The CHESS (Community, Home-based Education, Screening Services) Strategy to increase cervical cancer control access for HIV positive women in Nigeria

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Abstract Despite the increased risk of cervical cancer (CC) for women living with HIV (WLWH), access to CC screening in Nigeria is limited. Access to screening, prevention programs, and highly active antiretroviral therapy has contributed to dramatic declines in the incidence of many AIDS-associated malignancies but have not lowered CC risk in WLWH. Therefore, we seek to leverage the existing HIV treatment infrastructure in Nigeria to integrate home-based CC (HCC) screening for WLWH and evaluate the implementation and sustainability of this model. We will weave HCC activities into the successful, long-standing MoMent (MOther MENTor) peer- based HIV support program and evaluate the implementation of this adapted program for adoption, integration, sustainability, and potential for national scale-up. The Consolidated Framework for Implementation Research (CFIR) and Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) conceptual frameworks will guide our implementation and impact evaluation. In this project, we will pursue three specific aims: 1) use a stakeholder deliberation conference methodology to adapt the successful MoMent program to promote home-based HPV CC screening and follow-up treatment for women who are HIV positive; 2) implement the MoMent HIV+HCC screening program and assess program reach, effectiveness, adoption, and fidelity; and 3) conduct post-implementation process evaluation of barriers and enablers to program maintenance and sustainability. Stakeholder input from WLWH, peer counselors, clinical managers, and federal/state policymakers will shape the adapted program and promote its successful implementation in a sample of 1,500 WLWH. We will be among the first to apply recent systematic review findings that the “characteristics of systems” construct of CFIR is particularly relevant in low/middle income countries. We ensure scalability by focusing on national and state policymaker perspectives in the pre-implementation, implementation, and maintenance phases of the adapted program. In this project, we will advance CC control for WLWH in Nigeria and generate data that can inform effective adaptation and implementation of evidence- based cancer control strategies for people living with HIV in low/middle income countries worldwide.