Leveraging health infrastructure to optimize HPV vaccination for adolescents in Zambia: Protocol for an implementation study.
Leveraging health infrastructure to optimize HPV vaccination for adolescents in Zambia: Protocol for an implementation study.
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DOI：
10.1371/journal.pone.0285031
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发表时间：
2023
期刊：
影响因子：
3.7
通讯作者：
Hunleth, Jean M.
中科院分区：
文献类型：
--
作者：
Miti, Sam;Shato, Thembekile;Asante, Comfort;Baumann, Ana;Chongwe, Gershom;Bobo, Patricia M.;Silver, Michelle I.;Hunleth, Jean M.
宫颈癌是赞比亚癌症死亡的主要原因，艾滋病毒流行率也很高（11.3%）。艾滋病毒增加了患宫颈癌和死于宫颈癌的风险。人乳头瘤病毒（HPV）疫苗可以预防90%的宫颈癌，在赞比亚，建议14-15岁的少女接种，包括艾滋病毒感染者。目前，他们主要通过以学校为基础的运动提供HPV疫苗接种，这可能会排除最脆弱的人群-那些失学或不定期上学的人。感染艾滋病毒的青少年更有可能存在这些脆弱性。此外，以学校为基础的运动并不适合世卫组织推荐的ALHIV HPV疫苗接种时间表（3剂与2剂）。将HPV疫苗接种纳入青少年艾滋病毒诊所的常规护理中，可确保ALHIV能够按照世卫组织建议的时间表获得疫苗。鉴于在包括赞比亚在内的中低收入国家提供HPV疫苗的已知挑战，这种整合需要多层次的方法、利益攸关方的参与和多样化的实施战略。我们的研究旨在将HPV疫苗接种纳入青少年HIV诊所的常规护理中。为了取得成功，我们将共同设计一套实施战略，使用以前成功的实施研究方法，为中低收入国家的宫颈癌预防开发：实施研究的综合系统实践（INSPIRE）。INSPIRE是一种新颖的，全面的方法来开发，实施和评估实施科学的努力。根据INSPIRE的关键要素，我们的具体目标是：1）识别独特的多层次背景因素（障碍和促进因素）（2）利用执行情况摸底调查将利益攸关方的反馈和目标1的调查结果转化为一揽子执行战略，将HPV疫苗纳入艾滋病毒诊所; 3）进行混合型3有效性实施试验，以评估将HPV疫苗纳入艾滋病毒诊所的多层次实施策略。我们的研究团队拥有强大的支持、技术专长和资源（例如，赞比亚卫生部提供的疫苗;以及扩大规模的政治意愿。这一以艾滋病毒持有者为基础的实施模式有可能推广到赞比亚各地的艾滋病毒诊所，并成为解决其他中低收入国家艾滋病毒感染者癌症预防优先事项的模式。在目标3之前，即执行战略最后确定时登记。
Cervical cancer is the leading cause of cancer death in Zambia, where HIV prevalence is also high (11.3%). HIV heightens the risk of developing and dying from cervical cancer. The human papillomavirus (HPV) vaccine can prevent 90% of cervical cancers, and in Zambia is recommended for adolescent girls ages 14–15 years, including those with HIV. Currently they mainly deliver HPV vaccination via school-based campaigns, which may exclude the most vulnerable adolescents—those out-of-school or who irregularly attend. Adolescents living with HIV (ALHIV) are more likely to have these vulnerabilities. Further, school-based campaigns are not tailored to the WHO-recommended HPV vaccination schedule for ALHIV (3 versus 2 doses). Integrating HPV vaccination into routine care in adolescent HIV clinics may ensure that ALHIV have access to vaccine at the WHO-recommended schedule. Such integration requires a multilevel approach, stakeholder engagement, and diversified implementation strategies, given known challenges of providing the HPV vaccine in LMICs, including Zambia. Our study aims to integrate HPV vaccination into routine care in adolescent HIV clinics. To achieve success, we will co-design a package of implementation strategies using a previously successful implementation research approach developed for cervical cancer prevention in LMICs: the Integrative Systems Praxis for Implementation Research (INSPIRE). INSPIRE is a novel, comprehensive approach to develop, implement, and evaluate implementation science efforts. Following key elements of INSPIRE, our specific aims are to: 1) Identify the unique multilevel contextual factors (barriers and facilitators) across HIV settings (rural, urban, peri-urban) that influence HPV vaccine uptake; 2) Use Implementation Mapping to translate stakeholder feedback and findings from Aim 1 into a package of implementation strategies to integrate HPV vaccine into HIV clinics; 3) Conduct a Hybrid Type 3 effectiveness-implementation trial to evaluate the package of multilevel implementation strategies for integrating HPV vaccine into HIV clinics. Our research team has strong support, technical expertise, and resources (e.g., vaccines) from the Zambian Ministry of Health; and political will for scale-up. This stakeholder-based implementation model has the potential to be transported to HIV clinics across Zambia and serve as a model to address cancer prevention priorities for those with HIV in other LMICs. To be registered prior to Aim 3, when implementation strategies finalized.
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DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
1.9
作者：
Hunleth, Jean
通讯作者：
Hunleth, Jean
影响因子：
3.7
作者：
Gallagher, Katherine E.;Howard, Natasha;Watson-Jones, Deborah
通讯作者：
Watson-Jones, Deborah
影响因子：
7.8
作者：
Deignan C;Swartz A;Cooper S;Colvin CJ
通讯作者：
Colvin CJ
影响因子：
0.6
作者：
Asante, Comfort;Burack, Sarah;Hunleth, Jean
通讯作者：
Hunleth, Jean