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

描述(由申请人提供)： R01摘要：在肯尼亚西部评估社区驱动的宫颈癌预防模式每年影响全球50多万妇女宫颈癌。虽然富裕国家的宫颈癌控制是上个世纪公共卫生方面的成功故事之一，但这种疾病仍然对发展中国家的妇女构成重大威胁，那里几乎90%的病例发生在那里。虽然已经开发了有效的筛查技术用于低资源环境，但作为完整的宫颈癌预防战略的一部分，这些技术的实施存在复杂的、特定于背景的障碍。除了采用循证筛查和治疗技术外，宫颈癌筛查的总体人口影响取决于两个主要因素：(1)社区范围内获得筛查的机会；(2)筛查呈阳性的妇女与治疗或随访的成功联系。应对这些因素的战略也必须是可接受的、相对容易实施的、具有成本效益的、可持续的。我们在肯尼亚西部--一个宫颈癌负担很重的国家--开展的形成性工作，为“宫颈癌预防级联”中的这些关键步骤发现了切实的障碍和促进者，并促成了一项将增加妇女参与宫颈癌预防活动的战略。基于这项工作，我们提出了以下假设：(1)通过社区卫生运动而不是政府诊所提供的自我收集的人类乳头瘤病毒(HPV)样本进行宫颈癌筛查将接触到更多的妇女；以及(2)社区制定的战略将成功地将更多的妇女与治疗联系起来，而不是目前的护理标准(即转诊到治疗地点)。为了验证这些假设，我们提出了一项两阶段的整群随机试验，以实施卫生部和世卫组织推荐的肯尼亚西部宫颈癌预防方案的实施策略。在第一阶段，社区将随机接受社区卫生运动或诊所的HPV检测，并将HPV+妇女的治疗标准转介到政府机构。我们将使用RE-AIM框架，这是一个用于评估实施战略(REACH、有效性、采用、实施一致性和成本以及维护)的框架，以评估关键成果；然后，我们将与社区合作，制定加强与护理挂钩的战略。在第二阶段，所有社区将提供以社区为基础的检测，并加强与护理的联系。进行这项整群随机试验将使我们能够评估每个社区接受宫颈癌筛查的妇女比例、通过加强与护理的联系而获得的治疗机会，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改进项目的具体情况，以产生一个“工具包”，以便在该区域内扩大规模，并在类似的环境中实施。

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.