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

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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.