Patient Reported Outcomes of Cervical Screening in HIV+ Women in Zambia

2004年，全世界每5名妇女中就有1名妇女死于浸润性宫颈癌。 在非洲，5名死于结核病的妇女死于艾滋病毒/艾滋病，1名妇女死于国际刑事法院。在赞比亚， 国际刑事法院负担仅次于坦桑尼亚的第二大国家，坚持跟进 目前，在接受宫颈前驱病变筛查的女性中，推荐的比例很低，有传闻称 有证据表明参与者经历了严重的焦虑和筛查相关的痛苦。在此R21中 针对PA-06-351《癌症行为研究》撰写的探索性/开发性建议书 对照，我们打算开展形成性和以患者为中心的研究(1)以评估 应用醋酸(VIA)后宫颈外观检查对健康相关质量的筛选 赞比亚卢萨卡艾滋病毒携带者和HIV携带者的生活质量(HRQOL)；(2)比较现有 筛查方案和筛查选项正在开发中，但尚未提供。拟议的研究将 作为设计和实施干预试验的经验基础，旨在最小化 心理社会危害和宫颈筛查的可接受性增加。R21研究将在 以下四个阶段： 我们将在文化上改编并严格翻译SF-36v2健康调查，宫颈发育不良痛苦 斯皮尔伯格状态-特质焦虑量表(6个项目版)的问卷和状态量表 在南部非洲地区广泛使用的语言。我们还将测试使用离散的可行性 旨在揭示女性对VIA筛查和替代筛查选项偏好的选择实验 目前处于早期测试阶段。然后，我们将采访360名通过CIDRZ筛查提供的女性 卢萨卡的诊所在筛查前的基线。接受检测的女性将被 又采访了两次，分别在宫颈筛查后立即和筛查后1个月。数据 生成的将用于验证在开发阶段采用的仪器和方法，并进行测试 关于低技术宫颈筛查不良后果和可接受性的研究假设 赞比亚。筛查相关健康状态的质量权重估计也将作为一项研究产生 副产品。全球每五名死于艾滋病毒/艾滋病的妇女中就有一名妇女死于宫颈癌， 越来越多的人认为宫颈筛查技术不完美，但潜在的成本效益很高 减轻发展中国家宫颈癌负担的方法。这项探索性研究项目 旨在找出最大限度地提高当天宫颈癌筛查的可接受性的方法和 治疗，最大限度地减少筛查的不良心理社会后果，并确保遵守 HIV感染和未感染HIV的妇女参加筛查后的建议 赞比亚卢萨卡的门诊部。

In 2004, 1 woman died from invasive cervical cancer (ICC) worldwide for every 5 women who died from HIV/AIDS and 1 woman died from ICC in Africa for 5 women who died from tuberculosis. In Zambia, the second country with the highest ICC burden in the world after Tanzania, adherence to follow-up recommendation is currently low among women screened for cervical precursor lesion, and there is anecdotal evidence that participants experience substantial anxiety and screening-related distress. In this R21 exploratory/developmental proposal written in response to PA-06-351 for Behavioral Research in Cancer Control, we intend to carry out formative and patient-centered research (1) to assess the short-term effects of screening by Visual Inspection of the cervix after application of Acetic Acid (VIA) on the health-related quality of life (HRQoL) of HIV+ and HIV- women in Lusaka, Zambia; (2) to compare the acceptability of existing screening protocols and screening options in development but not yet available. The proposed study will serve as an empirical foundation for the design and conduct of an intervention trial aiming at minimizing psychosocial harms and increasing acceptability of cervical screening. The R21 study will be conducted in the following four phases: We will culturally adapt and rigorously translate the SF-36v2 Health Survey, the Cervical Dysplasia Distress Questionnaire, and state scale of the Spielberger's State-Trait Anxiety Inventory (6-item version) in two languages widely spoken in the Southern African region. We will also test the feasibility of using Discrete Choice Experiments to uncover women's preferences for VIA screening and alternative screening options currently in early testing phase. Then, we will interview 360 women offered VIA screening at CIDRZ clinics in Lusaka at baseline, before screening. Women who accept to undergo testing will be interviewed two more times, immediately after cervical screening and at 1-month post-screening. Data generated will be used to validate the instruments and methods adapted in the Development Phase, and test research hypotheses about adverse outcomes and acceptability of low-technology cervical screening in Zambia. Estimates of quality weights for screening-related health states will also be generated as a study byproduct. With one woman dying from cervical cancer worldwide for every five women who die from HIV/AIDS, low- technology cervical screening programs are increasingly proposed as imperfect but potentially cost-effective approaches to reduce cervical cancer burden in the developing world. This exploratory research project aims to identify ways to maximize the acceptability of same-day cervical cancer screening and treatment, minimize the adverse psychosocial consequences of screening, and ensure adherence to post-screening recommendations among both HIV-infected and HIV-uninfected women attending outpatient clinics in Lusaka, Zambia.