The Empilisweni Center for Women's Health - Advancing Implementation of Equitable Cervical Cancer Control

Empilisweni 妇女健康中心 - 推进公平宫颈癌控制的实施

• 批准号: 10738103
• 负责人: Juanita Olivia Arendse
• 金额: $ 96.76万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-19 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10738103
• 关键词: Acceleration; Cancer Control; Cancer Etiology; Cervical; Cervical Cancer Screening; Cessation of life; Clinical; Clinical Trials; Collaborations; Communities; Complement; Cost Savings; Cytology; Detection; Development; Education; Effectiveness; Eligibility Determination; Equity; Evidence based intervention; Fostering; Goals; Guidelines; Health; Health Sciences; Healthcare; Human Papillomavirus; Intervention; Knowledge; Lead; Lesion; Malignant neoplasm of cervix uteri; Medical center; Mentorship; Mission; Outcome; Population Control; Prevention strategy; Primary Prevention; Province; Public Health; Public Sector; Recommendation; Research; Research Methodology; Research Personnel; Resource-limited setting; Safety; Secondary Prevention; Seminal; Site; South Africa; Testing; Training; Universities; Vaccinated; Vaccination; Woman; Women' s Health; Work; World Health Organization; aged; clinical care; cost; evidence base; girls; global health; healing; health care settings; health inequalities; implementation barriers; implementation evaluation; implementation framework; implementation research; implementation science; implementation strategy; innovation; knowledgebase; low and middle-income countries; point of care; poor communities; premalignant; primary care setting; scale up; screening; screening program; treatment duration; treatment site; uptake

Abstract (Overall). Cervical cancer is a leading cause of cancer-related deaths among women in low- and middle-income countries (LMICs), and it is almost entirely preventable.1,2-4 In 2020, the World Health Organization (WHO) announced a global strategy to accelerate the elimination of cervical by the end of this millennium by vaccinating 90% of girls by aged 15 and screening 70% of women and treating 90% of treatment eligible women by 2030.5 Based on strong empirical evidence of effectiveness and safety, the WHO recommends Human Papillomavirus (HPV)-based testing followed by immediate treatment of pre-cancerous lesions, an approach called screen-and-treat (SAT) for achieving cervical cancer control in LMICs.6 Our investigator team at Columbia University Irving Medical Center (CUIM) and the University of Cape Town (UCT), through a nearly thirty-year collaboration under the Khayelitsha Cervical Cancer Screening Program (KCCP), have conducted seminal clinical trials demonstrating the safety and effectiveness of HPV-based screening and treatment.7-9 Although endorsed in global and national guidelines, the SAT approach has not yet been widely implemented. Like most LMICs, South Africa is grappling with how to operationalize and promote the widespread and equitable integration and uptake of HPV screening in healthcare settings. Stakeholders cite a lack of context-specific implementation, costs, and financing as important implementation barriers. Aligned with RFA-CA-22-019 and in partnership between the KCCP and the Western Cape Department of Health (WCDoH), we propose the Empilisweni (isiXhosa for a place of healing) Center for Women’s Health with the overarching mission to accelerate the integration and scale-up of evidence-based interventions for equitable cervical cancer elimination among women in resource-constrained settings. Led by MPIs; Denny (UCT), and Kuhn (CUIMC), who founded KCCSP, will be joined by MPI Castor (Contact: CUIMC), Mbatani (UCT), Saidu (UCT), Shelton (CUIMC), Tehranifar (CUIMC); and Arendse (UCT/WCDoH) and collaborator Cloete (WCDoH) Informed by implementation science frameworks and stakeholder engagement approaches, we propose to: Aim 1: Support the WHO’s global strategy to accelerate the elimination of cervical cancer by the end of this millennium by equitably integrating scalable, affordable HPV-based point-of-care screen-and-treat (POC-SAT) strategies to achieve the secondary prevention cascade goal of 70% screening and 90% treatment of women who screen positive by 2030 in the Western Cape Province of South Africa; and Aim 2. Catalyze equitable integration and sustainable scale-up of POC-SAT by fostering effective collaboration, coordination, capacity-building, and knowledge sharing across multiple key stakeholders. By the end of the five years, POC SAT will increase the proportion of women who are screened and treated regionally, will complement centralized HPV testing, and be economically feasible. We will have a strengthened capacity for leading implementation research in the region and advanced work on strategies to inform scalable delivery and innovative financing of cervical cancer control for population-level impact.

摘要（总体）。宫颈癌是在低和低 - 和 中等收入国家（LMIC），几乎完全可以预防。1,2-4在2020年，世界卫生 组织（WHO）宣布了一项全球战略，以加快宫颈的消除。 千年通过15岁的女孩接种90％的女孩，并筛查70％的妇女并治疗90％ 符合条件的妇女到2030.5，基于有效性和安全性的有力经验证据，谁推荐 基于人乳头瘤病毒（HPV）的测试，然后立即治疗癌前病变 在LMICS中获得宫颈癌控制的方法称为筛查和治疗（SAT）。6我们的研究员团队 在哥伦比亚大学欧文医学中心（CUIM）和开普敦大学（UCT）的 根据Khayelitsha宫颈癌筛查计划（KCCP）进行的30年合作已进行 第二次临床试验证明了基于HPV的筛查和治疗的安全性和有效性。7-9 尽管在全球和国家指南中得到认可，但SAT方法尚未得到广泛实施。 像大多数LMIC一样，南非正在努力如何操作和促进宽度和公平 HPV筛查在医疗机构中的集成和吸收。利益相关者援引缺乏特定环境的 实施，成本和融资是重要的实施障碍。与RFA-CA-22-019和IN对齐 KCCP与西开普卫生部（WCDOH）之间的伙伴关系，我们建议 Empilisweni（Isixhosa是康复的地方）妇女健康中心，总体使命是 加速基于循证干预措施的公平宫颈癌紧急情况的整合和规模 在资源受限环境中的妇女中。由MPI领导； Denny（UCT）和Kuhn（Cuimc），成立 KCCSP，将由MPI Castor（联系人：CUIMC），MBATANI（UCT），SAIDU（UCT），Shelton（Cuimc）， Tehranifar（Cuimc）;和Arendse（UCT/WCDOH）和合作者Cloete（WCDOH）通过实施告知 科学框架和利益相关者的参与方法，我们建议：目标1：支持世界卫生组织的全球 通过同样整合，在本千年结束时加速消除宫颈癌的策略 可扩展的，负担得起的基于HPV的护理点屏幕和治疗（POC-SAT）策略以实现次要 预防级联目标是70％筛查和90％的妇女治疗，她们在2030年之前筛查阳性 南非西开普省；和目标2。催化公平的整合和可持续的规模 通过培养有效的协作，协调，能力建设和知识共享，通过培养POC-SAT 多个主要利益相关者。到五年结束时，POC SAT将增加 在区域进行筛选和处理，将补充集中的HPV测试，并在经济上可行。我们将 具有在该地区领先实施研究的能力并在战略上进行高级工作 为宫颈癌控制的可扩展交付和创新融资，以实现人群水平的影响。