Evaluating a community-driven cervical cancer prevention model in western Kenya

描述（由申请人提供）： R 01摘要：评估肯尼亚西部社区驱动的宫颈癌预防模式宫颈癌每年影响全球50多万妇女。虽然富裕国家的宫颈癌控制是过去世纪公共卫生的成功故事之一，但该疾病仍然是发展中国家妇女的重大威胁，近90%的病例发生在发展中国家。虽然有效的筛查技术已开发用于低资源环境，但作为完整的宫颈癌预防战略的一部分，实施这些技术存在复杂的特定背景障碍。除了采用循证筛查和治疗技术外，宫颈癌筛查对总体人群的影响取决于两个主要因素：（1）全社区范围内的筛查机会和（2）筛查阳性妇女的治疗或随访成功联系。解决这些因素的战略也必须是可接受的，相对容易实施，具有成本效益，才能持续。我们在肯尼亚西部这个宫颈癌负担很重的国家开展的形成工作，发现了“宫颈癌预防级联”中这些关键步骤的有形障碍和促进因素，并制定了一项战略，将增加妇女对宫颈癌预防活动的参与。基于这项工作，我们提出了以下假设：（1）与政府诊所相比，通过社区卫生运动提供的自我收集的人乳头瘤病毒（HPV）标本进行宫颈癌筛查将覆盖更多的妇女;（2）社区制定的战略将成功地将更多的妇女与目前的护理标准（即，转介至治疗地点）。为了检验这些假设，我们提出了一个两阶段的集群随机试验的实施策略，卫生部和世卫组织建议的宫颈癌预防协议在肯尼亚西部。在第一阶段，社区将在社区卫生运动或诊所中随机进行HPV检测，并将HPV+妇女的治疗标准转诊到政府设施。我们将使用RE-AIM框架，一个用于评估实施策略的框架，（覆盖范围，有效性，采用，实施一致性和成本，以及维护）来评估关键结果;然后，我们将与社区合作，制定一项加强与护理联系的战略。在第二阶段，所有社区都将提供基于社区的检测，并加强与护理的联系。进行这项随机分组试验将使我们能够评估每个社区中接受宫颈癌筛查的妇女比例，增强与护理联系的治疗机会的增加，以及两种干预措施的成本效益。RE-AIM框架将使我们能够衡量和完善项目的具体内容，以产生一个“工具包”，用于在该区域内扩大规模并在类似环境中实施。

DESCRIPTION (provided by applicant): Abstract for R01: Evaluating a community- driven cervical cancer prevention model in western Kenya Cervical cancer impacts over half a million women globally each year. While cervical cancer control in wealthy countries is one of the public health success stories of the past century, the disease remains a significant threat for women in developing countries where almost 90% of cases occur. Although effective screening technologies have been developed for use in low-resource settings, there are complicated, context-specific barriers to their implementation as part of a complete cervical cancer prevention strategy. In addition to employing evidence-based screening and treatment techniques, the overall population impact of cervical cancer screening depends on two main factors: (1) community-wide access to screening and (2) successful linkage to treatment or follow-up for women who screen positive. Strategies to address these factors must also be acceptable, relatively easy to implement, and cost-effective to be sustainable. Our formative work in western Kenya, a country with a high cervical cancer burden, uncovered tangible barriers and facilitators to these key steps in the "cervical cancer prevention cascade" and has led to a strategy that will increase women's uptake of cervical cancer prevention activities. Based on this work, we have developed the following hypotheses: (1) cervical cancer screening with self-collected human papillomavirus (HPV) specimens will reach more women when offered through community health campaigns versus government clinics; and (2) community-developed strategies will successfully link more women to treatment than the current standard of care (i.e., referral to treatment sites). To test these hypotheses, we propose a two- phase cluster-randomized trial of implementation strategies for a Ministry of Health and WHO-recommended cervical cancer prevention protocol in western Kenya. During Phase 1, communities will be randomized to HPV-testing in either community-health campaigns or in clinics, with standard referral for treatment of HPV+ women to government facilities. We will use the RE-AIM framework, a framework used to evaluate implementation strategies, (Reach, Efficacy, Adoption, Implementation consistency and costs, and Maintenance) to assess the key outcomes; we will then work in partnership with the community to develop a strategy for enhanced linkage to care. In Phase 2, all communities will offer community-based testing with enhanced linkage to care. Conducting this cluster-randomized trial will enable us to assess the proportion of women in each community who get cervical cancer screening, the gain in treatment access with enhanced linkage to care, and the cost-effectiveness of the two interventions. The RE-AIM framework will allow us to measure and refine the context-specific dimensions of the project to produce a "toolkit" for scale-up within ths region and implementation into similar settings.