Project 1

项目1

基本信息

批准号：
10598771
负责人：
MICHAEL E HAGENSEE
金额：
$ 12.65万
依托单位：
LSU HEALTH SCIENCES CENTER
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-01 至 2028-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10598771
关键词：
AIDS with Kaposi&apos s sarcoma Adherence Adopted Africa Africa South of the Sahara Age Awareness Biopsy Caring Cervical Cancer Screening Clinic Clinical Communities Community Networks Community Workers Consent Country Coupling Cutaneous Data Detection Diagnosis Disease Early Diagnosis Early treatment Education Effectiveness Fostering HIV HIV/AIDS Health Health Personnel Healthcare Hospitals Incidence Intervention Kaposi Sarcoma Knowledge Lesion Link Malignant Neoplasms Malignant neoplasm of cervix uteri Morbidity - disease rate Network-based Oceans Outcome Pathology Persons Physical Examination Provider Recurrence Reporting Respondent Role Sampling Services Site Social Network Standardization Structure Tanzania Teaching Hospitals Treatment outcome Universities Zambia antiretroviral therapy cancer care cancer diagnosis care providers care systems effectiveness evaluation empowerment experience implementation strategy improved improved outcome integrated care mortality neoplastic pre-clinical programs scale up screening skills treatment center

项目摘要

Despite more than a decade of implementing universal access to antiretroviral therapy (ART) in sub-Saharan Africa (SSA), Kaposi’s sarcoma (KS) remains the most common malignancy in people living with HIV/AIDS (PLWH), causing significant morbidity and mortality. Compared to the US, ART implementation in SSA has not resulted in a significant reduction of KS cases. For many PLWH in SSA, the only connection to health care is through HIV care and treatment centers (CTC). Lack of recognition of early KS by both CTC care providers and PLWH, and ineffective connection to diagnosis, care, and treatment when the disease presents in the setting of HIV management at CTC may foster late presentation and ultimately, poor outcomes. Compared to cervical cancer, where screening and early detection approaches have been successfully integrated into HIV care for PLWH, efforts to detect, diagnose, and treat KS early are lacking. Since KS presents mostly cutaneous, coupling KS detection to HIV management as has been done in cervical cancer for early detection should readily improve early KS detection, definitive diagnosis, and linkage to care. As services for HIV management are conducted through CTCs throughout SSA, these community-associated structures are the best platform to integrate KS interventions and can be leveraged to increase early-stage presentation, early KS diagnosis, and early treatment initiation. In this study, we will implement an integrated education package to raise awareness and to impart the skills for early KS detection and diagnosis to PLWH, health care providers, and community workers. This package includes recurrent educational sessions at CTCs in order to enhance detection, diagnosis, and to initiate KS treatment early to improve outcomes of PLWH. It will also include a social network-based strategy to enhance the sustainability of such an implementation program. We hypothesize that an integrated care approach will increase the number and proportion of PLWH detected with early KS, thereby improving early KS diagnosis and treatment to improve KS outcomes. There are 3 Specific Aims. 1) Implement KS education, early detection, diagnosis, and linkage to care program at CTCs in Tanzania and Zambia. 2) To enhance and sustain early KS detection, diagnosis, and linkage to care program through a community network-based respondent-driven sampling (RDS) strategy in Tanzania and Zambia. 3) To evaluate the effectiveness of integrating early KS detection, diagnosis, and RDS strategy in existing HIV care services for PLWH in Tanzania and Zambia. Together, this will determine whether sensitization of providers and PLWH to a combined HIV care and early KS detection approach is efficacious and viable in the setting. This study is significant, as it will increase the proportion of PLWH examined for early KS detection, diagnosed, and linked to cancer care. It will also focus on empowering and equipping providers and PLWH to make more informed health decisions. This can be readily adopted and scaled up in Tanzania and Zambia, and subsequently in other SSA to facilitate early KS diagnosis and treatment.

尽管撒哈拉以南地区普遍获得抗逆转录病毒治疗（ART）已经十多年了非洲（SSA），卡波西肉瘤（KS）仍然是艾滋病毒/艾滋病患者最常见的恶性肿瘤与美国相比，艾滋病毒感染者 (PLWH) 的发病率和死亡率并没有很高。对于 SSA 的许多 PLWH 来说，与医疗保健的唯一联系是 KS 病例显着减少。艾滋病毒护理和治疗中心 (CTC) 缺乏对早期 KS 的认可。和 PLWH，以及当疾病出现在患者中时与诊断、护理和治疗的联系不力与 CTC 相比，艾滋病毒管理的设置可能会导致晚期就诊，并最终导致不良结果。宫颈癌，筛查和早期检测方法已成功融入艾滋病毒由于 KS 大多出现，因此对 PLWH 的护理缺乏早期发现、诊断和治疗 KS 的努力。皮肤，将 KS 检测与 HIV 管理结合起来，就像在宫颈癌中进行早期检测一样应随时改善早期 KS 检测、明确诊断以及与艾滋病毒护理的联系。管理是通过整个 SSA 的 CTC 进行的，这些与社区相关的结构是整合 KS 干预措施的最佳平台，可用于增加早期表现、早期 KS 在本研究中，我们将实施综合教育方案，以促进诊断和早期治疗。提高认识并向 PLWH、卫生保健提供者传授早期 KS 检测和诊断的技能，该计划包括在 CTC 举办的定期教育课程，以增强能力。检测、诊断并尽早开始 KS 治疗以改善 PLWH 的结果。基于社交网络的战略，以增强此类实施计划的可持续性。追求综合护理方法将增加发现的艾滋病病毒感染者的数量和比例早期 KS，从而改善早期 KS 诊断和治疗，以改善 KS 结局。具体有 3 种。目标。 1) 在坦桑尼亚 CTC 实施 KS 教育、早期检测、诊断和护理计划 2) 通过以下方式加强和维持早期 KS 检测、诊断以及与护理计划的联系。坦桑尼亚和赞比亚基于社区网络的受访者驱动抽样 (RDS) 战略 3) 至。评估将早期 KS 检测、诊断和 RDS 策略整合到现有 HIV 护理中的有效性坦桑尼亚和赞比亚为艾滋病患者提供的服务将共同决定服务提供者是否提高认识。艾滋病毒感染者和感染者接受艾滋病毒护理和早期 KS 检测相结合的方法在该环境中是有效且可行的。这项研究意义重大，因为它将增加 PLWH 进行早期 KS 检测、诊断、它还将重点关注为医疗服务提供者和艾滋病患者提供赋权和装备，以创造更多收入。坦桑尼亚和赞比亚可以很容易地采用和推广知情的卫生决策，以及随后在其他 SSA 中进行，以促进 KS 的早期诊断和治疗。