Translating Molecular Diagnostics for Cervical Cancer Prevention into Practice

摘要/摘要 宫颈癌是完全可以预防的，仍然是#年癌症发病率和死亡率的第四大常见原因。 女性，在没有持续扩大HPV的情况下，未来50年预计将有超过1200万新病例 接种疫苗和宫颈筛查。80%以上的疾病负担发生在中低收入者 小岛屿发展中国家(LMIC)，反映了不公平的供应和采取有效的预防战略。 不幸的是，宫颈癌筛查和管理的可持续实施 预防在LMIC中一直难以捉摸，反映出在#年实施复杂的卫生干预措施的挑战 复杂的适应性卫生系统。在家长研究中，使用参与式系统思维作为我们的 理论，我们将各种实现科学框架集成到集成系统实践中，以 实施研究(INSPIRE)指导多层利益相关者完成迭代周期的四个阶段 实施活动，使利益攸关方参与使复杂的卫生技术适应当地 卫生系统背景。在本项目继续进行的目标1中，我们将对 参与INSPIRE研究的利益相关者，以了解 INSPIRE活动导致成功地采用了基于HPV的检测，并在大型健康中迅速扩大了规模 秘鲁亚马逊的网络。在目标2中，我们建议将INSPIRE研究方法转化为 可概括的执行战略(目标2)--“适应、扩大、可持续性：通过以下方式执行 系统思维“(协助)--并开发实施工具包，使利益攸关方能够参与 实施规划和背景适应。在目标3中，我们将利用计划中的HPV扩大规模 秘鲁卫生部的执行计划，以测试#年援助执行战略 使用中断时间序列设计对筛查覆盖和管理的影响，使用扩展的 重新定位评价框架。同时，我们将进行定性的比较案例研究，以使 理解上下文相关的调解者和修饰者对辅助实施成功的影响 战略(目标3)。现实主义评估的目的是检查什么对谁有效，在什么情况下 情况，在哪些方面，以及如何与假设一刀切。最终，满足我们的建议 AIMS将通过提供一个可广泛推广的适应环境的过程和工具包来促进公共卫生 可用于LMIC的基于HPV的筛选和管理，以及实施科学，通过帮助 缩小实施科学中的证据差距，以接近综合体的扩大和可持续性 不同背景下的卫生干预措施。

ABSTRACT/SUMMARY Cervical cancer, entirely preventable, remains the 4th most common cause of cancer incidence and mortality in women, with over 12 million new cases predicted in the next 50 years without sustained scale-up of HPV vaccination and cervical screening. More than 80% of the disease burden occurs in low- and middle-income countries (LMICs), reflecting inequitable availability and adoption of effective preventive strategies. Unfortunately, sustainable implementation of cervical screening and management for cervical cancer prevention has been elusive in LMICs, reflecting challenges of implementing complex health interventions in complex adaptive health systems. In the parent study, using participatory systems thinking as our `grand theory', we integrated various implementation science frameworks into the Integrative Systems Praxis for Implementation Research (INSPIRE) to guide multilevel stakeholders through four phases of an iterative cycle of implementation activities, enabling stakeholder-engaged adaptation of complex health technologies to local health system contexts. In Aim 1 of the continuation of this project, we will conduct a realist evaluation of stakeholders involved in the INSPIRE research, to gain an understanding of the mechanisms through which the INSPIRE activities led to successful adoption and rapid scale-up of HPV-based testing in a large health network in the Peruvian Amazon. In Aim 2 we propose to translate the INSPIRE research methodology into a generalizable implementation strategy (Aim 2) – “Adaptation, Scale-Up, Sustainability: Implementation by Systems Thinking” (ASSIST) - and develop an implementation toolkit to enable stakeholder-engaged implementation planning and context adaptation. In Aim 3, we will leverage the planned scale-up of HPV implementation plans from the Peruvian Ministry of Health to test the ASSIST implementation strategy for impact on screening coverage and management using an interrupted time series design, using the extended RE-AIM evaluation framework. In parallel, we will conduct a qualitative comparative case study to enable understanding of context-dependent mediators and modifiers to the success of the ASSIST implementation strategy (Aim 3). The realist evaluations are designed to examine `what works for whom, in what circumstances, in what respects, and how' vs assuming that one size fits all. Ultimately, meeting our proposal aims will advance public health, by providing a broadly generalizable process and toolkit for context-adaption of HPV-based screening and management that can be used in LMICs, and implementation science, by helping to reduce the evidence gap in implementation science for approaching scale-up and sustainability of complex health interventions in diverse contexts.