A stigma responsive service delivery model for HPV-based screening among women living with HIV

摘要 感染艾滋病毒的妇女（WLWH）感染人乳头瘤病毒（HPV）的生物风险增加， 发展为浸润前和浸润性宫颈癌。世界卫生组织最近呼吁， 艾滋病毒方案，通过综合筛查服务加强预防宫颈癌的努力。 理解和解决污名化问题，包括艾滋病毒、人乳头瘤病毒和宫颈癌相关污名化的交叉问题， 将是至关重要的设计干预措施，这将有助于吸收癌症筛查之间WLWH和 艾滋病毒感染率高的环境中的妇女，如肯尼亚西部。癌症相关的耻辱感对几个 接受癌症筛查的决定因素，包括对癌症风险的认识、癌症筛查的益处，以及 筛选方法的可接受性。在我们之前评估肯尼亚HPV筛查的工作中，我们发现， 缺乏有关宫颈癌的教育和对筛查益处的认识不足，这两者都可以增强 与癌症有关的耻辱，是接受筛查的主要障碍。我们的团队还发现， 对HPV诊断和癌症的耻辱感与以下妇女的随访率降低有关： HPV检测呈阳性我们的团队开发了一个耻辱框架，为以下方面提供信息并验证测量工具： HPV、宫颈癌和艾滋病毒相关的耻辱。我们发现教育信息集中在癌症相关的 结果和HPV流行病学，包括与性行为和艾滋病毒相关的风险，是耻辱的，而 社交网络的支持和对提供有效治疗的重视减少了耻辱感， 促进了筛查的普及。我们利用这些数据开发了一种应对污名的教育干预措施， 包括为多名卫生工作者干部提供的简化脚本，这些脚本提供了有关HPV和 放映的好处以及旨在从同伴角度解决恐惧和误解的录像。我们 我建议将这些教育内容纳入“Elimisha HPV”，这是一个多层次的应对耻辱感的方案， 在西区提供爱滋病护理的诊所内推行子宫颈癌预防服务模式 肯尼亚. Elimisha HPV在斯瓦希里语中的意思是增加对HPV的了解，将包括以下内容 组成部分：通过自我收集进行HPV检测，简化脚本和视频， 筛查或治疗犹豫，以及通过短信接收结果和信息的选择。为了适应， 实施和测试这一模式的有效性，我们将：1）与主要利益相关者合作，最终确定Elimisha HPV 2）比较宫颈癌预防结果和在提供 将Elimisha HPV模式推广到提供标准护理外展、教育和筛查策略的诊所;以及3） 确定缓解Elimisha HPV对宫颈癌影响的个人和机构因素 预防成果。如果有效，这可能代表一种新的基于HPV的宫颈癌筛查模式， 以及为艾滋病毒/艾滋病患者提供全面的、对污名敏感的一揽子服务的新模式。 艾滋病。

ABSTRACT Women living with HIV (WLWH) are at increased biologic risk for infection with human papillomavirus (HPV) and development of pre-invasive and invasive cervical cancer. The World Health Organization has recently called for HIV-programs to bolster their efforts to prevent cervical cancer through integrated screening services. Understanding and addressing stigma, including the intersection of HIV, HPV and cervical cancer-related stigma, will be crucial to designing interventions that will facilitate the uptake of cancer screening among WLWH and women in high HIV prevalence settings like western Kenya. Cancer-related stigma negatively influences several determinants of cancer screening uptake, including perception of cancer risk, cancer screening benefit, and acceptability of screening methods. In our prior work to evaluate HPV-based screening in Kenya, we found that lack of education about cervical cancer and low awareness of screening benefits, both of which can potentiate cancer-related stigma, were major barriers to screening uptake. Our team also found that misperceptions and stigma about an HPV diagnosis and cancer were associated with reduced rates of follow-up among women who tested positive for HPV. Our team developed a stigma framework to inform and validate a measurement tool for HPV-, cervical cancer- and HIV-related stigmas. We found that educational messages focused on cancer-related outcomes and HPV epidemiology, including risks related to sexual behavior and HIV, were stigmatizing, while support from social networks and emphasis on the availability of effective treatment reduced stigma and promoted screening uptake. We used this data to develop a stigma-responsive educational intervention which includes simplified scripts for multiple cadres of health workers that provide clear messages about HPV and the benefits of screening and a video aimed at addressing fears and misperceptions from a peer perspective. We propose to incorporate these educational components into “Elimisha HPV,” a multilevel stigma-responsive cervical cancer prevention service delivery model for integration within clinics providing HIV-care in western Kenya. Elimisha HPV, which in Kiswahili means to increase understanding of HPV, will include the following components: HPV-testing via self-collection, simplified scripts and video, peer navigators for women with screening or treatment hesitancy, and the option to receive results and information via text messages. To adapt, implement and test the effectiveness of this model, we will: 1) work with key stakeholders to finalize Elimisha HPV 2) compare cervical cancer prevention outcomes and engagement in HIV care in clinics offering the Elimisha HPV model to clinics providing standard of care outreach, education and screening strategies; and 3) identify individual and institutional factors that moderate the effects of Elimisha HPV on cervical cancer prevention outcomes. If effective, this may represent a new model for HPV-based cervical cancer screening as well as a new paradigm for comprehensive, stigma-responsive service delivery packages for people living with HIV.