Social determinants of health associated to the cervical cancer-related care across the cancer control continuum among women living with HIV in Puerto Rico

项目负责人/主要研究者（最后，第一，中间）：Colón-López，Vivian 项目总结/摘要：研究项目1 宫颈癌是艾滋病毒感染妇女（WLWH）的主要癌症原因。虽然宫颈癌 筛查是WLWH常规临床护理的一部分，该人群缺乏定期筛查，适当的随访- 癌前病变和/或宫颈癌的治疗。在大多数情况下， 健康的重要社会决定因素（SDoH）与获得整个宫颈癌护理的相关性 WLWH之间的连续性（筛查，诊断和治疗）。本次调查的总体目标是 采用混合方法确定SDoH中影响及时获取 WLWH中整个癌症护理连续体（筛查、诊断和治疗）的宫颈癌护理 波多黎各（PR）. PR是美国（US）内发病率较高的司法管辖区之一， 艾滋病毒/艾滋病的流行，以及最近宫颈癌发病率的显著增加（2001 - 2017年）。我们 具体目标是：（1）研究艾滋病毒感染状况对宫颈癌延迟的程度和决定因素的影响， 癌症护理（筛查，诊断和治疗）在PR期间诊断的宫颈癌患者 （2）在SDoH内建立影响及时宫颈癌护理的多层次因素 在患有高度宫颈病变（HSIL）或宫颈癌的妇女中进行筛查、诊断和治疗 评估有效的初级（HPV疫苗接种）和次级（筛查和治疗）的使用 2023年和2024年，在PR中被诊断患有艾滋病毒或艾滋病的妇女中采用HSIL预防方法。我们的最终 我们的目标是，所有WLWH都能公平地获得宫颈癌治疗，同时降低发病率， 与这种恶性肿瘤相关的死亡率。这项提案支持一项为期3年的研究和培训计划，使博士。 索托将在作为独立调查员和领域领导者的职业生涯中取得实质性进展 SDoH，癌症控制和艾滋病毒。该项目的结果将确定SDoH内的干预机会 沿着宫颈癌护理连续体。此外，调查结果将指导这些项目的开发和评估。 在随后的R01申请中采取干预措施，以减少获得护理的障碍，并确保WLWH之间的健康公平。 这些信息也可能适用于美国和其他人群的西班牙裔WLWH。 OMB编号0925 - 0001/0002（修订版03/2020批准至02/28/2023）页码继续格式页码

Program Director/Principal Investigator (Last, First, Middle): Colón-López, Vivian PROJECT SUMMARY/ABSTRACT: RESEARCH PROJECT 1 Cervical cancer is the leading cause of cancer among women living with HIV (WLWH). Although cervical cancer screening is part of routine clinical care for WLWH, this population lacks regular screening, appropriate follow- up and/or treatment for precancerous lesions and/or cervical cancer. There is no consensus on the most important social determinants of health (SDoH) associated with access to care across the cervical cancer care continuum (screening, diagnosis, and treatment) among WLWH. The overall goal of this investigation is to employ a mixed-methods approach to identify multi-level factors within the SDoH that affect timely access to cervical cancer care across the cancer care continuum (screening, diagnosis, and treatment) among WLWH in Puerto Rico (PR). PR is one of the jurisdictions within the United States (US) with a high incidence and prevalence of HIV/AIDS, and a recent significant increase in the incidence of cervical cancer (2001-2017). Our specific aims are: (1) To examine the impact of HIV status on the extent and determinants of delay in cervical cancer care (screening, diagnosis and treatment) among cervical cancer patients diagnosed in PR during the period 2013-2020; (2) Establish multi-level factors within the SDoH that affect timely cervical cancer care (screening, diagnosis and treatment) among women with high-grade cervical lesions (HSIL) or cervical cancer in PR; and (3) Estimate the use of effective primary (HPV vaccination) and secondary (screening for, and treating HSIL) prevention approaches among women diagnosed with HIV or AIDS in PR for 2023 and 2024. Our ultimate goal is that all WLWH have equitable health access to cervical cancer care, while reducing morbidity and mortality associated to this malignancy. This proposal supports a 3-year research and training plan to allow Dr. Soto to make substantial progress toward a career as an independent investigator and leader in the field of SDoH, cancer control and HIV. Results from this project will identify intervention opportunities within the SDoH along the cervical cancer care continuum. Moreover, findings will guide the development and evaluation of these interventions to reduce barriers to care and ensure health equity among WLWH in a subsequent R01 application. This information could also potentially be adapted to Hispanic WLWH in the US and in other populations. OMB No. 0925-0001/0002 (Rev. 03/2020 Approved Through 02/28/2023) Page Continuation Format Page