Integrated delivery of cancer control interventions for adolescents and young adults living with HIV in Zambia

为赞比亚艾滋病毒感染者提供综合癌症控制干预措施

基本信息

批准号：
10878015
负责人：
CATHERINE KASONGO MWABA
金额：
$ 74.82万
依托单位：
IMPLENOMICS LLCS
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：
2023-09-01 至 2027-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10878015
关键词：
AIDS related cancer Address Adherence Administrator Adolescent and Young Adult Adult African Age Years CD4 Lymphocyte Count Cancer Burden Cancer Center Cancer Control Cancer Model Cancer Patient Caring Cervical Cancer Screening Childhood Communities Consultations Continuity of Patient Care Cost Analysis Country Data Data Set Diagnostic Services Diagnostic tests Disease Early Diagnosis Early Intervention Education Ensure Face Feedback Goals Guidelines HIV HIV diagnosis Health Policy Health Services Health care facility Healthcare Healthcare Systems Hospitals Incidence Individual Intervention Investments Kaposi Sarcoma Knowledge Learning Link Malignant Childhood Neoplasm Malignant Neoplasms Malignant neoplasm of cervix uteri Mediating Methods Modeling Morbidity - disease rate Non-Hodgkin&apos s Lymphoma Nurses Oncology Outcome Pamphlets Patients Persons Physicians Policies Policy Maker Premature Mortality Prevalence Preventive service Primary Care Process Professional counselor Provider Province Rapid diagnostics Recommendation Reporting Research Resource-limited setting Risk Role Self Efficacy Services Signs and Symptoms Specialist Testing Vulnerable Populations Work Zambia antiretroviral therapy cancer care cancer diagnosis cancer referral center cancer risk cancer therapy care delivery cohort cost effectiveness cost-effectiveness evaluation design economic evaluation effectiveness evaluation evidence base experience future implementation implementation efforts implementation evaluation implementation outcomes implementation science implementation trial improved incremental cost-effectiveness individual patient learning network member mortality peer peer learning peer support peri-urban policy implication premature programs randomized trial rural area scale up service uptake simulation survivorship theories treatment as usual treatment optimization treatment planning treatment program unethical urban area

项目摘要

PROJECT SUMMARY/ABSTRACT Zambia is a global epicenter for HIV with a large number of adolescents and young adults living with HIV (AYAHIV). Compared with their uninfected peers, AYAHIV are at increased risk of developing cancer, most frequently Kaposi sarcoma (KS), non-Hodgkin’s lymphoma (NHL), and cervical cancer (CC). To reduce this premature mortality, evidence-based strategies should be implemented to both diagnose cancers at an earlier stage and help AYAHIV complete recommended cancer treatment. We will use theory-informed multilevel strategies to create the AYAHIV Role-based Responsibilities for Oncology-focused Workforce (ARROW) program to increase uptake of services for early diagnosis and improve compliance with cancer treatment for KS, NHL, and CC. Our overall approach is based on the evidence-based strategy of peer support for engagement and learning. At the individual level, we will address barriers by embedding peer counselors to support AYAHIV. At the provider level, we will create a peer-to-peer learning network to build linkages between those specializing in pediatric and adult HIV treatment and cancer care. At the health care system level, we will bring together health care administrators and Zambian Ministry of Health policy makers to review barriers and to develop and implement collaborative solutions. We will use implementation science methods to evaluate effectiveness, implementation outcomes, and cost-effectiveness of the ARROW program compared with a one-time education campaign by pursuing the following aims: Aim 1. Conduct randomized trials to compare the ARROW program with the one-time education campaign in increasing services received by AYAHIV to facilitate early diagnosis (physical exam for KS and NHL, CC screening, and timely diagnostic testing) and in improving adherence to cancer treatment. Aim 2. Use mixed methods to assess implementation outcomes of the ARROW program compared with one- time education based on acceptability, feasibility, appropriateness, fidelity, and sustainability. Aim 3. Perform economic evaluations to assess cost-effectiveness and return-on-investment scenarios. Successful completion of these aims will yield a set of data-driven strategies that can be scaled up to reduce premature cancer mortality among AYAHIV. To support future implementation efforts, we will generate incremental cost-effectiveness estimates, conduct policy simulations, evaluate implementation outcomes, and assess challenges and facilitators to optimize the ARROW program. The model tested in Zambia can serve as a blueprint for other Sub-Saharan African countries to ensure AYAHIV receive optimal services to facilitate early diagnosis and ensure completion of guideline-recommended treatments. The ARROW program will also provide a framework for implementing expanded services, such as preventive services and survivorship care, to further reduce the burden of cancer AYAHIV face.

项目概要/摘要赞比亚是全球艾滋病毒感染中心，有大量青少年和年轻人感染艾滋病毒 (AYAHIV) 与未感染的同龄人相比，AYAHIV 患癌症的风险更高。通常是卡波西肉瘤 (KS)、非霍奇金淋巴瘤 (NHL) 和宫颈癌 (CC)。过早死亡，应实施基于证据的策略来及时诊断癌症早期阶段并帮助 AYAHIV 完成推荐的癌症治疗。为专注于肿瘤学的劳动力制定 AYAHIV 基于角色的责任的多层次战略 (ARROW) 计划，旨在增加早期诊断服务的使用并提高癌症患者的依从性 KS、NHL 和 CC 的治疗方法基于同行的循证策略。在个人层面上，我们将通过嵌入同伴来解决障碍。支持 AYAHIV 的辅导员在提供者层面，我们将创建一个同侪学习网络来建立。专门从事儿童和成人艾滋病毒治疗以及癌症护理的人员之间的联系。在系统层面，我们将汇集医疗保健管理者和赞比亚卫生部决策者我们将利用实施科学来审查障碍并制定和实施协作解决方案。评估 ARROW 的有效性、结果实施和成本效益的方法该计划与一次性教育活动相比，旨在实现以下目标：目标 1. 进行随机试验，将 ARROW 计划与一次性教育活动进行比较增加 AYAHIV 接受的服务，以促进早期诊断（KS 和 NHL 体检、CC 筛查和及时的诊断测试）以及提高癌症治疗的依从性。目标 2. 使用混合方法实施 ARROW 计划的结果与单一方法的比较基于可接受性、可行性、适当性、忠实性和可持续性的时间教育。目标 3. 进行经济评估，以评估成本效益和投资回报情景。成功完成这些目标将产生一套数据驱动的策略，可以扩大规模以减少为了支持未来的实施工作，我们将制定 AYAHIV 的过早癌症死亡率。增量成本效益估计，进行政策模拟，评估实施结果，并评估优化 ARROW 计划的挑战和促进因素在赞比亚测试的模型可以。为其他撒哈拉以南非洲国家提供蓝图，确保 AYAHIV 获得最佳服务促进早期诊断并确保完成指南推荐的治疗。该方案还将提供一个实施扩展服务的框架，例如预防性服务和生存护理，进一步减轻AYAHIV面临的癌症负担。