The effectiveness, cost-effectiveness, and budget impact of interventions to improve the delivery of cervical cancer screening in Puerto Rico.

波多黎各改善宫颈癌筛查的干预措施的有效性、成本效益和预算影响。

• 批准号: 10718886
• 负责人: Ashish A. Deshmukh
• 金额: $ 56.69万
• 依托单位: COMPREHENSIVE CANCER CENTER/ UNIV/PR
• 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/10718886
• 关键词: Address; Adoption; Age; Caring; Cervical; Cervical Cancer Screening; Clinic; Clinical; Collection; Colposcopy; Communities; Diagnosis; Diagnostic Reagent Kits; Disasters; Disparity; Distant; Early Diagnosis; Effectiveness; Eligibility Determination; Evaluation; Event; Future; Goals; Government; Home; Human Papillomavirus; Hybrids; Hysterectomy; Incidence; Individual; Intervention; Intervention Studies; Interview; Island; Knowledge; Low income; Maintenance; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Medicaid; Medicare; Minority Women; Morbid Obesity; Natural History; Obesity; Pap smear; Patients; Population; Population Study; President' s Cancer Panel; Provider; Puerto Rican; Puerto Rico; Randomized, Controlled Trials; Recovery; Sampling; Screening Result; Site; Squamous intraepithelial lesion; Testing; Transportation; Treatment outcome; United States; Visit; Woman; Work; World Health Organization; acceptability and feasibility; arm; budget impact; cervical cancer prevention; cohort; cost effective; cost effectiveness; effectiveness evaluation; effectiveness/implementation study; follow-up; home test; implementation evaluation; implementation outcomes; improved; interest; mathematical model; models and simulation; mortality; multi-component intervention; multidisciplinary; patient navigation; patient navigator; premalignant; screening; screening participation; secondary analysis; secondary outcome; self testing; success; trend; uptake

PROJECT SUMMARY Cervical cancer incidence is increasing dramatically (2.5% per year) in Puerto Rico (PR), with increased occurrence of regional (1.7% per year) and distant (4.7% per year) stage cancer, which reflects a real increase and indicates missed screening opportunities. Unfortunately, 80% of cervical cancer cases diagnosed in PR occur among low-income women covered by Medicaid or Medicare, who also have a 70% greater likelihood of being diagnosed with cervical cancer. Cervical cancer screening uptake continues to decline in PR, particularly among low-income Medicaid enrollees, mainly seen by government clinics. Barriers to cervical cancer screening in PR are mainly due to personal (lack of transportation, obesity-related embarrassment) and environmental (repeated disaster events that hampered screening uptake and made recovery slow) factors. The absence of evidence on the effectiveness, cost-effectiveness, and budget impact of patient navigators has limited its adoption among government clinics in this US territory. Multicomponent interventions that can address common screening barriers and improve screening participation in clinic-based settings or avert the need for a clinical-based visit could help improve screening uptake and follow-up care. Our preliminary work suggests the feasibility and acceptability of HPV self-sampling in PR. We now propose a hybrid type 1 effectiveness-implementation study using a four-arm multi-site randomized controlled trial (RCT) conducted within government OBGYN clinics in PR. We will assess the effectiveness of patient reminders plus patient navigation and HPV self-collection (individually and in combination) compared to patient reminders alone in increasing cervical cancer screening, timely colposcopy, and cervical precancer treatment (Aim 1). The secondary aim will evaluate key implementation outcomes, including patient and provider receptivity, reach, level of implementation and fidelity, and sustainment intentions. We will then develop an open-cohort microsimulation model to evaluate the population impact, cost-effectiveness, and budget impact of alternative strategies (Aim 2) to inform their potential applicability at delivery organization, community, and territory levels. This study will provide much-needed knowledge that is necessary to successfully facilitate the adoption and sustained integration of optimal strategies that will improve cervical cancer screening participation and reduce magnifying disparities in Puerto Rico.

项目概要 波多黎各 (PR) 的宫颈癌发病率急剧增加（每年 2.5%），其中 区域期（每年 1.7%）和远处期（每年 4.7%）癌症的发生率，这反映了实际增加 并表示错过了筛选机会。不幸的是，80% 的宫颈癌病例是在 PR 中诊断出来的 发生在受医疗补助或医疗保险覆盖的低收入女性中，她们患此病的可能性也高出 70% 被诊断患有宫颈癌。 PR 地区的宫颈癌筛查率持续下降，尤其是 低收入医疗补助参与者中，主要是政府诊所。宫颈癌的障碍 PR中的筛查主要是由于个人原因（缺乏交通、肥胖相关的尴尬）和 环境（阻碍筛查普及并使恢复缓慢的重复灾害事件）因素。 由于缺乏关于患者导航器的有效性、成本效益和预算影响的证据， 限制了其在该美国领土的政府诊所中的采用。多成分干预措施可以 解决常见的筛查障碍并提高临床环境中的筛查参与度或避免 临床就诊的需求可能有助于提高筛查率和后续护理。我们的前期工作 表明 HPV 自我采样在 PR 中的可行性和可接受性。我们现在提出一种混合型 1 使用四组多中心随机对照试验（RCT）进行的有效性实施研究 在 PR 的政府妇产科诊所内。我们将评估患者提醒和患者提醒的有效性 导航和 HPV 自我收集（单独和组合）与单独的患者提醒相比 加强宫颈癌筛查、及时阴道镜检查和宫颈癌前治疗（目标 1）。这 次要目标将评估关键实施成果，包括患者和提供者的接受度、覆盖范围、 实施水平和忠诚度以及维持意图。然后我们将开发一个开放队列 用于评估替代方案的人口影响、成本效益和预算影响的微观模拟模型 战略（目标 2），以告知其在交付组织、社区和地区层面的潜在适用性。 这项研究将提供成功促进采用和实施所必需的急需知识。 持续整合最佳策略，将提高宫颈癌筛查参与度并减少 波多黎各的差距不断扩大。