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.

本申请是对特别利益通知(NOSI)的回应，该通知被标识为“非-- CA-21-026“。在撒哈拉以南非洲，卡波西氏肉瘤(KS)仍然是与艾滋病毒有关的最常见的疾病之一 癌症--由于该地区艾滋病毒感染的高流行率--是#年最常见的 普通民众。KS不仅在非洲很常见，而且经常是致命的；两年的死亡率 KS诊断率高达45%。生存不佳的原因是多方面的，但潜在的一个原因 可修改的原因是在确诊后未能及时将患者与癌症护理联系起来。在一次设置中 例如，肯尼亚临床上有资格接受化疗的KS患者中，只有50%实际接受了化疗。 当个人被认可、被贴上“其他”标签并因以下原因而受到歧视时，就会产生耻辱 社会不受欢迎的特征。在资源丰富的环境中，污名的健康后果包括 在癌症患者中，已经被识别了50多年。在资源有限的情况下，耻辱 在艾滋病毒感染者中得到了最深入的研究。但相对较少的是 在资源有限的环境中对癌症患者进行耻辱的调查 经过研究，表现形式类似于资源丰富的环境。非洲与艾滋病毒相关的KS具有潜在的 授予三种共同出现的污名：与癌症相关的污名，与皮肤病相关的污名，以及 与艾滋病毒有关的耻辱。因此，这种癌症为在资源有限的情况下研究污名提供了一个独特的视角。 如果在HIV相关的KS患者中存在，这三种相互交叉的耻辱形式可能会影响 在多个层面上的医疗保健参与，包括确诊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 污名对东非HIV相关KS患者护理联系的影响。我们的具体目标是： 目的1.描述新诊断的HIV相关KS患者的横断面污名。vbl.使用 半结构化访谈和量化工具，我们将描述患病率和关系 有3种形式的污名：a)与癌症有关；b)与皮肤病有关；以及c)与艾滋病毒有关。 目的2.评估耻辱在HIV相关的KS中与癌症治疗的联系上的影响。其中 肯尼亚西部新诊断的艾滋病毒相关KS患者，我们将评估3项措施的影响 与癌症护理相关的污名类型，定义为a)第一次去肿瘤诊所就诊的时间，b)第一次评估 由诊所有资格制定治疗计划的肿瘤学提供者提供，以及c)最初的化疗使用。 为了达到这些目标，我们将在一个已经存在的人口实验室中研究耻辱，以进行调查 在父母赠款U54 CA254571的支持下，在肯尼亚西部的AMPATH网络中推广与艾滋病毒相关的KS。 这项工作的发现有望扩大我们对耻辱及其对护理联系的影响的理解 在KS患者中，并告知未来针对撒哈拉以南非洲所有癌症的耻辱减少干预措施。