An integrated community-clinic model of optimized implementation strategies to increase early detection of breast and cervical cancers in Kenya

优化实施策略的综合社区诊所模型，以提高肯尼亚乳腺癌和宫颈癌的早期发现率

• 批准号: 10582296
• 负责人: SUJHA SUBRAMANIAN
• 金额: $ 14.6万
• 依托单位: RESEARCH TRIANGLE INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10582296
• 关键词: Address; Adopted; African; Awareness; Behavioral; Breast Cancer Detection; Breast Cancer Early Detection; Cancer Control; Cancer Detection; Catchment Area; Cervical Cancer Screening; Clinic; Cluster randomized trial; Communication; Communities; Community Health; Community Practice; Continuity of Patient Care; Cost Effectiveness Analysis; Country; DNA; Data; Diagnosis; Diagnostic; Diagnostic Services; Diagnostic tests; Disease; Education; Eligibility Determination; Ensure; Family member; Fostering; Funding; Future; Goals; Grant; Guidelines; Health; Health care facility; Health system; Human Papillomavirus; Incidence; Individual; Infrastructure; Investments; Kenya; Learning; Maintenance; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Mammography; Methods; Modeling; Motivation; National Cancer Institute; Outcome; Pap smear; Pathway interactions; Patients; Phase; Play; Population; Procedures; Process; Program Efficiency; Recommendation; Research; Resources; Role; Screening for cancer; Self Efficacy; Series; Services; Testing; Woman; aged; cancer care; community clinic; community setting; cost effectiveness; cost efficient; design; effectiveness evaluation; empowerment; evidence base; follow-up; implementation evaluation; implementation facilitators; implementation intervention; implementation outcomes; implementation strategy; improved; improved outcome; malignant breast neoplasm; mortality; motivational enhancement therapy; multimodality; optimal treatments; policy implication; posters; process improvement; programs; scale up; screening; screening services; social stigma; standard of care; team-based care; theories; treatment services; uptake; volunteer

PROJECT SUMMARY/ABSTRACT Kenya has a high incidence of breast and cervical cancers, and most women are diagnosed with late- stage disease. Implementing effective programs to screen and detect these cancers at an early stage could substantially decrease the high mortality. Kenya has been increasing access to cancer screening, but less than one-sixth of eligible women have ever received breast and cervical cancer screening. The goal of the study is to assess the effectiveness and cost-effectiveness of multicomponent strategies to increase the uptake of breast and cervical cancer screeening. A key gap that perpetuates the low screening rates in Kenya is the lack of community–clinic linkages. There is evidence that women are often unaware of the screening services offered in facilities, and, even among those who are aware, there is lack of motivation, anticipated or perceived stigma, and reduced self-efficacy to undergo screening. We will conduct a pragmatic cluster randomized trial to evaluate the screening outcomes, including screening uptake, diagnostic test completion, and treatment initiation and implementation outcomes to support scale- up. We will test two multicomponent packages of strategies: (1) Cancer Community–Clinic Linkage (C3Link) Core: Community health volunteer (CHV)-delivered group education for women and family members to increase screening uptake in the community setting and practice facilitation to improve the screening process and develop team-based care with CHV participation in the clinic setting; (2) C3Link Plus: C3Link Core strategies along with a sequential series of individual strategies that increase in intensity at 3-month intervals; women who remain unscreened will first receive one-on-one education; second, motivational interviewing; and, finally, navigation to address specific barriers. We will implement the study across 27 communities in Kenya to address the following three specific aims: Aim 1: Conduct a cluster randomized trial to assess short-term (intervention implementation phase) and longer-term impacts (maintenance phase) of the two packages of multicomponent strategies on breast and cervical cancer screening outcomes along the continuum of care compared to enhanced standard of care (communities receiving a messaging campaign only); Aim 2: Use a mixed-methods approach to assess and compare multilevel implementation outcomes of the package of strategies focusing on acceptability, feasibility, appropriateness, fidelity, and sustainability; Aim 3: Perform cost-effectiveness and return-on- investment analysis to support scale-up of an effective package of implementation strategies across Kenya and other sub-Saharan African countries. The Kenyan Ministry of Health can use the findings from this study to design optimal approaches and plan investments in screening infrastructure to scale up implementation of guideline recommendations. The lessons learned can be applied to other sub-Saharan African settings.

项目概要/摘要 肯尼亚乳腺癌和宫颈癌的发病率很高，大多数女性被诊断出患有晚期癌症 实施有效的计划来早期筛查和检测这些癌症可以。 肯尼亚一直在增加癌症筛查的机会，但数量较少 超过六分之一的符合资格的女性曾经接受过乳腺癌和宫颈癌筛查。 该研究的目的是评估多成分策略的有效性和成本效益 提高乳腺癌和宫颈癌筛查的普及率是导致乳腺癌和宫颈癌筛查长期存在的一个关键差距。 肯尼亚筛查率低的原因在于缺乏社区与诊所的联系。有证据表明，妇女往往缺乏社区与诊所的联系。 不了解设施中提供的筛查服务，即使了解的人也缺乏了解 动机、预期或感知的耻辱以及自我效能感降低，我们将进行筛查。 进行务实的整群随机试验来评估筛查结果，包括筛查 摄取、诊断测试完成以及治疗启动和实施结果，以支持规模- 我们将测试两个多组成部分的策略包：(1) 癌症社区与诊所的联系 (C3Link)。 核心：社区健康志愿者 (CHV) 为妇女和家庭成员提供团体教育 提高社区环境中的筛查率并提供便利以改善筛查 (2) C3Link Plus：C3Link 核心策略以及一系列连续的个人策略，这些策略在 3 个月时强度会增加 未接受筛查的女性首先会接受一对一的教育； 访谈；最后，导航以解决特定障碍。 我们将在肯尼亚 27 个社区开展这项研究，以解决以下三个具体问题 目标： 目标 1：进行整群随机试验以评估短期（干预实施阶段） 两套多成分策略对乳房的长期影响（维持阶段） 与增强的标准相比，在连续护理过程中宫颈癌筛查结果 护理（仅接受信息宣传活动的社区）；目标 2：使用混合方法进行评估 并比较以可接受性为重点的一揽子实施战略的多层次成果， 可行性、适当性、保真度和可持续性；目标 3：实现成本效益和回报 投资分析，以支持在肯尼亚推广一揽子有效的实施战略 和其他撒哈拉以南非洲国家卫生部可以利用这项研究的结果。 设计最佳方法并规划对筛查基础设施的投资，以扩大实施范围 指南建议。所吸取的经验教训可应用于其他撒哈拉以南非洲地区。