Leveraging HIV infrastructure to implement cervical cancer prevention: A study to integrate HPV vaccination in adolescent HIV clinics in Zambia

利用艾滋病毒基础设施实施宫颈癌预防：一项将 HPV 疫苗接种纳入赞比亚青少年艾滋病毒诊所的研究

• 批准号: 10698170
• 负责人: Jean Marie Hunleth
• 金额: $ 65.39万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-06 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10698170
• 关键词: Address; Adolescence; Adolescent; African; Age; Cancer Burden; Cancer Etiology; Cessation of life; Child; Clinic; Clinical; Communities; Country; Development; Dose; Education; Educational workshop; Elements; Ethnography; Evidence based intervention; Exclusion; Exposure to; Feedback; Friends; HIV; HIV-infected adolescents; Health; Health Services; Household; Human Papilloma Virus Vaccination; Human Papilloma Virus Vaccine; Human Papillomavirus; Human papilloma virus infection; Hybrids; Inequity; Infrastructure; Institution; Intention; Intervention; Interview; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Maps; Methods; Misinformation; Modeling; Orphan; Outcome; Persons; Politics; Population; Prevalence; Process; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Recommendation; Research; Resources; Risk; Rural; Schedule; Schools; Services; Sex Behavior; Site; Source; Southern Africa; Strategic Planning; System; Technical Expertise; Testing; Thinking; Translating; Trust; Vaccination; Vaccines; Vulnerable Populations; Woman; Zambia; acceptability and feasibility; cancer prevention; cancer risk; cervical cancer prevention; clinical care; clinical infrastructure; contextual factors; design; effectiveness/implementation trial; evidence base; experience; girls; high risk; high risk population; implementation design; implementation evaluation; implementation outcomes; implementation research; implementation science; implementation strategy; informant; low and middle-income countries; novel; peri-urban; prevent; routine care; scale up; social stigma; success; supply chain; tool; vaccine acceptance; vaccine access; vulnerable adolescent

ABSTRACT/SUMMARY Cervical cancer is the leading cause of cancer death in Zambia, where HIV prevalence is also high (11.3%). HIV heightens the risk of developing and dying from cervical cancer. The human papillomavirus (HPV) vaccine is a WHO-endorsed, evidence-based tool that can prevent 90% of cervical cancers, and is recommended for girls ages 9-14. However, HPV vaccine coverage is low (16%) in low- and middle- income countries (LMICs), and our team's on-the-ground experience suggests HPV vaccination is even lower in Zambia, particularly among girls with HIV, who are most at risk of poor cancer outcomes. Currently, HPV vaccination is delivered via school-based campaigns, which are viewed as efficient for broad coverage but also exclude the most vulnerable children—those out-of-school or who irregularly attend (e.g., orphans, poor). Adolescents living with HIV (ALHIV) are more likely to have these additional vulnerabilities. In addition, WHO recommends ALHIV receive a 3rd dose of the HPV vaccine, which is not given in traditional 2-dose school-based campaigns. To ensure that ALHIV have access to the WHO-recommended 3-doses, we propose to integrate HPV vaccination into routine care in adolescent HIV clinics. Adolescent HIV clinics in Zambia have regular contact with ALHIV and are trusted sources of health information for the community. Given the known challenges of providing cervical cancer prevention in LMICs, including Zambia (e.g., stigma, misinformation, staffing, supply chain), integrating HPV vaccination requires a multilevel approach, stakeholder engagement, and diversified implementation strategies. To achieve success, we will co-design a package of implementation strategies using a previously successful implementation research approach developed for cervical cancer prevention in LMICs: the Integrative Systems Praxis for Implementation Research (INSPIRE). INSPIRE is a novel, formal, and comprehensive framework to develop, implement, and evaluate implementation science efforts. Following key elements of INSPIRE, our specific aims are to: 1) Identify the unique multilevel contextual factors (barriers and facilitators) across HIV settings (rural, urban, peri-urban) that influence HPV vaccine uptake; 2) Use Implementation Mapping to translate stakeholder feedback and findings from Aim 1 into a package of implementation strategies to integrate HPV vaccine into HIV clinics; 3) Conduct a Hybrid Type 3 effectiveness-implementation trial to evaluate the package of multilevel implementation strategies for integrating HPV vaccine into HIV clinics. Our research team has significant expertise in HIV, HPV, cancer prevention, implementation science, and LMIC research. Wehave strong institutional backing, including$325,000 over the course of the study;strong support, technical expertise, and resources (e.g., vaccines) from the Zambian Ministry of Health; and political will for scale-up. If successful, this stakeholder-based implementation model could be transported to HIV clinics across Zambia and serve as a model to address cancer prevention priorities for those with HIV in other LMICs.

