Integrated delivery of cancer control interventions for adolescents and young adults living with HIV in Zambia

项目摘要/摘要 赞比亚是全球艾滋病毒的中心，有大量青少年和青年艾滋病毒携带者 (AYAHIV)。与未感染的同龄人相比，AYAHIV患癌症的风险更高，大多数 常见的有卡波西肉瘤(KS)、非霍奇金淋巴瘤(NHL)和宫颈癌(CC)。为了减少这一点 过早死亡，应实施循证策略，既能同时诊断癌症，又能 早期帮助AYAHIV完成推荐的癌症治疗。我们将使用理论知情的 为以肿瘤学为重点的工作人员创建基于角色的AYAHIV责任的多层次战略 (箭头)计划增加对早期诊断服务的接受并改善对癌症的依从性 治疗KS、NHL和CC。我们的总体方法是基于Peer的循证策略 支持参与和学习。在个人层面，我们将通过嵌入Peer来解决障碍 支持AYAHIV的顾问。在提供商层面，我们将创建一个点对点学习网络来构建 专攻儿童和成人艾滋病毒治疗和癌症护理的人之间的联系。在医疗保健中心 在系统层面，我们将把卫生保健管理人员和赞比亚卫生部政策制定者聚集在一起 审查障碍并开发和实施协作解决方案。我们将使用实施科学 评估箭头的有效性、执行结果和成本效益的方法 该计划与一次性教育活动相比，实现了以下目标： 目标1.进行随机试验，将ARROW计划与一次性教育活动 增加AYAHIV接受的服务，以促进早期诊断(KS和NHL、CC的体检 筛查和及时的诊断测试)和提高癌症治疗的依从性。 目的2.使用混合方法评估ARRAW方案的执行结果，并与一种方法进行比较- 基于可接受性、可行性、适当性、保真度和可持续性的时间教育。 目标3.进行经济评估，以评估成本效益和投资回报情景。 成功完成这些目标将产生一套数据驱动的战略，这些战略可以扩展以减少 AYAHIV中的过早癌症死亡率。为了支持未来的实施工作，我们将生成 增量成本效益估算，进行政策模拟，评估执行成果， 并评估挑战和促进者，以优化ARRAW计划。在赞比亚测试的模型可以 为其他撒哈拉以南非洲国家提供蓝图，确保AYAHIV获得最佳服务 促进早期诊断，确保完成指南推荐的治疗。这支箭 该方案还将提供实施扩大服务的框架，如预防性服务和 生存关怀，进一步减轻AYAHIV面临的癌症负担。

PROJECT SUMMARY/ABSTRACT Zambia is a global epicenter for HIV with a large number of adolescents and young adults living with HIV (AYAHIV). Compared with their uninfected peers, AYAHIV are at increased risk of developing cancer, most frequently Kaposi sarcoma (KS), non-Hodgkin’s lymphoma (NHL), and cervical cancer (CC). To reduce this premature mortality, evidence-based strategies should be implemented to both diagnose cancers at an earlier stage and help AYAHIV complete recommended cancer treatment. We will use theory-informed multilevel strategies to create the AYAHIV Role-based Responsibilities for Oncology-focused Workforce (ARROW) program to increase uptake of services for early diagnosis and improve compliance with cancer treatment for KS, NHL, and CC. Our overall approach is based on the evidence-based strategy of peer support for engagement and learning. At the individual level, we will address barriers by embedding peer counselors to support AYAHIV. At the provider level, we will create a peer-to-peer learning network to build linkages between those specializing in pediatric and adult HIV treatment and cancer care. At the health care system level, we will bring together health care administrators and Zambian Ministry of Health policy makers to review barriers and to develop and implement collaborative solutions. We will use implementation science methods to evaluate effectiveness, implementation outcomes, and cost-effectiveness of the ARROW program compared with a one-time education campaign by pursuing the following aims: Aim 1. Conduct randomized trials to compare the ARROW program with the one-time education campaign in increasing services received by AYAHIV to facilitate early diagnosis (physical exam for KS and NHL, CC screening, and timely diagnostic testing) and in improving adherence to cancer treatment. Aim 2. Use mixed methods to assess implementation outcomes of the ARROW program compared with one- time education based on acceptability, feasibility, appropriateness, fidelity, and sustainability. Aim 3. Perform economic evaluations to assess cost-effectiveness and return-on-investment scenarios. Successful completion of these aims will yield a set of data-driven strategies that can be scaled up to reduce premature cancer mortality among AYAHIV. To support future implementation efforts, we will generate incremental cost-effectiveness estimates, conduct policy simulations, evaluate implementation outcomes, and assess challenges and facilitators to optimize the ARROW program. The model tested in Zambia can serve as a blueprint for other Sub-Saharan African countries to ensure AYAHIV receive optimal services to facilitate early diagnosis and ensure completion of guideline-recommended treatments. The ARROW program will also provide a framework for implementing expanded services, such as preventive services and survivorship care, to further reduce the burden of cancer AYAHIV face.