West Africa Self-Sampling HPV Based Cervical Cancer Control Program (WA-SS-HCCP) for WLWHA: Barriers, challenges, and needs

西非 WLWHA 基于 HPV 的自我采样宫颈癌控制计划 (WA-SS-HCCP)：障碍、挑战和需求

• 批准号: 10700092
• 负责人: JANE Louise HOLL
• 金额: $ 62.57万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-07 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10700092
• 关键词: Address; Adoption; Africa; Africa South of the Sahara; African; Cancer Control; Caring; Cervical; Cervical Cancer Education; Cervical Cancer Screening; Cessation of life; Clinic; Clinic Visits; Clinical; Collaborations; Collection; Communication; Community Health Aides; Competence; Counseling; Country; Cytology; DNA; Data; Diagnostic; Diagnostic tests; Early Diagnosis; Early treatment; Face; Female; Funding; HIV; HIV Infections; HIV Seronegativity; HIV/AIDS; HPV-High Risk; Health system; Home; Human Papilloma Virus Vaccination; Human Papilloma Virus-Related Malignant Neoplasm; Human Papillomavirus; Human papilloma virus infection; Immune Evasion; Immunosuppression; Incidence; Income; Infection; Infrastructure; Knowledge; Laboratories; Learning; Maintenance; Mali; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Methods; Muslim population group; Needs Assessment; Nigeria; Oncogene Activation; Patients; Persons; Prevalence; Prevention strategy; Process; Recommendation; Religion; Reporting; Research; Resources; Risk; Risk Assessment; Sampling; Secure; Sexually Transmitted Diseases; Site; Specimen; Surveys; Swab; Target Populations; Temperature; Test Result; Testing; Training; Transportation; United States National Institutes of Health; Vagina; Woman; Women' s Health; acceptability and feasibility; care systems; cervical cancer prevention; cervical carcinogenesis; cervicovaginal; co-infection; collaborative approach; cost; cost effective; dashboard; effectiveness evaluation; evidence base; experience; health care settings; high risk; hospital laboratories; human papilloma virus oncogene; implementation fidelity; implementation framework; implementation strategy; improved; low and middle-income countries; novel; programs; sample collection; scale up; screening; social; social culture; social stigma; success; webinar

PROJECT SUMMARY/ABSTRACT Worldwide, 70% of new HIV infections every year occur in Sub-Saharan Africa (SSA), home to 74% of people living with HIV/AIDS (PLWHA), of whom over 50% are women. Furthermore, the highest rates of cervical cancer (CC) incidence and related death also occur in SSA, where approximately 60% of all CC cases are in women living with HIV/AIDS (WLWHA). Human Papillomavirus (HPV), amajor cause of CC, is the most common sexually transmitted infection in SSA and nearly all WLWHA worldwide who develop CC are co- infected with HPV. CC is largely preventable by HPV vaccination and cervical screening for early detection and treatment. In high income countries (HICs), these strategies have led to a steep decline in CC; however they remain largely inaccessible to women in low- and middle-income countries (LMICs). Self-sampling-based HPV (SS-HPV) tests have been shown to be a cost-effective and feasible approach to identifying women infected with high-risk HPV strains (hr-HPV) who need more advanced diagnostic tests and treatment. However, SS- HPV testing has not been widely implemented in most LMICs, including SSA despite high HIV prevalence. Leveraging our decade-long, extensive, and successful training partnership and research collaborations in Mali and Nigeria, we propose to implement a novel West African Self-Sampling HPV-Based Cervical Cancer Control Program (WA-SS-HCCP). The project capitalizes on existing strengths and resources including the HIV systems of care with Community Health Workers (CHWs) who have established relationships with WLWHA and can provide HPV and CC education/counseling and SS specimen collection guidance, rapid transportation of specimens to hospital laboratories, personalized delivery of test results directly to the women, and facilitation of clinic referrals for women with hr-HPV for advanced diagnostics and treatment. The study will conduct in-depth assessment of barriers, challenges, and needs to contextually adapt, implement, and evaluate the effectiveness and success of WA-SS-HCCP. The specific aims are to (1) Assess barriers and needs for contextual adaptations of WA-SS-HCCP among WLWHA in Mali and Nigeria, using qualitative risk assessment and observation methods; (2) Contextually adapt, using a learning collaborative approach (e.g., monthly webinars, rapid-cycle small tests of change) and an implementation framework (e.g., training to competency of CHWs, data coordination across settings, implementation dashboard) to optimize the WA-SS- HCCP across all four sites; and (3) Conduct a dual evaluation of the effectiveness (e.g., % WLWHA fully screened and % change in) and implementation (e.g., reach, adoption, implementation fidelity, and maintenance or sustainability) and develop a “WA-SS-HCCP Scale-Up Toolkit” for wide dissemination of this “detect-to-treat” program that can be expanded to HIV- women and across LMICs.

