Project 1

项目1

• 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
• 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' 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

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.

尽管在撒哈拉以下 非洲（SSA），卡波西的肉瘤（KS）仍然是艾滋病毒/艾滋病患者中最常见的恶性肿瘤 （PLWH），导致明显的发病率和死亡率。与美国相比，SSA中的艺术实施没有 导致KS病例大大减少。对于SSA中的许多PLWH，与医疗保健的唯一联系是 通过HIV护理和治疗中心（CTC）。两个CTC护理提供者都缺乏对早期KS的认可 和PLWH，以及与诊断，护理和治疗无效的联系 CTC的艾滋病毒管理设置可能会促进较晚的演讲，并最终促进较差的结果。相比 宫颈癌，筛查和早期检测方法已成功整合到HIV中 缺乏照顾PLWH，努力检测，诊断和治疗KS早期。由于KS主要是 皮肤，将KS检测与HIV管理耦合，就像宫颈癌中所做的那样早期检测 应该很容易改善早期的KS检测，确定的诊断和与Care的联系。作为艾滋病毒的服务 管理是通过SSA的CTC进行的，这些相关的结构是 集成KS干预措施的最佳平台，并可以利用以增加早期演示文稿，早期KS 诊断和早期治疗计划。在这项研究中，我们将实施一个集成的教育计划 提高认识并赋予早期KS检测和诊断的技能，以使医疗保健提供者， 和社区工作者。该软件包包括CTC的经常性教育会议，以增强 检测，诊断并尽早开始KS治疗以改善PLWH的结果。它也将包括一个 基于社交网络的策略，以增强这种实施计划的可持续性。我们 假设综合护理方法将增加检测到的PLWH的数量和比例 早期KS，从而改善了KS早期诊断和治疗以改善KS结果。有3个特定的 目标。 1）在坦桑尼亚的CTCS实施KS教育，早期检测，诊断和与CARE计划的联系 和赞比亚。 2）通过一个 坦桑尼亚和赞比亚的基于社区网络的受访者驱动式采样（RDS）策略。 3）到 评估在现有HIV护理中整合早期KS检测，诊断和RDS策略的有效性 坦桑尼亚和赞比亚的PLWH服务。一起，这将决定提供者的敏感 在艾滋病毒综合护理和早期KS检测方法中，PLWH在环境中是有效且可行的。 这项研究很重要，因为它将增加对早期KS检测的PLWH的比例，被诊断为 并与癌症护理有关。它还将着重于授权和装备提供商和PLWH，以使更多 明智的健康决定。这可以在坦桑尼亚和赞比亚很容易采用和扩展 随后在其他SSA中促进早期KS诊断和治疗。