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.

摘要 本申请是回应被确认为非CA-23的特别利益通知(NOSI)而提交的。 038《NCI全球肿瘤学指导性研究的行政补充》，并提出了 我们父母奖的行政补充R01CA258590。 背景 虽然宫颈癌的预防和治疗策略已经存在，但它仍然是导致死亡的主要原因。 在撒哈拉以南非洲。宫颈癌前病变的及时筛查、早期诊断和治疗 是减轻疾病负担的关键。目前的治疗目标集中在消融方法上，但 是需要通过切除、子宫切除或放射治疗进行不同治疗的妇女。我们将进行 对不能修改的肯尼亚宫颈癌前病变妇女进行的一项混合方法研究 消融治疗和我们的研究推荐用于其他治疗-这一群体几乎没有研究可用。 妇女将从父母资助的提巴诊所招募。我们将通过以下两个目标对其进行评估： 目标1：评估障碍和促进者(卫生系统、卫生保健提供者和服务对象层面) 转诊和联动护理筛查癌前病变呈阳性且不服从 消融治疗。我们将进行半结构化调查，重点小组讨论和深入 访谈，从卫生保健提供者和客户那里获得有关障碍和促进者的信息。 目标2a：确定患有癌前病变和不适合切除的妇女的比例 在四个月内接受治疗的人。 所有筛查阳性且没有资格接受消融治疗的女性都将被邀请参加这次活动。 研究并随访4个月，以确定是否接受治疗。 目标2b：为癌症前期筛查呈阳性的妇女进行现有转诊服务的流程图 病变和不可接受的消融治疗，重点是确定造成障碍的步骤 治疗通道。 四到五名筛查癌前病变呈阳性但不愿接受 热消融和医疗保健提供者将接受采访，以执行血流测绘。障碍和 在流程绘图过程中，将对治疗通道的促进者进行编目 这项研究的目的是了解宫颈癌护理连续过程中的瓶颈 这些妇女的转介和联系。这将为未来的研究奠定基础，从而增强无缝 综合治疗为宫颈癌前病变转诊的妇女。

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