Fidelity and adaptation of breast cancer resource-stratified treatment guidelines in Botswana

项目摘要 乳腺癌是全球女性癌症死亡的主要原因。 2018年报告的死亡人数为62.6万人。尽管#年乳腺癌死亡率大幅下降 发达国家、低收入和中等收入国家(LMIC)继续经历高增长 死亡率。这种差异在撒哈拉以南非洲(SSA)和艾滋病毒中更加明显 高发地区，在那里艾滋病毒感染(HIV+)乳腺癌患者有明显的 全因死亡的风险增加。《世界卫生组织-选择干预措施》 评估乳腺癌的系统治疗覆盖率为95% SSA是性价比最高的。随后，强有力的基于证据的资源分层指导方针 旨在促进在SSA提供高质量的乳腺癌治疗服务。不管多么关键 真实世界的数据缺乏治疗的保真度和以指南为基础的实施 关心。这些数据对于了解不良结局是否与 准则执行的质量或程度或其他无关因素。如果干预措施 最大限度地提高治疗保真度和最大限度地减少随机变异性是有针对性的 很可能会取得成果。 长期目标是改善HIV阳性和HIV阳性乳腺癌患者的生存结果。 在SSA中，通过设计有针对性的干预措施来增加高质量的治疗交付。这个 此应用程序的目标是让Martei博士正式培训成为一名独立的 SSA癌症护理服务实施科学研究人员，并获得实用 通过以下研究目的掌握的技能：1)比较HIV+和HIV+之间的治疗保真度- 接受治疗意向治疗的乳腺癌患者，并确定艾滋病毒的保真度修饰物；2) 采用混合方法设计高、低保真度患者的偏差样本 确定影响保真度的社会经济和文化因素；以及3)使用协作 干预规划框架，以确定指南调整的目标并制定菜单 实施战略和干预试验，以促进治疗的保真度。这项研究发表在 博茨瓦纳建立在博茨瓦纳和该大学之间长达15年的合作研究基础上 包括一个由美国和博茨瓦纳的高级导师组成的多学科小组， 以及强大的公共资助的艾滋病毒和乳腺癌医疗体系。这是对齐的 美国国家癌症研究所全球健康中心重点关注的领域是“加强全球 癌症研究和资源适宜型癌症控制策略“促进癌症 在低收入国家开展以证据为基础、可持续的研究和控制工作。

Project Summary Breast cancer is the leading cause of cancer mortality among women globally with over 626,000 deaths reported in 2018. Despite substantial reductions in breast cancer mortality in developed countries, low- and middle- income countries (LMICs) continue to experience a high fatality rate. The disparity is more pronounced in Sub Saharan Africa (SSA) and in HIV prevalent regions, where HIV-infected (HIV+) breast cancer patients have a significantly increased risk of all-cause mortality. The “World Health Organization-Choosing Interventions that are Cost-Effective” team assessed systemic treatment for breast cancer at 95% coverage in SSA as cost-effective. Subsequently robust evidence-based resource-stratified guidelines have been developed to promote high quality breast cancer therapy delivery in SSA. However critical real-world data are lacking on the treatment fidelity and the implementation of guideline-based care. These data are critical to understanding whether inferior outcomes are related to the quality or extent of guideline implementation or other unrelated factors. If interventions that maximize treatment fidelity and minimize random variability are implemented, targeted outcomes will likely be achieved. The long-term goal is to improve survival outcomes in HIV+ and HIV- breast cancer patients in SSA by designing targeted interventions to increase high-quality therapy delivery. The objectives of this application are to allow Dr. Martei to formally train to become an independent investigator in implementation science in cancer care delivery in SSA, and to obtain practical skills through the following research aims: 1) compare treatment fidelity between HIV+ and HIV- breast cancer patients receiving curative intent therapy and identify HIV modifiers of fidelity; 2) using mixed methods design and a deviance sample of patients with high and low fidelity identify socioeconomic and cultural modifiers of fidelity; and 3) using the collaborative intervention planning framework to identify targets for guideline adaptation and develop a menu of implementation strategies and intervention trials to promote treatment fidelity. This study in Botswana builds upon 15 years of collaborative research between Botswana and the University of Pennsylvania, including a multidisciplinary group of US- and Botswana-based senior mentors, and the strong publicly-funded healthcare system for HIV and breast cancer. This is aligned with the National Cancer Institute Center for Global health priority areas of “Strengthening Global Cancer Research and Resource-Appropriate Cancer Control Strategies” to promote cancer research and control efforts that are evidence-based and sustainable in LMICs.