Pilot of a network-driven, advocacy intervention to promote cervical cancer screening in Uganda

项目摘要 宫颈癌（CC）是最常见的癌症，占所有癌症相关死亡的25%， 乌干达是世界上发病率最高的国家之一。增加负担的是将军 在乌干达，对CC及其筛查缺乏了解和社会耻辱感，终身CC筛查是 估计低至5%。迫切需要在乌干达增加CC筛查，以确保及时和 拯救生命的治疗，以及需要加强开展行为和健康服务的能力 在当地研究人员和服务提供者中开展有关CC和其他污名化状况的研究。这些 这些需求直接符合PAR-19-059及其改善低收入国家非传染性疾病预防和治疗的目标。 资源设置和地方研究能力，以实现这一目标。因此，拟议的干预试点研究 寻求（1）赋予患有CC风险（WLCCR）的妇女权力，定义为接受癌前病变治疗 或癌性病变，在妇女的社交网络中倡导CC筛查和早期治疗， (2)参与并培训当地公共卫生研究人员和程序员。拟议的干预措施借鉴了理论 社会扩散，认知一致性和社会影响力，以及我们自己最近开发和测试的小组 动员乌干达艾滋病毒感染者成功地作为艾滋病毒预防的变革推动者的干预措施 在他们的社交网络中。干预措施减少了艾滋病毒的耻辱感，增加了对宣传的参与 培训参与者中的艾滋病毒信息披露，以及在其网络中增加艾滋病毒检测和安全套使用 成员干预积极针对内化的耻辱，披露决策，积极的生活， 倡导沟通技巧-所有这些都是同样相关的CC的背景下，导致我们的计划，以适应 这种有前途的干预方法的背景下，CC控制。在建议研究的第一阶段， 重点小组与WLCCR和妇女在其社交网络，以了解促进和障碍， 成功的宣传，并就干预措施的设计征求反馈意见。第二阶段借鉴了第一阶段的发现， 从我们先前对艾滋病毒背景下的干预模式的评估中，制定和调整干预措施， CC的背景。在第三阶段，我们将在40名WLCCR中试行干预，其中20人将被随机 分配参与干预，20名分配到等待名单控制。将在基线时进行评估 以及每个指数参与者的最多三名女性社交网络成员 (up共120个）。主要结果是在参与的社交网络成员中进行CC筛查。如果成功， 这种干预模式不仅有可能影响CC筛查和治疗的接受， 这是一个可以应用于其他健康状况和非传染性疾病的范例。研究的主要目的是评估 团体干预促进CC筛查的可行性、可接受性和初步效果， 治疗;确定与成功宣传有关的特点;提高地方开展 关于CC控制的公共卫生研究以及基于社会网络的干预和测量方法的使用。

PROJECT SUMMARY Cervical cancer (CC) is the most common cancer and accounts for ~25% of all cancer related deaths among women in Uganda, which has one of the highest incidence rates in the world. Adding to the burden is the general lack of knowledge about, and social stigma towards CC and its screening in Uganda, where lifetime CC screening is estimated to be as low as 5%. There is a dire need to increase CC screening in Uganda to ensure timely and lifesaving treatment, as well as the need to enhance the capacity to conduct behavioral and health services research related to CC and other stigmatizing conditions among local researchers and service providers. These needs are directly in line with PAR-19-059 and its goal of improving prevention and treatment of NCDs in low resource settings, and local research capacity to target this goal. Accordingly, the proposed intervention pilot study seeks to (1) empower women living with CC risk (WLCCR), defined as having received treatment for pre-cancerous or cancerous lesions, to advocate for CC screening and early treatment among women in their social networks, and (2) engage and train local public health researchers and programmers. The proposed intervention draws on theories of social diffusion, cognitive consistency, and social influence, and our own recently developed and tested group intervention that mobilized people living with HIV in Uganda to successfully act as change agents for HIV prevention within their social networks. The intervention resulted in reduced HIV stigma, increased engagement in advocacy and HIV disclosure among the trained participants, and increased HIV testing and condom use among their network members. The intervention actively targeted internalized stigma, disclosure decision making, positive living, and advocacy communication skills– all of which are equally relevant in the context of CC, resulting in our plan to adapt this promising intervention approach to the context of CC control. In Phase 1 of the proposed study, we will conduct focus groups with WLCCR and women in their social networks to understand facilitators of and barriers to successful advocacy and elicit feedback on the intervention design. Phase 2 draws upon findings of Phase 1, and from our prior evaluation of the intervention model in the context of HIV, to develop and adapt the intervention for the context of CC. In Phase 3, we will pilot the intervention among 40 WLCCR, 20 of whom will be randomly assigned to take part in the intervention, and 20 to the wait-list control. Assessments will be administered at baseline and month 6 to index participants as well as up to three female social network members of each index participant (up to 120 total). The primary outcome is CC screening among participating social network members. If successful, this intervention model has the potential to not only impact uptake of CC screening and treatment, but also establish a paradigm that can be applied to other health conditions and NCDs. The primary aims of the study are to assess the feasibility, acceptability and preliminary efficacy of the group intervention to promote CC screening and treatment; identify characteristics associated with successful advocacy; and increase local capacity for conducting public health research on CC control and use of social network-based intervention and measurement methods.