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

节目概要 尼日利亚是世界上艾滋病毒流行最严重的国家之一，有180万人感染艾滋病毒。与 估计女性人口为1.02亿，成年女性艾滋病毒感染率为1.6%，尼日利亚 妇女人数最多，妇女艾滋病毒感染者人数在非洲排名第四。虽然 多年来，尼日利亚的WLHIV患者获得抗逆转录病毒治疗（ART）的机会有所增加， 在96万名接受抗逆转录病毒治疗的艾滋病毒感染者中，艾滋病相关死亡率仍然很高。2020年，16，000名WLHIV死于艾滋病- 相关疾病包括宫颈癌。尼日利亚的一个试点实施方案表明， 利用美国总统艾滋病紧急救援计划（PEPFAR）， 在WLWH中提供循证宫颈癌筛查和治疗干预措施是可行的。试点 然而，该计划表明，将需要量身定制的实施战略，以解决具体的问题， 沿着癌症控制连续体的多层次障碍，以解决采用、覆盖和可持续性问题， 是成功扩大规模的必要条件。然而，在许多艾滋病毒和艾滋病负担沉重的非洲国家， 宫颈癌，缺乏循证实施战略，以告知有效整合 提供艾滋病毒和宫颈癌服务。本提案的目标是：1）完善战略， 在现有的艾滋病毒综合治疗方案中进行宫颈癌筛查、治疗和管理 并确定实施准备情况; 2）确定一套核心 执行战略与核心+强化执行战略的比较; 3）评估 将宫颈癌筛查、治疗和管理干预纳入艾滋病毒方案。我们有 由加州圣地亚哥大学、尼日利亚恩苏卡大学和约翰· 霍普金斯大学在实施科学、艾滋病护理和研究以及癌症护理方面拥有专业知识， research.我们的提案是对NCI RFA的响应，并与世界卫生组织的全球 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， 文化适应性强和可持续的实施战略， 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.