A multilevel intervention (Potlako+) to improve timely cancer detection and treatment initiation

多层次干预（Potlako）可改善及时的癌症检测和治疗启动

• 批准号: 10242834
• 负责人: Scott Dryden-Peterson
• 金额: $ 47.91万
• 依托单位: BRIGHAM AND WOMEN'S HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-19 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10242834
• 关键词: Accounting; Adult; Advanced Malignant Neoplasm; Advocacy; Affect; Africa South of the Sahara; Age; Anus; Awareness; Botswana; Breast; Breast Cancer Cell; Breast Cancer Early Detection; Cancer Burden; Cancer Detection; Cancer Patient; Caring; Cause of Death; Cervix Uteri; Cessation of life; Clinic; Communities; Complex; Counseling; Country; Diagnosis; Diagnostic; Disease; Early Diagnosis; Education; Effectiveness; Environment; Family; Geography; HIV; HIV diagnosis; Head and Neck Squamous Cell Carcinoma; Head and neck structure; Health system; Healthcare; Incidence; Income; Individual; International; Intervention; Knowledge; Limited Stage; Malignant Neoplasms; Medical; Mentors; Modeling; Oncology; Pathology; Pathway interactions; Patients; Persons; Phase; Physicians; Population; Prevalence; Primary Health Care; Printed Media; Probability; Provider; Qualitative Research; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Records; Research; Resources; Rural Community; Schedule; Self Efficacy; Social Workers; Speed; Suggestion; Symptoms; Syndrome; Team Nursing; Time; Transportation; Vagina; Viral; Vital Status; Vulva; aged; cancer care; cancer diagnosis; cancer initiation; cancer risk; cancer survival; cancer therapy; cohort; common symptom; community clinic; curative treatments; effectiveness evaluation; effectiveness implementation study; effectiveness implementation trial; effectiveness testing; family support; implementation intervention; improved; innovation; low and middle-income countries; medical care fees; mortality; multidisciplinary; pandemic disease; penis; pilot trial; programs; response; rural dwellers; self help; theories; treatment duration

Project Summary/Abstract The HIV pandemic has intensified the growing burden of cancer in low- and middle-income countries (LMICs), where nearly three-quarters of all cancer deaths occur. The majority of patients in LMICs have advanced cancer stage and limited opportunity for survival. Meaningful improvements in cancer mortality in LMICs will require prompt diagnosis and efficient linkage to care, however research identifying effective strategies has not been conducted. Botswana has key resources in place— free-of-charge medical care including comprehensive cancer care, accessible primary clinics, and an internationally-emulated ART program— yet large gaps in timely cancer care and thus provides a key opportunity to innovate strategies to detect cancer earlier and engage patients in care. The Potlako pilot trial (ORBIT phase IIa), evaluating an intervention targeting diagnostic and pre-treatment intervals in a single district (27 communities) in Botswana, has successfully increased the number of patients entering cancer care and number treated with curative intent compared to historical controls. As a next step, the Potlako+ trial— a community-randomized (26 geographically diverse rural communities, 1:1), pragmatic, ORBIT phase IIb, type 1 hybrid effectiveness-implementation trial— will assess a complex, theory-informed intervention to promote earlier clinic presentation with symptoms suggestive of cancer, enable efficient diagnosis, and facilitate prompt initiation of oncologic treatment. The Potlako+ trial targets high burden cancers accounting for 60% of cancer deaths (breast, cervix, anus, penis, vulva, and head and neck) which are typically curable with early detection of symptoms. We utilize cancer stage at time of treatment initiation, incidence of curative intent treatment, and the duration of Models of Pathways to Treatment intervals as primary effectiveness endpoints. Implementation will be evaluated using the RE-AIM framework. The project will achieve three aims: 1) Assess the effectiveness of cancer symptom awareness intervention with rural residents (persons living with HIV and HIV-uninfected) aged 30 years and older in decreasing time to presentation with moderate and high probability cancer syndromes, 2) Assess impact of a comprehensive cancer patient navigation platform on reducing time to diagnosis and initiation of cancer treatment (diagnostic and pre-treatment intervals), and 3) Evaluate whether the combined multilevel intervention improves early stage treatment and cumulative incidence of curative intent treatment. Understanding the impact and implementation of these interventions will inform strategies of care for LMIC populations at increasing risk of cancer death and contribute to developing models of primary care in resource- constrained environments.

项目摘要/摘要 艾滋病毒大流行激发了低收入和中等收入国家（LMIC）的癌症的日益增长的燃烧 几乎四分之三的癌症死亡发生。 LMIC的大多数患者患有晚期癌症 舞台和生存机会有限。 LMIC中癌症死亡率的有意义的改善将需要 迅速诊断和有效地与护理联系，但是研究确定有效策略的研究并非 实施。博茨瓦纳拥有关键资源 - 免费的医疗服务，包括全面的癌症 护理，可访问的初级诊所以及国际女性的艺术计划 - 但及时的差距很大 癌症护理，因此为创新策略提供了一个关键的机会，以更早发现癌症并参与 护理患者。 Potlako试验试验（轨道IIA），评估针对诊断和的干预措施 博茨瓦纳一个单个地区（27个社区）的预处理间隔已成功增加了 与历史相比 控件。下一步，Potlako+试用 社区，1：1），务实的轨道IIB期，类型1混合有效性试验 - 将评估 复杂的，理论信息的干预措施，以促进早期的诊所表现，并出现暗示的症状 癌症，能够有效的诊断，并促进肿瘤治疗的及时主动性。 Potlako+试验 靶标高燃烧癌，占癌症死亡的60％（乳房，子宫颈，肛门，阴茎，外阴和头部） 和颈部）通常可以在符号的早期检测中治愈。我们在当时使用癌症阶段 治疗计划，治疗意图治疗的事件以及通往途径模型的持续时间 治疗间隔是主要有效性终点。将使用re-aim评估实施 框架。该项目将实现三个目标：1）评估癌症症状意识的有效性 与30岁及以上的农村居民（艾滋病毒和艾滋病毒未见的人）的干预 减少中度和高概率癌症综合症的表现时间，2）评估A的影响 综合性癌症患者导航平台减少诊断和癌症开始的时间 治疗（诊断和治疗间隔）和3）评估是否合并多级 干预改善了治疗意图治疗的早期治疗和累积发生率。 了解这些干预措施的影响和实施将为LMIC提供护理策略 人口增加了癌症死亡风险的增加，并有助于发展资源中的初级保健模型 - 受约束的环境。