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

基本信息

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
项目类别：
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&apos 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

项目摘要

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（总体而言），宫颈癌是低收入和低收入女性癌症相关死亡的主要原因。中等收入国家 (LMIC)，而且几乎完全可以预防。1,2-4 2020 年，世界卫生组织世界卫生组织（WHO）宣布了一项全球战略，旨在今年年底前加速消除宫颈癌千禧年通过为 90% 的 15 岁女孩接种疫苗、对 70% 的妇女进行筛查以及对 90% 的治疗进行治疗到 2030 年，符合资格的女性。5 基于有效性和安全性的有力经验证据，世界卫生组织的建议基于人乳头瘤病毒（HPV）的检测，然后立即治疗癌前病变，用于在中低收入国家实现宫颈癌控制的称为筛查和治疗 (SAT) 的方法。6 我们的研究团队在哥伦比亚大学欧文医学中心 (CUIM) 和开普敦大学 (UCT)，通过近 Khayelitsha 宫颈癌筛查计划 (KCCP) 下三十年的合作，已开展开创性临床试验证明基于 HPV 的筛查和治疗的安全性和有效性。7-9 尽管 SAT 方法已得到全球和国家指南的认可，但尚未得到广泛实施。与大多数中低收入国家一样，南非正在努力解决如何实施和促进广泛和公平的利益相关者指出，HPV 筛查在医疗机构中的整合和采用缺乏针对具体情况的指导。实施、成本和融资是重要的实施障碍，与 RFA-CA-22-019 一致。 KCCP 与西开普省卫生部 (WCDoH) 之间的合作伙伴关系，我们建议 Empilisweni（伊西科萨语，意为治愈之地）女性健康中心的首要使命是加速整合和扩大循证干预措施，以实现公平消除宫颈癌由MPI (UCT) 和Kuhn (CUIMC) 领导的资源有限环境中的妇女； KCCSP 将由 MPI Castor（联系人：CUIMC）、Mbatani（UCT）、Saidu（UCT）、Shelton（CUIMC）加入， Tehranifar (CUIMC)；以及 Arendse (UCT/WCDoH) 和合作者 Cloete (WCDoH) 通过实施获知科学框架和利益相关者参与方法，我们建议：目标 1：支持世界卫生组织的全球通过公平整合，在本世纪末加速消除宫颈癌的战略可扩展、负担得起的基于 HPV 的护理点筛查和治疗 (POC-SAT) 策略，以实现二级治疗预防级联目标是到 2030 年对筛查呈阳性的女性进行 70% 的筛查和 90% 的治疗南非西开普省；目标 2. 促进公平一体化和可持续扩大 POC-SAT 通过促进跨领域的有效协作、协调、能力建设和知识共享到五年结束时，POC SAT 将增加女性的比例。进行区域性筛查和治疗，将补充集中的 HPV 检测，并且在经济上是可行的。加强领导该地区实施研究和推进战略工作的能力为宫颈癌控制的可扩展实施和创新融资提供信息，以产生人口层面的影响。