Full Project 2: Determining Optimal Anal Cancer Prevention Strategies for HIV-Infected Individuals Living in Puerto Rico

完整项目 2：为居住在波多黎各的艾滋病毒感染者确定最佳的肛门癌预防策略

• 批准号: 10020949
• 负责人: Ashish A. Deshmukh
• 金额: $ 12.38万
• 依托单位: UNIVERSITY OF TX MD ANDERSON CAN CTR
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-08-16 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10020949
• 关键词: 17 year old; Adherence; Adoption; Age; Anal Intraepithelial Neoplasia; Anal carcinoma; Anus; Area; Behavior Therapy; Biopsy; Caring; Clinical Research; Cohort Studies; Costs and Benefits; Cross-Sectional Studies; Data; Data Analyses; Databases; Detection; Development; Diagnostic; Disease; Epidemic; Epidemiology; Evaluation; Expert Opinion; Focus Groups; Frequencies; Future; General Population; Geographic state; Goals; Guidelines; HIV; Health Promotion; Hispanics; Human Papilloma Virus Vaccination; Human Papillomavirus; Incidence; Individual; Interview; Link; Malignant Neoplasms; Malignant neoplasm of anus; Measures; Methods; Modeling; Patient Recruitments; Patients; Persons; Prevalence; Prevention; Prevention strategy; Prospective cohort study; Puerto Rico; Quality of life; Randomized Clinical Trials; Randomized Controlled Trials; Recommendation; Regimen; Reporting; Risk; Screening for cancer; Secondary Prevention; Series; Squamous cell carcinoma; Squamous intraepithelial lesion; Stage at Diagnosis; Surveys; Treatment outcome; Uncertainty; University of Texas M D Anderson Cancer Center; Woman; Youth; aged; anticancer research; arm; base; cancer prevention; cancer therapy; cost; cost effective; cost effectiveness; epidemiology study; evidence base; health related quality of life; improved; life time cost; mathematical model; men; mortality; neoplasm registry; patient oriented; public health priorities; racial and ethnic; screening; screening guidelines; tool

FULL PROJECT 2: DETERMINING OPTIMAL ANAL CANCER PREVENTION STRATEGIES FOR HIV-INFECTED INDIVIDUALS LIVING IN PUERTO RICO PROJECT SUMMARY/ABSTRACT Squamous cell carcinoma of the anus (SCCA) is an epidemic among persons living with HIV (PLWH). Studies in the US and Puerto Rico (PR) have reported >80-fold risk of SCCA among PLWH when compared with the general population. Guidelines based on expert opinion recommend anal cancer screening for PLWH. To inform evidence-based use of screening, studies are currently underway; however, findings from those studies will not be generalizable to PLWH in PR. This is because racial and ethnic composition, disease prevalence, anal cancer treatment outcomes including cost and quality of life (QOL) substantially differ for PLWH in PR. This increases the importance of anal cancer screening evaluation specifically and separately for PLWH in PR majority of which are of Hispanic origin. Furthermore, no ongoing or future randomized controlled trials (RCTs) will evaluate mortality benefits of screening as it unethical to evaluate a “no screening” arm. As such, a mathematical model (incorporating epidemiological, cost, and quality of life data specific to PLWH in PR) could be utilized as a unique tool to evaluate survival and QOL benefits and cost-effectiveness of screening with the goal to promote health and value-based care. Our overarching goal is to optimize anal cancer prevention for PLWH in PR. We will study the epidemiology of SCCA, and evaluate the cost of and QOL after SCCA treatment to inform a mathematical model that will determine the best screening regimen for PLWH in PR. We also seek to study critical barriers and facilitators necessary to decrease potential uncertainty in screening adoption and adherence to screening recommendations. Our Specific Aims are: (1) Determine epidemiological, cost, and QOL measures of anal precancer and cancer among PLWH living in PR. (2) Identify barriers to and facilitators of screening for anal cancer, and adherence to anal cancer screening and high-grade squamous intraepithelial lesions (HSIL) treatment. (3) Construct and execute a mathematical model to determine effective and cost-effective screening strategies for the detection of anal precancer among PLWH in PR. (4) Use value of information (VOI) analysis to determine high priority future clinical studies to improve screening accuracy and adherence to screening recommendations. In Aims 1 and 2, we will perform secondary data analyses of existing databases, and conduct focus groups and three epidemiologic studies (two cross-sectional studies and one cohort study) that involve patient recruitment. Parameters identified through these activities will inform the development of the SCCA screening model and the execution of the VOI analysis (Aims 3 and 4). The end result of this study will be utilized to inform an optimal anal cancer screening regimen specific to PLWH in PR.

完整项目2：确定最佳肛门癌预防策略 对于居住在波多黎各的艾滋病毒感染者 项目摘要/摘要 肛门（SCCA）的鳞状细胞癌是艾滋病毒（PLWH）患者的流行病。研究 在美国和波多黎各（PR）报告说，与 一般人口。基于专家意见建议的准则肛门癌筛查PLWH。到 为基于证据的筛查使用，目前正在进行研究；但是，这些研究的发现 在PR中不会推广到PLWH。这是因为种族和种族组成，疾病患病率， PR中PLWH的肛门癌治疗结果包括成本和生活质量（QOL）。 这增加了肛门癌筛查评估的重要性，并分别针对PR中的PLWH 其中大多数是西班牙裔。此外，没有持续或将来的随机对照试验（RCT） 将评估筛查的死亡率益处，因为评估“无筛查”部门的不道德。因此， 数学模型（合并PR中特定于PLWH的流行病学，成本和生活质量数据）可以 用作评估生存和质量收益的独特工具 促进基于健康和价值的护理的目标。我们的总体目标是优化预防肛门癌 pr中的plwh。我们将研究SCCA的流行病学，并评估SCCA之后的成本和质量 用于告知数学模型的治疗方法，该模型将确定PR中PLWH的最佳筛选方案。我们 还寻求研究必要的关键障碍和促进因素，以减少筛查的潜在不确定性 采用和遵守筛选建议。我们的具体目的是：（1）确定流行病学， 居住在PR中的PLWH中的肛门预科剂和癌症的成本和质量测量。 （2）确定障碍和 筛查肛门癌的促进者，并遵守肛门癌筛查和高级鳞状 上皮内病变（HSIL）治疗。 （3）构建并执行数学模型以确定有效 PR中PLWH中检测肛门预科剂的经济高效筛选策略。 （4）使用值 信息（VOI）分析以确定未来临床研究的高优先级以提高筛查准确性 并遵守筛选建议。在目标1和2中，我们将执行辅助数据分析 现有数据库，并进行焦点小组和三项流行病学研究（两项横断面研究） 以及一项涉及患者招募的队列研究）。通过这些活动确定的参数将告知 SCCA筛选模型的开发和VOI分析的执行（目标3和4）。结尾 这项研究的结果将用于告知PR中特定于PLWH的最佳肛门癌筛查方案。