An implementation science approach to address multi-level barriers to cancer screening among women living with HIV in South Africa

一种实施科学方法，以解决南非艾滋病毒感染妇女癌症筛查的多层次障碍

• 批准号: 10242935
• 负责人: Carla J Chibwesha
• 金额: $ 14.56万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-14 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10242935
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adopted; Adult; Affect; Africa; Africa South of the Sahara; African; Age; Bayesian Method; Cancer Burden; Cancer Control; Cancer Etiology; Caring; Cessation of life; Clinical; Communities; Data; Diagnosis; Drug Interactions; Early Diagnosis; Educational workshop; Enrollment; Epidemic; Focus Groups; Funding; Goals; HIV; HIV Infections; Health; Health Personnel; Health system; Human papilloma virus infection; Incidence; Intervention; Interview; Lead; Life Expectancy; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Methods; Modeling; Outcome; Participant; Patients; Phase; Policies; Policy Maker; Prevention Research; Provider; Public Health; Public Sector; Reporting; Research; Research Infrastructure; Resources; Risk; Science; Screening for cancer; Services; Site; South Africa; South African; Testing; Thinking; Time; Training; Woman; Work; acceptability and feasibility; antiretroviral therapy; base; breast and cervical cancer screening; cancer health disparity; cancer prevention; care seeking; chemotherapeutic agent; civil society; cohort; contextual factors; design; disparity elimination; experimental study; high risk population; implementation science; implementation trial; improved; innovation; low and middle-income countries; malignant breast neoplasm; men; mortality; preference; prevent; preventable death; programs; recruit; screening; screening services; simulation; social; tool; treatment program; uptake

ABSTRACT Over the next 20 years, cancer incidence and mortality are expected to rise at staggering rates worldwide, with much of the burden concentrated in low- and middle-income countries (LMICs). Despite widescale availability of antiretroviral therapy (ART) in LMICs, women living with HIV remain vulnerable to both AIDS- and non-AIDS defining cancers such as cervical and breast cancer. This is because screening coverage for breast and cervical cancer is low – and access to timely diagnosis and treatment is limited. In South Africa, for example, fewer than one-third of HIV-infected women undergo breast and cervical cancer screening at the recommended intervals. Attrition between cancer screening and treatment is also substantial among HIV-infected women in under- resourced South African settings. We seek to eliminate disparities in breast and cervical cancer outcomes among HIV-infected women in South Africa. In this application, we propose an innovative implementation science project to close the gap between cancer control policy and cancer screening practices in this high-risk population. Specific Aim 1 will use a sequential mixed-methods design consisting of focus groups, a discrete choice experiment (DCE), and in-depth interviews to study multi-level drivers of cancer screening and determine women’s preferences for cancer screening services. We will enroll 80 HIV-infected women and 32 men in 14 focus groups (8 participants in each group), 600 HIV-infected women in the DCE, and conduct 24 in- depth interviews with key stakeholders. In Specific Aim 2, we will co-create a multi-level intervention package with patients, providers, and policy makers, applying Design Thinking principles to design the package and assess its acceptability. We anticipate that the package will include training, clinical tools, and user-focused interventions applied at various levels of the Social Ecological Model to address the barriers identified in Aim 1. We will explore acceptability of the intervention package through user pre-testing workshops conducted with 6 user groups: 2 groups of HIV-infected women, 2 of healthcare providers, and 2 of policy makers. This project will provide robust preliminary data to inform larger-scale implementation trials to (1) promote uptake of cancer screening among women living with HIV and (2) improve retention in care for women who screen positive. We will leverage longstanding partnerships and a strong research infrastructure in Johannesburg to implement the proposed work.

抽象的 在接下来的20年中，癌症事件和死亡率预计将以全球惊人的速度上升，并且 大部分燃烧集中在低收入和中等收入国家（LMIC）。尽管有广泛的可用性 LMIC中的抗逆转录病毒疗法（ART），艾滋病毒的妇女仍然容易受到艾滋病和非辅助的影响 定义癌症，例如宫颈癌和乳腺癌。这是因为筛查乳房和宫颈的覆盖范围 癌症很低 - 及时诊断和治疗受到限制。例如，在南非，比 三分之一的艾滋病毒感染妇女以建议的时间进行乳腺癌和宫颈癌筛查。 癌症筛查和治疗之间的损耗也很重要 资源的南非环境。我们寻求消除乳腺癌和宫颈癌预后的分布 南非的艾滋病毒感染妇女。在此应用程序中，我们提出了创新的实施科学 在此高风险 人口。特定目标1将使用由焦点组组成的顺序混合方法设计，一个离散 选择实验（DCE）和深入研究癌症筛查的多级驱动因素 确定妇女对癌症筛查服务的偏好。我们将注册80名HIV感染妇女和32名 14个焦点小组的男性（每组中有8名参与者），600名DCE中的HIV妇女，并进行24个IN- 与主要利益相关者的深度访谈。在特定的目标2中，我们将共同创建一个多级干预套件 与患者，提供者和政策制定者一起使用设计思维原则来设计包装和 评估其可接受性。我们预计该软件包将包括培训，临床工具和以用户为中心 在社会生态模型的各个层面上采用干预措施来解决目标1中确定的障碍。 我们将通过用户预测试的研讨会探索干预套件的可接受性 用户组：2组HIV感染的妇女，2个医疗保健提供者和2个政策制定者。这个项目将 提供强大的初步数据，以告知大规模实施试验以（1）促进癌症的吸收 在艾滋病毒妇女和（2）中筛查筛查阳性的妇女的保留率。我们 将利用长期合作伙伴关系和约翰内斯堡的强大研究基础设施来实施 建议的工作。