A Mentored Research Experience in Investigating the Socio-geographic Expansion to Liberia of a Novel Campaign-based Public Health Approach to Cervical Cancer Prevention

调查基于运动的新型宫颈癌预防公共卫生方法向利比里亚的社会地理扩张的指导研究经验

• 批准号: 10846445
• 负责人: Andrew Ddungu Kambugu
• 金额: $ 12.45万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-13 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10846445
• 关键词: Address; Adopted; Affect; Africa; Africa South of the Sahara; African; Area; Award; Cancer Control; Cervical; Cervical Cancer Screening; Cognitive; Collection; Communities; Community Health Aides; Community Surveys; Data Analyses; Disease; Disparity; Doctor of Philosophy; Eligibility Determination; Evaluation; Female Adolescents; Future; Geography; Goals; Health; Health Fairs; Human Papilloma Virus Vaccination; Human Papillomavirus; Immunization Programs; Incidence; Kenya; Learning Skill; Liberia; Liberian; Life Cycle Stages; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Manuscripts; Mentors; Methods; Parents; Persons; Physicians; Preventive; Preventive service; Principal Investigator; Public Health; Research; Research Design; Research Personnel; Resources; Scientist; Senior Scientist; Services; Site; Statistical Data Interpretation; Training; Uganda; United States National Institutes of Health; Universities; Vaccination; Woman; Work; World Health Organization; anticancer research; career development; cervical cancer prevention; data dissemination; disparity reduction; early experience; experience; follow-up; implementation intervention; interest; low and middle-income countries; member; mortality; novel; novel strategies; parent grant; peer; population based; premalignant; preventive intervention; programs; response; satisfaction; screening; screening program; skills; uptake

This application is being submitted in response to the Notice of Special Interest (NOSI) identified as NOT-CA- 23-038. Women in sub-Saharan Africa bear the greatest burden of cervical cancer in the world, and the reasons are clear: lack of HPV vaccination, screening for pre-cancer, and treatment. In recognition of the global disparities surrounding cervical cancer and that preventive solutions exist, the WHO has adopted a global strategy for cervical cancer elimination. It calls for 90% vaccination coverage, 70% screening coverage, and treatment of 90% of those with cervical disease. Lacking in this strategy, however, is a clear path to implementation. Furthermore, a shortage in the research workforce in areas most affected, such as sub-Saharan Africa, hinders the ability for context-specific evidence to be generated to reduce the disparities. Through parent award U54 CA254571, we have developed in East Africa what we call a campaign-based public health approach to address gaps in the implementation of preventive interventions for cervical cancer control. Our approach features Community Health Worker-led mobilization of eligible community members to attend local Health Fairs at which HPV vaccination and HPV-based cervical cancer screening (via self- collection) are offered, followed by ablative therapy for those found to be HPV-infected by a Mobile Treatment Team at a convenient central site in the community. In Kenya and Uganda, these community-based campaigns have been well-attended and well-accepted. NOT-CA-23-038 is a well-timed opportunity for us to expand our work in East Africa to another resource-limited socio-geographic context — Liberia, in West Africa — while concurrently providing a research practicum for an early-stage low- and middle-income country (LMIC) investigator (ESLI) from Liberia. Accordingly, our specific aims are to: Aim 1: Evaluate the uptake and acceptability of HPV vaccination and cervical cancer screening offered through a campaign-based public health approach to cervical cancer control in Liberia. Aim 2: Determine the factors explaining non-participation in either community-based HPV vaccination among adolescent girls or in cervical cancer screening among women in Liberia. Aim 3: Provide a mentored career development experience for Dr. Cozie Gwaikolo, a Liberian ESLI. To address our aims, we will evaluate a community-based integrated cervical cancer vaccination and screening program (developed in parent grant U54 CA254571), which will be implemented by our Ministry of Health (MOH) partners in Liberia. Evaluation will include assessment of acceptability and follow-up among Health Fair attendees as well as a population-based door-to-door community survey after completion of the campaign, which will determine uptake of the program and reasons for non-participation. Findings from this work may form a blueprint for the ultimate elimination of cervical cancer in the region. Finally, the project is an incomparable opportunity for Dr. Gwaikolo in his quest to become an independent principal investigator.

