ACCESS: Accelerating Cervical Cancer Elimination through the integration of Screen-and-treat Services

计划摘要 尼日利亚是世界上艾滋病毒流行最严重的国家之一，有180万艾滋病毒携带者。使用 据估计，尼日利亚成年女性人口为1.02亿，艾滋病毒感染率为1.6%，尼日利亚的 是非洲最大的妇女人口和第四大艾滋病毒携带者。虽然 多年来，尼日利亚WLHIV患者获得抗逆转录病毒治疗的机会有所增加，98%以上的患者 与艾滋病相关的96万WLHIV抗逆转录病毒治疗的死亡率仍然居高不下。2020年，16,000名WLHIV死于艾滋病- 相关疾病，包括宫颈癌。尼日利亚的一项试点实施方案表明， 利用美国总统艾滋病紧急救援计划(PEPFAR)支持 在妇幼保健院提供循证宫颈癌筛查和治疗干预是可行的。飞行员 然而，计划表明，将需要量身定做的实施战略来解决特定的 癌症控制连续体的多层次障碍，以解决采用、覆盖和可持续发展问题 是成功扩展所必需的。然而，在许多艾滋病毒和艾滋病负担沉重的非洲国家， 对于宫颈癌，缺乏循证的实施战略来有效地整合 艾滋病毒和宫颈癌服务的交付。这项提议的目标是：1)完善战略以整合 在现有综合艾滋病毒治疗方案内进行宫颈癌筛查、治疗和管理 并确定实施准备情况；2)确定以下各项的相对有效性 实施战略与核心+强化实施战略；以及3)评估 将宫颈癌筛查、治疗和管理干预纳入艾滋病毒项目。我们有 组建了一支强大的团队，来自加州大学圣地亚哥分校、尼日利亚大学、恩苏卡和约翰 霍普金斯大学拥有实施科学、艾滋病毒护理和研究以及癌症护理和研究方面的专业知识 研究。我们的建议是对NCI RFA的响应，并与世界卫生组织全球 到2030年消除宫颈癌计划。如果有效，拟议的项目将产生一套可行的、 整合循证宫颈癌的文化适应性和可持续实施战略 将筛查和治疗纳入艾滋病毒方案，以改善WLHIV的健康和预期寿命。

Program Summary Nigeria has one of the largest HIV epidemics in the world with 1.8 million people living with HIV infection. With an estimated female population of 102 million and HIV prevalence of 1.6% among adult females, Nigeria has the largest population of women and the 4th largest number of women living with HIV (WLHIV) in Africa. Although access to antiretroviral therapy (ART) among WLHIV in Nigeria has increased over the years, with over 98% of the 960,000 WLHIV on ART, AIDS-related mortality remains high. In 2020, 16,000 WLHIV died from AIDS- related illnesses including cervical cancer. A pilot implementation program in Nigeria demonstrated that leveraging the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) supported HIV programs for the provision of evidence-based cervical cancer screen-and-treat interventions in WLWH is feasible. The pilot program demonstrated, however, that tailored implementation strategies will be needed to address specific multilevel barriers along the cancer control continuum in order to address adoption, reach, and sustainability that are necessary for successful scale-up. However, in many African countries with a high burden of both HIV and cervical cancer, there is a paucity of evidence-based implementation strategies to inform effective integration of HIV and cervical cancer services delivery. Objectives of this proposal are to: 1) Refine strategies to integrate cervical cancer screening, treatment and management within existing comprehensive HIV treatment programs and determine implementation readiness; 2) Determine the comparative effectiveness of a Core set of implementation strategies versus Core+ enhanced implementation strategies; and 3) assess sustainment of the integration of cervical cancer screening, treatment, and management intervention into HIV programs. We have assembled a strong team from University of California San Diego; University of Nigeria, Nsukka and John Hopkins University with expertise in implementation science, HIV care and research, and cancer care and research. Our proposal is responsive to the NCI RFA and consistent with the World Health Organization global plan of elimination of cervical cancer by 2030. If effective, the proposed project will result in a set of feasible, culturally adaptable, and sustainable implementation strategies to integrate evidence-based cervical cancer screening and treatment into HIV programs in order to improve the health and life expectancy of WLHIV.