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

评估东非艾滋病毒相关卡波西肉瘤中交叉耻辱与癌症护理的影响

• 批准号: 10406121
• 负责人: Andrew Ddungu Kambugu
• 金额: $ 19.81万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-13 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10406121
• 关键词: AIDS related cancer; Address; Administrative Supplement; Africa; Africa South of the Sahara; Area; Award; Cancer Control; Caring; Characteristics; Clinic; Clinic Visits; Clinical; Diagnosis; Early Diagnosis; Evaluation; Failure; Future; General Population; Goals; HIV; HIV Infections; HIV diagnosis; Health; Healthcare; High Prevalence; Individual; Intervention; Interview; Investigation; Kaposi Sarcoma; Kenya; Label; Laboratories; Link; Malignant Neoplasms; Measurement; Newly Diagnosed; Oncology; Parents; Pathway interactions; Patients; Persons; Population; Prevalence; Prevention; Provider; Research; Resources; Structure; Time; United States; Work; cancer care; career development; chemotherapy; comparative; experience; follow-up; instrument; interest; intersectionality; lens; mortality; parent grant; participant enrollment; response; skin disorder; social; social stigma; treatment planning; virus related cancer

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.

本申请是为了响应被标识为“NOT- 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疾病之一 癌症，并且由于该地区艾滋病毒感染率很高，这是该地区最常见的癌症之一 普通民众。 KS 不仅在非洲很常见，而且常常是致命的。两年死亡率 KS 诊断后的发生率高达 45%。生存不佳的原因多种多样，但其中一个可能是 可改变的原因是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 以肯尼亚为例，临床上符合化疗条件的 KS 患者中只有 50% 真正接受了化疗。 当个人因以下原因而被认可、被贴上“其他”标签并受到歧视时，就会出现耻辱感： 社会上不受欢迎的特征。在资源丰富的环境中，耻辱对健康的影响包括 50 多年来，这一点在癌症患者中得到了认可。在资源有限的环境中，耻辱 在 HIV 感染者中进行了最深入的研究。一直以来都比较少 在资源有限的环境中对癌症患者的耻辱感进行调查，但在哪里 研究表明，其表现与资源丰富的环境相似。非洲与艾滋病毒相关的 KS 具有潜力 赋予三种同时存在的耻辱形式：与癌症相关的耻辱、与皮肤病相关的耻辱，以及 与艾滋病毒相关的耻辱。因此，这种癌症为研究资源有限环境中的耻辱提供了独特的视角。 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 多个层面的医疗保健参与，包括诊断后与癌症护理的关键初始联系。 作为 U54 CA254571 的行政补充，我们的首要目标是研究其规模和 东非 HIV 相关 KS 患者耻辱感对护理联系的影响。我们的具体目标是： 目标 1. 描述新诊断的 HIV 相关 KS 患者的交叉耻辱。使用 半结构化访谈和定量工具，我们将描述患病率和关系 三种形式的耻辱之间：a) 与癌症相关，b) 与皮肤病相关； c) 与艾滋病毒相关。 目标 2. 评估艾滋病毒相关 KS 中耻辱感对与癌症护理的联系的影响。之中 对于肯尼亚西部新诊断出的 HIV 相关 KS 患者，我们将评估 3 项措施的影响 与癌症护理联系的耻辱类型，定义为 a) 第一次肿瘤诊所就诊，b) 第一次评估的时间 由有资格制定治疗计划的诊所肿瘤科医生提供，以及 c) 初始化疗的使用。 为了实现这些目标，我们将在现有的人口实验室中研究耻辱感以进行调查 在家长拨款 U54 CA254571 的支持下，肯尼亚西部 AMPATH 网络中与 HIV 相关的 KS 的研究。 这项工作的结果预计将扩大我们对耻辱及其对护理联系的影响的理解 KS 患者的情况，并为撒哈拉以南非洲地区未来针对所有癌症的耻辱减少干预措施提供信息。