Towards Cervical cancer elimination: Implementation and scale-up of a single-visit, screen-and-treat approach with thermal ablation for sustainable cervical cancer prevention services in Kenya

消除宫颈癌：在肯尼亚实施和扩大单次就诊、筛查和治疗的热消融方法，以提供可持续的宫颈癌预防服务

• 批准号: 10843625
• 负责人: Sarah Odell Gimbel
• 金额: $ 12.45万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-21 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10843625
• 关键词: Ablation; Administrative Supplement; Africa South of the Sahara; Award; Caring; Cervical; Client; Clinic; Continuity of Patient Care; Early Diagnosis; Early treatment; Eligibility Determination; Excision; Focus Groups; Future; Goals; Health Personnel; Health Services Accessibility; Health system; Hysterectomy; Interview; Kenya; Lesion; Malignant neoplasm of cervix uteri; Maps; Mentors; Methods; Oncology; Parents; Prevention strategy; Process; Radiation therapy; Research; Sampling; Structure; Surveys; Thermal Ablation Therapy; Visit; Woman; barrier to care; burden of illness; cervical cancer prevention; follow-up; interest; mortality; parent grant; premalignant; prevention service; recruit; referral services; reproductive; response; scale up; treatment strategy; tv watching

ABSTRACT This application is submitted in response to the Notice of Special Interest (NOSI) identified as NOT-CA-23- 038 “Administrative Supplements for NCI Global Oncology Mentored Research” and proposes an administrative supplement to our parent award R01CA258590. Background While prevention and treatment strategies exist for cervical cancer, it remains the leading cause of mortality in Sub-Saharan Africa. The timely screening, early diagnosis and treatment of precancerous cervical lesions is key in reducing the disease burden. Current treatment goals have focused on ablative methods but there are women who require different treatment either by excision, hysterectomy, or radiotherapy. We will conduct a mixed methods study on Kenyan women with precancerous cervical lesions who are not amendable to ablative therapy and referred by our study for other treatment- little research is available for this group. Women will be recruited from the parent grant TIBA clinics. We will evaluate this via the following two aims: AIM 1: Evaluate the barriers and facilitators (health system, health care provider and client levels) in the referral and linkage to care for women who screen positive for pre-cancerous lesions and not amenable to ablative therapy. We shall conduct semi-structured surveys, focused group discussions and in-depth interviews to gain information on the barriers and facilitators from the health care providers and clients. AIM 2a: Determine the proportion of women with pre-cancerous cervical lesions and not amenable to ablation therapy who access treatment within a four-month period. All women who are screen-positive and not eligible for ablative therapy will be invited to participate in this study and followed up for a period of four months to determine whether they are treated or not. AIM 2b: Conduct flow mapping of existing referral services for women who screen positive for pre-cancer lesions and not amenable for ablative therapy with a focus on identifying the steps that create barriers to treatment access. A sample of four to five women who screen positive for pre-cancer lesions but who are not amenable to thermal ablation and health care providers will be interviewed to perform flow mapping. Barriers and facilitators to treatment access will be catalogued during the flow mapping process The objective of this study is to understand the bottlenecks in the cervical cancer care continuum following referral and linkage of these women. This will form the basis of future studies that will enhance seamless integration for women with precancerous cervical lesions referred for treatment.

抽象的 该申请是根据特殊利益通知（NOSI）提交的，该通知被确定为非CA-23-- 038“ NCI全球肿瘤学指导研究的行政补品”和提案 我们父母奖R01CA258590的行政补充。 背景 尽管存在预防和治疗策略，但它仍然是死亡率的主要原因 在撒哈拉以南非洲。癌前颈病变的及时筛查，早期诊断和治疗 是减少伯恩疾病的关键。当前的治疗目标集中在烧烤方法上，但 是否需要出人意料，子宫切除术或放射治疗的女性。我们将进行 一项关于肯尼亚妇女患有癌前病变的混合方法研究 我们的研究对其他治疗方法提到了烧蚀疗法 - 该小组几乎没有研究。 妇女将从父母赠款TIBA诊所招募。我们将通过以下两个目标对此进行评估： 目标1：评估障碍和促进者（卫生系统，卫生保健提供者和客户级） 推荐和联系与护理女性的关怀，这些女性对癌前病变呈阳性阳性，不适合 消融疗法。我们将进行半结构化调查，集中的小组讨论和深入 采访以获取有关医疗保健提供者和客户的障碍和促进者的信息。 目标2a：确定癌前宫颈病变的妇女比例 在四个月内获得治疗的治疗。 所有具有屏幕阳性且不符合烧烤疗法的妇女将邀请参加此事 研究并随访了四个月的时间，以确定是否接受过治疗。 AIM 2B：为筛选前癌阳性的女性进行现有转介服务的进行流程映射 病变，不适合用于消融疗法，重点是确定造成障碍的步骤 治疗访问。 样本的四到五名妇女的样本，她们对癌前病变呈阳性阳性，但不适合 热消融和医疗保健提供者将接受采访以执行流程图。障碍和 在流程映射过程中，将对治疗访问的促进者进行分类 这项研究的目的是了解宫颈癌的连续体中的瓶颈 这些妇女的推荐和联系。这将构成未来研究的基础，以增强无缝 参考治疗的癌前颈腿的女性整合。

项目成果

Implementation and scale-up of a single-visit, screen-and-treat approach with thermal ablation for sustainable cervical cancer prevention services: a protocol for a stepped-wedge cluster randomized trial in Kenya.

• DOI: 10.1186/s13012-023-01282-3
• 发表时间: 2023-06-26
• 期刊: IMPLEMENTATION SCIENCE
• 影响因子: 7.2
• 作者: Shin, Michelle B.;Oluoch, Lynda Myra;Barnabas, Ruanne V.;Baynes, Colin;Fridah, Harriet;Heitner, Jesse;Kerubo, Mary Bernadette;Ngure, Kenneth;Pinder, Leeya F.;Thomas, Katherine K.;Mugo, Nelly Rwamba;Gimbel, Sarah
• 通讯作者: Gimbel, Sarah