West Africa Self-Sampling HPV Based Cervical Cancer Control Program (WA-SS-HCCP) for WLWHA: Barriers, challenges, and needs

西非 WLWHA 基于 HPV 的自我采样宫颈癌控制计划 (WA-SS-HCCP)：障碍、挑战和需求

• 批准号: 10700092
• 负责人: JANE Louise HOLL
• 金额: $ 62.57万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-07 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10700092
• 关键词: Address; Adoption; Africa; Africa South of the Sahara; African; Cancer Control; Caring; Cervical; Cervical Cancer Education; Cervical Cancer Screening; Cessation of life; Clinic; Clinic Visits; Clinical; Collaborations; Collection; Communication; Community Health Aides; Competence; Counseling; Country; Cytology; DNA; Data; Diagnostic; Diagnostic tests; Early Diagnosis; Early treatment; Face; Female; Funding; HIV; HIV Infections; HIV Seronegativity; HIV/AIDS; HPV-High Risk; Health system; Home; Human Papilloma Virus Vaccination; Human Papilloma Virus-Related Malignant Neoplasm; Human Papillomavirus; Human papilloma virus infection; Immune Evasion; Immunosuppression; Incidence; Income; Infection; Infrastructure; Knowledge; Laboratories; Learning; Maintenance; Mali; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Methods; Muslim population group; Needs Assessment; Nigeria; Oncogene Activation; Patients; Persons; Prevalence; Prevention strategy; Process; Recommendation; Religion; Reporting; Research; Resources; Risk; Risk Assessment; Sampling; Secure; Sexually Transmitted Diseases; Site; Specimen; Surveys; Swab; Target Populations; Temperature; Test Result; Testing; Training; Transportation; United States National Institutes of Health; Vagina; Woman; Women' s Health; acceptability and feasibility; care systems; cervical cancer prevention; cervical carcinogenesis; cervicovaginal; co-infection; collaborative approach; cost; cost effective; dashboard; effectiveness evaluation; evidence base; experience; health care settings; high risk; hospital laboratories; human papilloma virus oncogene; implementation fidelity; implementation framework; implementation strategy; improved; low and middle-income countries; novel; programs; sample collection; scale up; screening; social; social culture; social stigma; success; webinar

PROJECT SUMMARY/ABSTRACT Worldwide, 70% of new HIV infections every year occur in Sub-Saharan Africa (SSA), home to 74% of people living with HIV/AIDS (PLWHA), of whom over 50% are women. Furthermore, the highest rates of cervical cancer (CC) incidence and related death also occur in SSA, where approximately 60% of all CC cases are in women living with HIV/AIDS (WLWHA). Human Papillomavirus (HPV), amajor cause of CC, is the most common sexually transmitted infection in SSA and nearly all WLWHA worldwide who develop CC are co- infected with HPV. CC is largely preventable by HPV vaccination and cervical screening for early detection and treatment. In high income countries (HICs), these strategies have led to a steep decline in CC; however they remain largely inaccessible to women in low- and middle-income countries (LMICs). Self-sampling-based HPV (SS-HPV) tests have been shown to be a cost-effective and feasible approach to identifying women infected with high-risk HPV strains (hr-HPV) who need more advanced diagnostic tests and treatment. However, SS- HPV testing has not been widely implemented in most LMICs, including SSA despite high HIV prevalence. Leveraging our decade-long, extensive, and successful training partnership and research collaborations in Mali and Nigeria, we propose to implement a novel West African Self-Sampling HPV-Based Cervical Cancer Control Program (WA-SS-HCCP). The project capitalizes on existing strengths and resources including the HIV systems of care with Community Health Workers (CHWs) who have established relationships with WLWHA and can provide HPV and CC education/counseling and SS specimen collection guidance, rapid transportation of specimens to hospital laboratories, personalized delivery of test results directly to the women, and facilitation of clinic referrals for women with hr-HPV for advanced diagnostics and treatment. The study will conduct in-depth assessment of barriers, challenges, and needs to contextually adapt, implement, and evaluate the effectiveness and success of WA-SS-HCCP. The specific aims are to (1) Assess barriers and needs for contextual adaptations of WA-SS-HCCP among WLWHA in Mali and Nigeria, using qualitative risk assessment and observation methods; (2) Contextually adapt, using a learning collaborative approach (e.g., monthly webinars, rapid-cycle small tests of change) and an implementation framework (e.g., training to competency of CHWs, data coordination across settings, implementation dashboard) to optimize the WA-SS- HCCP across all four sites; and (3) Conduct a dual evaluation of the effectiveness (e.g., % WLWHA fully screened and % change in) and implementation (e.g., reach, adoption, implementation fidelity, and maintenance or sustainability) and develop a “WA-SS-HCCP Scale-Up Toolkit” for wide dissemination of this “detect-to-treat” program that can be expanded to HIV- women and across LMICs.

项目摘要/摘要 全球，每年有70％的新艾滋病毒感染发生在撒哈拉以南非洲（SSA），占74％ 与艾滋病毒/艾滋病（PLWHA）一起生活，其中50％是女性。此外，宫颈的速率最高 癌症（CC）事件和相关死亡也发生在SSA中，其中大约60％的CC病例都在 患有艾滋病毒/艾滋病的妇女（WLWHA）。人类乳头瘤病毒（HPV）是CC的Amajor原因，是最多的 在SSA和几乎所有发展CC的WLWHA的常见性传播感染都是共同的 感染了HPV。 HPV疫苗接种和宫颈筛查可在很大程度上预防CC，以进行早期检测和 治疗。在高收入国家（HIC）中，这些策略导致了CC钢铁的下降。但是他们 对于低收入和中等收入国家（LMIC）的妇女来说，仍然难以接近。基于自绘制的HPV （SS-HPV）测试已被证明是识别感染妇女的一种经济高效且可行的方法 具有高风险的HPV条纹（HR-HPV），需要更高级的诊断测试和治疗。但是，SS- HPV测试尚未在大多数LMIC中广泛实施，包括SSA目的地高HIV患病率。 利用我们十年，广泛且成功的培训合作伙伴关系和马里研究合作 和尼日利亚，我们建议实施一种新型的西非自我采样HPV宫颈癌 控制程序（WA-SS-HCCP）。该项目利用现有的优势和资源，包括 与社区卫生工作者（CHW）建立关系的HIV护理系统 WLWHA可以提供HPV和CC教育/咨询和SS标本收集指导，快速 将标本运送到医院实验室，个性化的测试结果直接向妇女交付 以及针对HR-HPV女性进行晚期诊断和治疗的女性的临床转诊。研究将 对障碍，挑战进行深入评估，并需要在上下文适应，实施和 评估WA-SS-HCCP的有效性和成功。具体目的是（1）评估障碍和 使用定性风险，在马里和尼日利亚的WLWHA中对WA-SS-HCCP进行上下文改编的需求 评估和观察方法； （2）使用学习协作方法对上下文进行适应（例如， 每月网络研讨会，快速循环的小型测试）和实施框架（例如，培训 CHW的能力，跨设置的数据协调，实施仪表板），以优化WA-SS- HCCP在所有四个站点上； （3）对有效性进行双重评估（例如，％wlwha完全 筛选和％变化）和实施（例如，覆盖，适应性，实施保真度和 维护或可持续性）并开发一个“ WA-SS-HCCP扩展工具包”，以广泛传播此事 可以扩展到HIV妇女和跨LMIC的“检测到治疗”计划。