Evaluating the Impact of Intersectional Stigma on Linkage to Cancer Care in HIV-Associated Kaposi's Sarcoma in East Africa

本申请是为了回应被确定为“非- CA-21-026”。在撒哈拉以南非洲，卡波西肉瘤（KS）仍然是最常见的艾滋病毒相关的肿瘤之一。 癌症和-由于艾滋病毒感染在该地区的高流行率-最常见的疾病之一， 普通民众。KS不仅在非洲很常见，而且经常致命;两年死亡率 KS诊断后的发病率高达45%。生存率低的原因多种多样，但其中一个可能是 可改变的原因是在诊断后未能及时将患者与癌症护理联系起来。在一个设置中， 例如，在肯尼亚，只有50%的临床上符合化疗条件的KS患者实际接受了化疗。 当一个人被承认，被贴上“其他”的标签，并因 不受社会欢迎的特征。在资源丰富的环境中，污名化的健康后果，包括 在癌症患者中，50多年来一直得到认可。在资源有限的情况下， 在艾滋病毒感染者中进行了最深入的研究。相对来说， 在资源有限的环境中对癌症患者的耻辱感进行调查，但在 研究表明，其表现形式与资源丰富的环境相似。非洲与艾滋病毒相关的KS有可能 赋予三种共存形式的耻辱：癌症相关的耻辱，皮肤病相关的耻辱， 艾滋病相关的耻辱。因此，这种癌症为研究资源有限环境下的污名化提供了一个独特的透镜。 如果存在于HIV相关KS患者中，这三种“交叉”形式的耻辱可能会影响 在许多层面上的医疗保健参与，包括诊断后与癌症护理的关键初步联系。 作为对U 54 CA 254571的管理补充，我们的首要目标是研究其大小， 东非艾滋病毒相关KS患者的污名化对护理联系的影响我们的具体目标是： 目标1.描述新诊断的HIV相关KS患者的交叉羞辱。使用 半结构化访谈和定量工具，我们将描述患病率和关系 3种形式的耻辱：a）与癌症有关，B）与皮肤病有关; c）与艾滋病毒有关。 目标2.评估艾滋病毒相关KS中耻辱感对癌症护理的影响。之间 在肯尼亚西部新诊断的HIV相关KS患者中，我们将评估3 与癌症治疗相关的污名类型，定义为a）首次肿瘤门诊访视，B）首次评估的时间 由有资格制定治疗计划的诊所的肿瘤学提供者进行，以及c）初始化疗使用。 为了实现这些目标，我们将在一个现有的人口实验室进行研究， 艾滋病毒相关的KS在肯尼亚西部的AMPATH网络，由家长赠款U 54 CA 254571支持。 这项工作的结果有望扩大我们对污名及其对与护理联系的影响的理解 在KS患者中进行研究，并为撒哈拉以南非洲所有癌症的未来减少耻辱干预提供信息。

This application is being submitted in response to the Notice of Special Interest (NOSI) identified as "NOT- CA-21-026”. In sub-Saharan Africa, Kaposi’s sarcoma (KS) remains one of the most common HIV-related cancers and — by virtue of the high prevalence of HIV infection in the region — one of the commonest in the general population. Not only is KS common in Africa, but it is also frequently fatal; two-year mortality following KS diagnosis is as high as 45%. Reasons for poor survival are diverse, but one potentially modifiable cause is failure to promptly link patients to cancer care following diagnosis. In one setting in Kenya, for example, only 50% of patients with KS clinically eligible for chemotherapy actually received it. Stigma occurs when individuals are recognized, labeled as “other”, and discriminated against because of socially undesirable characteristics. In resource-rich settings, the health consequences of stigma, including amongst persons with cancer, have been recognized for over 50 years. In resource-limited settings, stigma has been most intensely studied amongst persons with HIV infection. There has been comparatively scant investigation of stigma amongst patients with cancer in resource-limited settings, but where it has been studied, manifestations are similar to resource-rich settings. HIV-associated KS in Africa has the potential to confer three co-occurring forms of stigma: cancer-related stigma, skin disease-related stigma, and HIV-related stigma. As such, this cancer provides a unique lens to study stigma in resource-limited settings. If present amongst patients with HIV-associated KS, these three “intersecting” forms of stigma may impact healthcare engagement at many levels, including the crucial initial linkage to cancer care after diagnosis. As an administrative supplement to U54 CA254571, our overarching goal is to study the magnitude and impact of stigma on linkage to care in patients with HIV-associated KS in East Africa. Our specific aims are: Aim 1. Describe intersectional stigma in patients with newly diagnosed HIV-associated KS. Using semi-structured interviews and quantitative instruments, we will describe the prevalence and relationship between 3 forms of stigma: a) cancer-related, b) skin disease-related; and c) HIV-related. Aim 2. Assess the impact of stigma on linkage to cancer care in HIV-associated KS. Among patients with newly-diagnosed HIV-associated KS in western Kenya, we will evaluate the impact of the 3 stigma types on linkage to cancer care, defined as time to a) first Oncology Clinic visit, b) first evaluation by an oncology provider at the clinic qualified to make a treatment plan, and c) initial chemotherapy use. To address these aims, we will study stigma in an already-existing population laboratory for the investigation of HIV-associated KS in the AMPATH network in western Kenya, supported by parent grant U54 CA254571. Findings from this work are expected to expand our understanding of stigma and its impact on linkage to care in patients with KS and inform future stigma reduction interventions for all cancers in sub-Saharan Africa.