该申请是为了响应特殊利益通知（NOSI）而提交 23-038。撒哈拉以南非洲的妇女是世界上最大的宫颈癌烧伤， 原因很明显：缺乏HPV疫苗接种，筛查前癌和治疗。认可 围绕宫颈癌和预防解决方案的全球分布，谁采用了 宫颈癌进化的全球战略。它要求进行90％的疫苗覆盖范围，70％筛查 覆盖范围以及90％的宫颈疾病的治疗。但是，缺乏这种策略是一个明显的 实施途径。此外，在受影响最大的领域的研究劳动力中缺乏 撒哈拉以南非洲，阻碍了为减少分布而产生的上下文特定证据的能力。 通过父母奖U54 CA254571，我们在东非开发了我们所谓的基于运动的东西 公共卫生方法来解决实施宫颈癌预防干预措施的差距 控制。我们的方法以社区卫生工作者领导的符合条件的社区成员的动员为特征 参加当地健康展览会，HPV疫苗接种和基于HPV的宫颈癌筛查（通过自我） 提供收集），然后为被移动治疗感染的HPV感染的患者提供烧蚀疗法 团队在社区中方便的中央站点。在肯尼亚和乌干达，这些基于社区的 运动的受人欢迎且受到良好的接受。 Not-CA-23-038对我们来说是一个恰当的机会 将我们在东非的工作扩展到另一个资源有限的社会地理环境 - 利比里亚，西非 - 同时为早期低收入国家提供研究实践 （LMIC）来自利比里亚的研究者（ESLI）。据此，我们的具体目的是： 目标1：评估HPV疫苗接种和宫颈癌筛查的摄取和可接受性 通过基于运动的公共卫生方法在利比里亚提供宫颈癌控制。 目标2：确定解释任何一个基于社区的HPV中无参与的因素 在利比里亚，青春期女孩或宫颈癌筛查中的疫苗接种。 AIM 3：为利比里亚ESLI的Cozie Gwaikolo博士提供了职业发展经验的问题。 为了解决我们的目标，我们将评估基于社区的综合宫颈癌疫苗接种和 筛选计划（在父母授予U54 CA254571中开发），该计划将由我们的部实施 利比里亚的健康（MOH）合作伙伴。评估将包括评估可接受性和随访 卫生博览会参与者以及以人口为基础的门到门社区调查 竞选活动将决定该计划的吸收和非参与的原因。从中的发现 工作可能会形成蓝图，以最终消除该地区的宫颈癌。最后，项目是 Gwaikolo博士成为一名独立的首席调查员，这是无与伦比的机会。

项目成果

Telling the story of intersectional stigma in HIV-associated Kaposi's sarcoma in western Kenya: a convergent mixed-methods approach.

• DOI: 10.1002/jia2.25918
• 发表时间: 2022-07
• 期刊: Journal of the International AIDS Society
• 影响因子: 6

A type III effectiveness-implementation hybrid evaluation of a multicomponent patient navigation strategy for advanced-stage Kaposi's sarcoma: protocol.

• DOI: 10.1186/s43058-022-00281-7
• 发表时间: 2022-05-13
• 期刊: Implementation science communications
• 作者: Collier, Sigrid;Semeere, Aggrey;Byakwaga, Helen;Laker-Oketta, Miriam;Chemtai, Linda;Wagner, Anjuli D.;Bassett, Ingrid V.;Wools-Kaloustian, Kara;Maurer, Toby;Martin, Jeffrey;Kiprono, Samson;Freeman, Esther E.
• 通讯作者: Freeman, Esther E.

Impact of Kaposi Sarcoma on Quality of Life Amongst HIV-infected Adults Initiating Antiretroviral Therapy in East Africa.

卡波西肉瘤对东非开始抗逆转录病毒治疗的艾滋病毒感染成人的生活质量的影响。

• DOI: 10.1101/2023.07.21.23292658
• 发表时间: 2023
• 期刊: medRxiv : the preprint server for health sciences
• 作者: Scott,Lu;Laker-Oketta,Miriam;Byakwaga,Helen;Glidden,David;Mwebesa,Bwana;Muzoora,Conrad;Maurer,Toby;Assenzio,Melissa;Hunt,Peter;Bangsberg,David;Haberer,Jessica;Martin,Jeffrey
• 通讯作者: Martin,Jeffrey

Understanding Diagnostic Delays for Kaposi Sarcoma in Kenya: A Qualitative Study.

• DOI: 10.1097/qai.0000000000003011
• 发表时间: 2022-08-15
• 期刊: Journal of acquired immune deficiency syndromes (1999)

Barriers and facilitators to chemotherapy initiation and adherence for patients with HIV-associated Kaposi's sarcoma in Kenya: a qualitative study.

• DOI: 10.1186/s13027-022-00444-0
• 发表时间: 2022-07-06
• 期刊: Infectious agents and cancer
• 影响因子: 3.7