Thibang Diphatlha: Testing adaptive strategies to close the gap from cervical cancer diagnosis to treatment in Botswana

本申请是为了响应特别利益通知（NOSI）而提交的， “NOT-CA-23-025”。 在博茨瓦纳，宫颈癌是癌症相关死亡的主要原因。大约一半的 博茨瓦纳的宫颈癌妇女得不到及时治疗，增加了她们患宫颈癌的风险。 发病率和死亡率更高。子宫颈癌的耻辱和恐惧 在这种文化背景下，护理的障碍，因为癌症及其治疗往往与消极的 协会，对生殖健康受损的担忧和自责。虽然先前的研究 探讨了污名对中低收入人群宫颈癌筛查的影响， 在一些国家（LMIC），关于癌症耻辱在治疗期间如何表现的知识有限。 诊断后护理和生存的后续阶段。这项研究建立在其 母项目“Thibang Diphatlha”（U 01 CA 275032），该项目测试了关闭 博茨瓦纳从宫颈癌诊断到开始治疗的差距。在这项补充研究中， 我们建议进行额外的定性评估，以了解宫颈癌如何 污名在整个护理级联过程中对幸存者产生多个层面的影响， 交叉因素，如艾滋病毒状况，体现在污名化过程中。通过接触 与不同的利益相关者群体，我们还将共同制作干预逻辑模型， 测试各个干预成分，以告知开发一种有效的、节俭的反 对博茨瓦纳宫颈癌幸存者的污名干预。拟议的研究将推进 我们对文化的理解浸润性宫颈癌患者污名的显著经历 幸存者，告知有针对性的干预措施的开发，优化和预测试， 减少耻辱感，促进这一高度脆弱群体的复原力和恢复， 博茨瓦纳和其他低收入国家。

This application is being submitted in response to the Notice of Special Interest (NOSI) identified as “NOT-CA-23-025”. Cervical cancer is the leading cause of cancer-related death in Botswana. About half of the women with cervical cancer in Botswana do not receive timely treatment, increasing their risk of greater morbidity and mortality. Stigma and fear surrounding cervical cancer present significant barriers to care in this cultural context, as cancer and its treatment are often paired with negative associations, concerns over impaired reproductive health, and self-blame. While prior studies have explored the impact of stigma on cervical cancer screening in low- and middle-income countries (LMIC), there is limited knowledge regarding how cancer stigma manifests during the subsequent stages of post-diagnosis care and survivorship. This proposed study builds upon its parent project “Thibang Diphatlha” (U01CA275032), which tests adaptive strategies to close the gap from cervical cancer diagnosis to treatment initiation in Botswana. In this supplemental study, we propose to conduct additional qualitative assessments to understand how cervical cancer stigma impacts survivors at multiple levels throughout the care cascade, and how other intersectional factors, such as HIV status, manifest in the stigma process. Through engagement with different stakeholder groups, we will also co-produce an intervention logic model and pre- test individual intervention components to inform development of an efficient, parsimonious anti- stigma intervention for cervical cancer survivors in Botswana. The proposed research will advance our understanding of culture salient experiences of stigma among invasive cervical cancer survivors, to inform the development, optimization, and pre-testing of a targeted intervention to reduce stigma and facilitate resilience and recovery among this highly vulnerable population in Botswana and other LMIC contexts.