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

患者报告的赞比亚艾滋病毒妇女宫颈筛查结果

• 批准号: 7418899
• 负责人: Eric Chamot
• 金额: $ 17.01万
• 依托单位: UNIVERSITY OF ALABAMA AT BIRMINGHAM
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-08-14 至 2010-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7418899
• 关键词: AIDS/HIV problem; Acetic Acid; Acetic Acids; Address; Adherence; Advocate; Africa; African; Age; Ambulatory Care Facilities; Anti-Retroviral Agents; Anxiety; Back; Behavior; Behavioral Research; Cancer Burden; Cancer Control; Caring; Cervical; Cervical Cancer Screening; Cervical Intraepithelial Neoplasia; Cervical dysplasia; Cervix Uteri; Child; Clinic; Cold Therapy; Condition; Counseling; Country; DNA; Data; Decision Making; Depth; Developed Countries; Developing Countries; Development; Diagnosis; Dimensions; Disease; Distress; Economic Models; Economics; Eligibility Determination; End Point; Ensure; Equipment and supply inventories; Ethics; Exercise; Female Adolescents; Foundations; Future; Generic Drugs; Goals; Grant; Guidelines; HIV; Health; Health Services; Health Status; Health Surveys; Healthcare; Human Papillomavirus; Image; Immunosuppression; Infectious Diseases Research; International; Intervention; Intervention Trial; Interview; Invasive; Investigation; Language; Learning; Lesion; Life; Loop electrosurgical excision procedure; Malignant neoplasm of cervix uteri; Marketing; Measures; Mental Health; Methodology; Methods; Minor; Monitor; Numbers; Nurses; Outcome; Outcomes Research; Participant; Patient Outcomes Assessments; Patients; Pattern; Performance; Phase; Policies; Premalignant; Prevention; Procedures; Process; Protocols documentation; Publishing; Quality-Adjusted Life Years; Quality-of-Life Assessment; Questionnaires; Randomized Controlled Clinical Trials; Range; Rate; Recommendation; Reporting; Research; Research Project Grants; Resources; Risk; SF-36; Sampling; Schedule; Score; Screening Result; Screening procedure; Sexuality; Solid; Specific qualifier value; Specificity; Speculums; Staging; Standards of Weights and Measures; System; Tanzania; Target Populations; Teaching Hospitals; Technology; Testing; Therapeutic immunosuppression; Time; Translating; Treatment Efficacy; Tuberculosis; Universities; Update; Urine; Vagina; Visit; Visual; Weight; Woman; Women' s Group; Women' s Health; Writing; Zambia; base; care seeking; cervical cancer prevention; cost; cost effectiveness; day; design; digital; digital imaging; experience; follow-up; health related quality of life; instrument; new technology; patient oriented; preference; programs; psychologic; psychological distress; psychosocial; reproductive; research study; response; success; theories; trait; uptake; willingness to pay

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.

2004年，全世界每5名妇女中就有1名妇女死于浸润性宫颈癌（ICC）。 在非洲，有1名妇女死于艾滋病毒/艾滋病，5名妇女死于结核病。在赞比亚， 继坦桑尼亚之后，国际刑事法院负担最重的第二个国家，遵守后续行动 目前，在筛查宫颈前病变的妇女中， 有证据表明参与者经历了大量的焦虑和与筛查相关的痛苦。在R21中 针对PA-06-351针对癌症行为研究撰写的探索性/开发性提案 对照组，我们打算进行形成性和以患者为中心的研究（1），以评估 应用醋酸（VIA）后通过目视检查宫颈进行健康相关质量筛查 （2）比较赞比亚卢萨卡艾滋病毒阳性和艾滋病毒阴性妇女的生活质量（HRQoL）; 筛选方案和筛选选项正在制定中，但尚未提供。拟定的研究将 作为设计和进行干预试验的经验基础，旨在最大限度地减少 社会心理危害和提高子宫颈筛查的可接受性。R21研究将在 分为四个阶段： 我们将文化适应和严格翻译SF-36 v2健康调查，宫颈发育不良困扰 施氏状态-特质焦虑量表（6项版） 非洲南部地区广泛使用的语言。我们还将测试使用离散 选择实验，以揭示妇女对VIA筛查和替代筛查方案的偏好 目前处于早期测试阶段。然后，我们将采访360名在CIDRZ提供VIA筛查的妇女 在筛选前的基线时，在卢萨卡的诊所。接受检测的女性将被 在子宫颈普查后立即和普查后1个月再进行两次面谈。数据 生成的数据将用于验证开发阶段采用的仪器和方法，并测试 关于低技术宫颈筛查的不良结果和可接受性的研究假设， 赞比亚.筛查相关健康状态的质量权重估计值也将作为研究生成 副产品全世界每五名死于艾滋病毒/艾滋病的妇女中就有一名妇女死于宫颈癌， 越来越多的人认为宫颈筛查项目不完善，但可能具有成本效益 减少发展中国家宫颈癌负担的方法。这个探索性的研究项目 旨在找出方法，以尽量提高同日子宫颈癌普查的可接受性， 治疗，最大限度地减少筛查的不良心理后果，并确保遵守 在艾滋病毒感染和未感染艾滋病毒的妇女中进行筛查后建议， 赞比亚卢萨卡的门诊诊所。