项目概要/摘要 在全球范围内，每年 70% 的新艾滋病毒感染发生在撒哈拉以南非洲 (SSA)，这里居住着 74% 的人口 艾滋病毒/艾滋病感染者（PLWHA），其中超过 50% 是女性。此外，宫颈癌发病率最高。 癌症 (CC) 发病率和相关死亡也发生在 SSA，其中大约 60% 的 CC 病例发生在 感染艾滋病毒/艾滋病 (WLWHA) 的女性，人类乳头瘤病毒 (HPV) 是导致 CC 的主要原因。 SSA 中常见的性传播感染和全世界几乎所有患有 CC 的 WLWHA 都患有 CC 感染 HPV 的人可通过 HPV 疫苗接种和宫颈筛查进行早期发现和预防。 在高收入国家（HIC），这些策略导致了 CC 的急剧下降； 低收入和中等收入国家 (LMIC) 的女性基本上无法获得基于自我采样的 HPV。 (SS-HPV) 检测已被证明是识别女性感染者的一种具有成本效益且可行的方法 患有高危 HPV 毒株 (hr-HPV) 的人需要更先进的诊断测试和治疗，但是 SS-。 尽管 HIV 患病率很高，但大多数中低收入国家（包括 SSA）尚未广泛实施 HPV 检测。 利用我们在马里长达十年、广泛且成功的培训伙伴关系和研究合作 和尼日利亚，我们建议实施一种新型西非自采样 HPV 宫颈癌 控制计划 (WA-SS-HCCP)。该项目利用现有优势和资源，包括 与社区卫生工作者 (CHW) 建立了关系的艾滋病毒护理系统 WLWHA 可以提供 HPV 和 CC 教育/咨询以及 SS 标本采集指导，快速 将样本运送到医院实验室，将个性化的测试结果直接交付给女性， 该研究将促进 hr-HPV 女性的临床转诊以进行高级诊断和治疗。 对障碍、挑战和需求进行深入评估，以便根据具体情况进行调整、实施和 评估 WA-SS-HCCP 的有效性和成功，具体目标是 (1) 评估障碍和 使用定性风险，了解马里和尼日利亚 WLWHA 对 WA-SS-HCCP 的具体情况进行调整的需求 评估和观察方法；（2）根据具体情况进行调整，使用学习协作方法（例如， 每月的网络研讨会、快速周期的小型变革测试）和实施框架（例如，培训 CHW 的能力、跨环境的数据协调、实施仪表板）以优化 WA-SS- 所有四个地点的 HCCP；以及 (3) 对有效性进行双重评估（例如，% WLWHA 完全 筛选和变化百分比）和实施（例如，覆盖面、采用、实施保真度和 维护或可持续性）并开发“WA-SS-HCCP 扩展工具包”以广泛传播这一点 “检测到治疗”计划可以扩展到艾滋病毒女性和整个中低收入国家。