A stigma responsive service delivery model for HPV-based screening among women living with HIV

针对感染艾滋病毒的女性进行基于 HPV 筛查的耻辱响应服务提供模式

• 批准号: 10542876
• 负责人: Megan J. Huchko
• 金额: $ 20.18万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-20 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10542876
• 关键词: Address; Anti-Retroviral Agents; Area; Awareness; Biological; Caring; Cervical Cancer Screening; Characteristics; Clinic; Collection; Communication; Communities; Community Health; County; Data; Diagnosis; Discrimination; Education; Educational Intervention; Educational Materials; Effectiveness; Epidemiology; Focus Groups; Fright; Government; HIV; Health; Health care facility; Healthcare; Human Development; Human Papillomavirus; Individual; Infrastructure; Intervention; Interview; Kenya; Language; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Measurement; Methods; Modeling; Outcome; Outpatients; Pamphlets; Patient-Centered Care; Perception; Persons; Prevalence; Randomized Clinical Trials; Risk; Risk Factors; Screening for cancer; Service delivery model; Sex Behavior; Social support; Stigmatization; Testing; Text Messaging; Training; Woman; Work; World Health Organization; base; cancer risk; care outcomes; cervical cancer prevention; design; effective therapy; effectiveness evaluation; effectiveness testing; follow-up; implementation strategy; infection risk; novel; outreach; peer; prevent; prevention service; programs; response; screening; screening services; service delivery; social stigma; standard of care; success; synergism; therapy design; tool; treatment arm; uptake; volunteer

ABSTRACT Women living with HIV (WLWH) are at increased biologic risk for infection with human papillomavirus (HPV) and development of pre-invasive and invasive cervical cancer. The World Health Organization has recently called for HIV-programs to bolster their efforts to prevent cervical cancer through integrated screening services. Understanding and addressing stigma, including the intersection of HIV, HPV and cervical cancer-related stigma, will be crucial to designing interventions that will facilitate the uptake of cancer screening among WLWH and women in high HIV prevalence settings like western Kenya. Cancer-related stigma negatively influences several determinants of cancer screening uptake, including perception of cancer risk, cancer screening benefit, and acceptability of screening methods. In our prior work to evaluate HPV-based screening in Kenya, we found that lack of education about cervical cancer and low awareness of screening benefits, both of which can potentiate cancer-related stigma, were major barriers to screening uptake. Our team also found that misperceptions and stigma about an HPV diagnosis and cancer were associated with reduced rates of follow-up among women who tested positive for HPV. Our team developed a stigma framework to inform and validate a measurement tool for HPV-, cervical cancer- and HIV-related stigmas. We found that educational messages focused on cancer-related outcomes and HPV epidemiology, including risks related to sexual behavior and HIV, were stigmatizing, while support from social networks and emphasis on the availability of effective treatment reduced stigma and promoted screening uptake. We used this data to develop a stigma-responsive educational intervention which includes simplified scripts for multiple cadres of health workers that provide clear messages about HPV and the benefits of screening and a video aimed at addressing fears and misperceptions from a peer perspective. We propose to incorporate these educational components into “Elimisha HPV,” a multilevel stigma-responsive cervical cancer prevention service delivery model for integration within clinics providing HIV-care in western Kenya. Elimisha HPV, which in Kiswahili means to increase understanding of HPV, will include the following components: HPV-testing via self-collection, simplified scripts and video, peer navigators for women with screening or treatment hesitancy, and the option to receive results and information via text messages. To adapt, implement and test the effectiveness of this model, we will: 1) work with key stakeholders to finalize Elimisha HPV 2) compare cervical cancer prevention outcomes and engagement in HIV care in clinics offering the Elimisha HPV model to clinics providing standard of care outreach, education and screening strategies; and 3) identify individual and institutional factors that moderate the effects of Elimisha HPV on cervical cancer prevention outcomes. If effective, this may represent a new model for HPV-based cervical cancer screening as well as a new paradigm for comprehensive, stigma-responsive service delivery packages for people living with HIV.

摘要 携带艾滋病毒的妇女感染人类乳头瘤病毒(HPV)的生物风险增加 侵袭前和浸润性宫颈癌的发生。世界卫生组织最近呼吁 艾滋病毒-通过综合筛查服务加强他们预防宫颈癌的努力的计划。 理解和解决耻辱，包括艾滋病毒、人乳头瘤病毒和与宫颈癌有关的耻辱， 将对设计干预措施至关重要，以促进WLWH和 在像肯尼亚西部这样艾滋病毒高流行地区的妇女。与癌症相关的耻辱对几个 癌症筛查接受的决定因素，包括对癌症风险的感知，癌症筛查的益处，以及 筛选方法的可接受性。在我们之前在肯尼亚评估基于HPV的筛查工作中，我们发现 缺乏有关宫颈癌的教育和对筛查益处的认识不足，这两者都会增强 癌症相关的耻辱，是筛查吸收的主要障碍。我们的团队还发现，误解和 对HPV诊断和癌症的耻辱与以下女性的随访率降低有关 HPV检测呈阳性。我们的团队开发了一个耻辱框架来通知和验证以下测量工具 与HPV、宫颈癌和艾滋病毒相关的耻辱。我们发现，关注与癌症相关的教育信息 结果和人乳头状瘤病毒流行病学，包括与性行为和艾滋病毒有关的风险，令人耻辱，而 来自社会网络的支持和对提供有效治疗的重视减少了耻辱和 促进筛查吸收。我们利用这些数据开发了一种污名反应教育干预措施， 包括针对多名卫生工作者干部的简化脚本，提供有关HPV和 放映的好处和旨在从同龄人的角度解决恐惧和误解的视频。我们 建议将这些教育内容纳入“消除HPV”，这是一种多层次的污名反应 西方提供艾滋病毒护理的诊所一体化的宫颈癌预防服务提供模式 肯尼亚。消除HPV，在斯瓦希里语中的意思是增加对HPV的了解，将包括以下内容 组件：通过自我收集、简化的脚本和视频进行HPV检测，为以下女性提供同行导航器 筛查或治疗犹豫不决，以及通过短信接收结果和信息的选项。为了适应， 实施并测试此模式的有效性，我们将：1)与关键利益相关方合作，最终消除 HPV 2)比较提供以下服务的诊所的宫颈癌预防结果和参与艾滋病毒护理的情况 消除HPV模式，向诊所提供标准护理外展、教育和筛查战略；以及3) 确定缓和消除HPV对宫颈癌影响的个人和机构因素 预防结果。如果有效，这可能代表着一种基于HPV的宫颈癌筛查的新模式 以及一种新的范例，为生活在一起的人提供全面的、应对耻辱的服务包 爱滋病毒。