Patient Reported Outcomes of Cervical Screening in HIV+ Women in Zambia

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In 2004, 1 woman died from invasive cervical cancer (ICC) worldwide for every 5 women who died from HIV/AIDS and 1 woman died from ICC in Africa for 5 women who died from tuberculosis. In Zambia, the second country with the highest ICC burden in the world after Tanzania, adherence to follow-up recommendation is currently low among women screened for cervical precursor lesion, and there is anecdotal evidence that participants experience substantial anxiety and screening-related distress. In this R21 exploratory/developmental proposal written in response to PA-06-351 for Behavioral Research in Cancer Control, we intend to carry out formative and patient-centered research (1) to assess the short-term effects of screening by Visual Inspection of the cervix after application of Acetic Acid (VIA) on the health-related quality of life (HRQoL) of HIV+ and HIV- women in Lusaka, Zambia; (2) to compare the acceptability of existing screening protocols and screening options in development but not yet available. The proposed study will serve as an empirical foundation for the design and conduct of an intervention trial aiming at minimizing psychosocial harms and increasing acceptability of cervical screening. The R21 study will be conducted in the following four phases: We will culturally adapt and rigorously translate the SF-36v2 Health Survey, the Cervical Dysplasia Distress Questionnaire, and state scale of the Spielberger's State-Trait Anxiety Inventory (6-item version) in two languages widely spoken in the Southern African region. We will also test the feasibility of using Discrete Choice Experiments to uncover women's preferences for VIA screening and alternative screening options currently in early testing phase. Then, we will interview 360 women offered VIA screening at CIDRZ clinics in Lusaka at baseline, before screening. Women who accept to undergo testing will be interviewed two more times, immediately after cervical screening and at 1-month post-screening. Data generated will be used to validate the instruments and methods adapted in the Development Phase, and test research hypotheses about adverse outcomes and acceptability of low-technology cervical screening in Zambia. Estimates of quality weights for screening-related health states will also be generated as a study byproduct. With one woman dying from cervical cancer worldwide for every five women who die from HIV/AIDS, low- technology cervical screening programs are increasingly proposed as imperfect but potentially cost-effective approaches to reduce cervical cancer burden in the developing world. This exploratory research project aims to identify ways to maximize the acceptability of same-day cervical cancer screening and treatment, minimize the adverse psychosocial consequences of screening, and ensure adherence to post-screening recommendations among both HIV-infected and HIV-uninfected women attending outpatient clinics in Lusaka, Zambia.