West Africa Self-Sampling HPV Based Cervical Cancer Control Program (WA-SS-HCCP) for WLWHA: Barriers, challenges, and needs

项目摘要/摘要 在世界范围内，每年70%的新增艾滋病毒感染发生在撒哈拉以南非洲(SSA)，那里有74%的人 艾滋病毒/艾滋病患者，其中50%以上是妇女。此外，子宫颈癌的最高发病率 癌症(CC)发病率和相关死亡也发生在SSA，那里大约60%的CC病例是在 感染艾滋病毒/艾滋病妇女(WLWHA)。人类乳头瘤病毒(HPV)是引起CC的主要原因之一，是最常见的 在SSA和全球几乎所有患CC的WLWHA中常见的性传播感染是共同的 感染了人乳头瘤病毒。CC主要可通过接种HPV疫苗和宫颈筛查及早发现和 治疗。在高收入国家(HIC)，这些战略导致CC急剧下降；然而，它们 低收入和中等收入国家(低收入和中等收入国家)的妇女在很大程度上仍然无法获得。基于自我采样的HPV (SS-HPV)测试已被证明是识别受感染妇女的一种经济有效和可行的方法 高危HPV毒株(hr-HPV)，需要更先进的诊断测试和治疗。然而，党卫军- 尽管艾滋病毒感染率很高，但HPV检测尚未在大多数LMIC中广泛实施，包括SSA。 利用我们在马里长达十年、广泛而成功的培训伙伴关系和研究合作 和尼日利亚，我们建议实施一种新的西非自采样HPV宫颈癌 控制程序(WA-SS-HCCP)。该项目充分利用现有的优势和资源，包括 与已建立关系的社区卫生工作者(CHW)建立艾滋病毒护理系统 WLWHA，并可提供HPV和CC教育/咨询和SS样本采集指导，快速 将标本运送到医院实验室，直接向妇女提供个性化的检测结果， 促进人类免疫缺陷病毒感染妇女的临床转诊，以进行高级诊断和治疗。这项研究将 深入评估障碍、挑战和需求，以适应、实施和 评价Wa-SS-HCCP的有效性和成功率。具体目标是(1)评估障碍和 马里和尼日利亚WLWHA使用质量风险对WA-SS-HCCP的上下文适应需求 评估和观察方法；(2)使用学习协作方法(例如， 每月的网络研讨会、快速循环的小规模变革测试)和实施框架(例如，培训 CHW的能力、跨设置的数据协调、实施仪表板)来优化WA-SS- 所有四个站点的HCCP；以及(3)对有效性进行双重评估(例如，完全的WLWHA 筛选和更改百分比)和实施(例如覆盖范围、采用率、实施保真度和 维护或可持续性)，并开发一个“WA-SS-HCCP放大工具包”来广泛传播这一点 “发现-治疗”计划，可扩展到艾滋病毒妇女和所有LMIC。

PROJECT SUMMARY/ABSTRACT Worldwide, 70% of new HIV infections every year occur in Sub-Saharan Africa (SSA), home to 74% of people living with HIV/AIDS (PLWHA), of whom over 50% are women. Furthermore, the highest rates of cervical cancer (CC) incidence and related death also occur in SSA, where approximately 60% of all CC cases are in women living with HIV/AIDS (WLWHA). Human Papillomavirus (HPV), amajor cause of CC, is the most common sexually transmitted infection in SSA and nearly all WLWHA worldwide who develop CC are co- infected with HPV. CC is largely preventable by HPV vaccination and cervical screening for early detection and treatment. In high income countries (HICs), these strategies have led to a steep decline in CC; however they remain largely inaccessible to women in low- and middle-income countries (LMICs). Self-sampling-based HPV (SS-HPV) tests have been shown to be a cost-effective and feasible approach to identifying women infected with high-risk HPV strains (hr-HPV) who need more advanced diagnostic tests and treatment. However, SS- HPV testing has not been widely implemented in most LMICs, including SSA despite high HIV prevalence. Leveraging our decade-long, extensive, and successful training partnership and research collaborations in Mali and Nigeria, we propose to implement a novel West African Self-Sampling HPV-Based Cervical Cancer Control Program (WA-SS-HCCP). The project capitalizes on existing strengths and resources including the HIV systems of care with Community Health Workers (CHWs) who have established relationships with WLWHA and can provide HPV and CC education/counseling and SS specimen collection guidance, rapid transportation of specimens to hospital laboratories, personalized delivery of test results directly to the women, and facilitation of clinic referrals for women with hr-HPV for advanced diagnostics and treatment. The study will conduct in-depth assessment of barriers, challenges, and needs to contextually adapt, implement, and evaluate the effectiveness and success of WA-SS-HCCP. The specific aims are to (1) Assess barriers and needs for contextual adaptations of WA-SS-HCCP among WLWHA in Mali and Nigeria, using qualitative risk assessment and observation methods; (2) Contextually adapt, using a learning collaborative approach (e.g., monthly webinars, rapid-cycle small tests of change) and an implementation framework (e.g., training to competency of CHWs, data coordination across settings, implementation dashboard) to optimize the WA-SS- HCCP across all four sites; and (3) Conduct a dual evaluation of the effectiveness (e.g., % WLWHA fully screened and % change in) and implementation (e.g., reach, adoption, implementation fidelity, and maintenance or sustainability) and develop a “WA-SS-HCCP Scale-Up Toolkit” for wide dissemination of this “detect-to-treat” program that can be expanded to HIV- women and across LMICs.