPV 检测，并按照标准将 HPV + 女性转诊至政府机构接受治疗。我们将使用 RE-AIM 框架，该框架用于评估实施策略（覆盖范围、有效性、采用、实施一致性和成本以及维护）来评估关键成果；然后，我们将与社区合作制定一项加强与护理联系的战略。在第二阶段，所有社区都将提供基于社区的检测，并加强与护理的联系。进行这项整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、通过加强与护理的联系而获得的治疗机会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具体情况，以生成一个“工具包”，以便在该地区扩大规模并在类似环境中实施。