摘要/总结 宫颈癌是赞比亚癌症死亡的主要原因，该国艾滋病毒感染率也很高（11.3%）。 艾滋病毒会增加患宫颈癌和死于宫颈癌的风险。人乳头瘤病毒 (HPV) 疫苗 是世界卫生组织认可的基于证据的工具，可以预防 90% 的宫颈癌，推荐用于 9-14 岁的女孩。然而，低收入和中等收入国家 (LMIC) 的 HPV 疫苗覆盖率较低 (16%)， 我们团队的实地经验表明，赞比亚的 HPV 疫苗接种率甚至更低，尤其是 感染艾滋病毒的女孩中，她们患癌症结果不佳的风险最大。目前，HPV疫苗接种 通过以学校为基础的活动来开展，这种活动被认为对于广泛覆盖是有效的，但也排除了 最弱势的儿童——那些失学或不定期上学的儿童（例如孤儿、穷人）。青少年 艾滋病毒感染者 (ALHIV) 更有可能存在这些额外的脆弱性。此外，世界卫生组织建议 ALHIV 患者需要接种第三剂 HPV 疫苗，而传统的 2 剂学校疫苗接种活动中并没有提供该疫苗。 为了确保 ALHIV 能够获得 WHO 推荐的 3 剂疫苗，我们建议整合 HPV 将疫苗接种纳入青少年艾滋病毒诊所的常规护理中。赞比亚的青少年艾滋病毒诊所定期开设 与 ALHIV 有接触，并且是社区值得信赖的健康信息来源。鉴于已知 在包括赞比亚在内的中低收入国家提供宫颈癌预防的挑战（例如耻辱、错误信息、 人员配置、供应链），整合 HPV 疫苗接种需要采取多层次的方法、利益相关者 参与和多样化的实施策略。为了取得成功，我们将共同设计一个包装 使用先前成功的实施研究方法制定实施策略 中低收入国家的宫颈癌预防：实施研究综合系统实践 (INSPIRE)。 INSPIRE 是一个新颖、正式且全面的框架，用于开发、实施和评估 实施科学努力。遵循 INSPIRE 的关键要素，我们的具体目标是： 1) 确定 艾滋病毒环境（农村、城市、城郊）独特的多层次背景因素（障碍和促进因素） 影响 HPV 疫苗的接种； 2) 使用实施映射来转化利益相关者的反馈和发现 从目标 1 转变为一揽子实施策略，将 HPV 疫苗纳入 HIV 诊所； 3) 进行 混合类型 3 有效性实施试验，用于评估多级实施方案 将 HPV 疫苗纳入 HIV 诊所的策略。我们的研究团队在艾滋病毒方面拥有丰富的专业知识， HPV、癌症预防、实施科学和中低收入国家研究。我们有强大的机构支持， 包括研究过程中的 325,000 美元；强有力的支持、技术专长和资源（例如， 疫苗）来自赞比亚卫生部；以及扩大规模的政治意愿。如果成功的话，这 基于利益相关者的实施模式可以推广到赞比亚各地的艾滋病毒诊所，并作为 模型来解决其他中低收入国家艾滋病毒感染者的癌症预防优先事项。

项目成果

Leveraging health infrastructure to optimize HPV vaccination for adolescents in Zambia: Protocol for an implementation study.

• DOI: 10.1371/journal.pone.0285031
• 发表时间: 2023
• 期刊: PLOS ONE
• 影响因子: 3.7
• 作者: Miti, Sam;Shato, Thembekile;Asante, Comfort;Baumann, Ana;Chongwe, Gershom;Bobo, Patricia M.;Silver, Michelle I.;Hunleth, Jean M.
• 通讯作者: Hunleth, Jean M.