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

项目概要/摘要 赞比亚是全球艾滋病毒的中心，有大量青少年和年轻人感染艾滋病毒 （AYAHIV）.与未感染的同龄人相比，AYAHIV患癌症的风险增加， 常见于卡波西肉瘤（KS）、非霍奇金淋巴瘤（NHL）和宫颈癌（CC）。减少这种 过早死亡率，应实施循证策略，以诊断癌症， 帮助AYAHIV完成推荐的癌症治疗。我们将使用理论知识 多层次战略，为以肿瘤学为重点的工作人员创建基于AYAHIV角色的职责 （ARROW）计划，以增加早期诊断服务的使用，并提高癌症的依从性 治疗KS、NHL和CC。我们的总体方法是基于同行的循证策略， 支持参与和学习。在个人层面，我们将通过嵌入对等网络来解决障碍， 辅导员支持AYAHIV。在供应商层面，我们将创建一个对等学习网络， 儿童和成人艾滋病毒治疗和癌症护理专业人员之间的联系。在医疗保健中心 在系统一级，我们将把卫生保健管理人员和赞比亚卫生部的决策者聚集在一起， 审查障碍并制定和实施协作解决方案。我们将使用实施科学 评估ARROW的有效性、实施结果和成本效益的方法 与一次性教育运动相比，该方案追求以下目标： 目标1.进行随机试验，比较ARROW计划与2009年的一次性教育运动。 增加AYAHIV获得的服务，以促进早期诊断（KS和NHL的体检，CC 筛查和及时的诊断测试）和提高癌症治疗的依从性。 目标2.使用混合方法评估ARROW计划的实施成果，并与单一方法进行比较- 基于可接受性、可行性、适当性、忠实性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方案。 成功完成这些目标将产生一套数据驱动的战略，可以扩大规模， 艾滋病毒感染者中的过早癌症死亡率。为了支持未来的实施工作，我们将 增量成本效益估计，进行政策模拟，评价执行结果， 并评估挑战和促进者，以优化ARROW计划。在赞比亚测试的模型可以 作为其他撒哈拉以南非洲国家的蓝图，以确保AYAHIV获得最佳服务， 促进早期诊断并确保完成指南推荐的治疗。箭头 该计划还将提供一个框架，以实施扩大服务，如预防服务， 生存护理，进一步减轻癌症AYAHIV面临的负担。

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.