The effectiveness, cost-effectiveness, and budget impact of interventions to improve the delivery of cervical cancer screening in Puerto Rico.

波多黎各改善宫颈癌筛查的干预措施的有效性、成本效益和预算影响。

• 批准号: 10718886
• 负责人: Ashish A. Deshmukh
• 金额: $ 56.69万
• 依托单位: COMPREHENSIVE CANCER CENTER/ UNIV/PR
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-09-19 至 2028-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10718886
• 关键词: Address; Adoption; Age; Caring; Cervical; Cervical Cancer Screening; Clinic; Clinical; Collection; Colposcopy; Communities; Diagnosis; Diagnostic Reagent Kits; Disasters; Disparity; Distant; Early Diagnosis; Effectiveness; Eligibility Determination; Evaluation; Event; Future; Goals; Government; Home; Human Papillomavirus; Hybrids; Hysterectomy; Incidence; Individual; Intervention; Intervention Studies; Interview; Island; Knowledge; Low income; Maintenance; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Medicaid; Medicare; Minority Women; Morbid Obesity; Natural History; Obesity; Pap smear; Patients; Population; Population Study; President' s Cancer Panel; Provider; Puerto Rican; Puerto Rico; Randomized, Controlled Trials; Recovery; Sampling; Screening Result; Site; Squamous intraepithelial lesion; Testing; Transportation; Treatment outcome; United States; Visit; Woman; Work; World Health Organization; acceptability and feasibility; arm; budget impact; cervical cancer prevention; cohort; cost effective; cost effectiveness; effectiveness evaluation; effectiveness/implementation study; follow-up; home test; implementation evaluation; implementation outcomes; improved; interest; mathematical model; models and simulation; mortality; multi-component intervention; multidisciplinary; patient navigation; patient navigator; premalignant; screening; screening participation; secondary analysis; secondary outcome; self testing; success; trend; uptake

PROJECT SUMMARY Cervical cancer incidence is increasing dramatically (2.5% per year) in Puerto Rico (PR), with increased occurrence of regional (1.7% per year) and distant (4.7% per year) stage cancer, which reflects a real increase and indicates missed screening opportunities. Unfortunately, 80% of cervical cancer cases diagnosed in PR occur among low-income women covered by Medicaid or Medicare, who also have a 70% greater likelihood of being diagnosed with cervical cancer. Cervical cancer screening uptake continues to decline in PR, particularly among low-income Medicaid enrollees, mainly seen by government clinics. Barriers to cervical cancer screening in PR are mainly due to personal (lack of transportation, obesity-related embarrassment) and environmental (repeated disaster events that hampered screening uptake and made recovery slow) factors. The absence of evidence on the effectiveness, cost-effectiveness, and budget impact of patient navigators has limited its adoption among government clinics in this US territory. Multicomponent interventions that can address common screening barriers and improve screening participation in clinic-based settings or avert the need for a clinical-based visit could help improve screening uptake and follow-up care. Our preliminary work suggests the feasibility and acceptability of HPV self-sampling in PR. We now propose a hybrid type 1 effectiveness-implementation study using a four-arm multi-site randomized controlled trial (RCT) conducted within government OBGYN clinics in PR. We will assess the effectiveness of patient reminders plus patient navigation and HPV self-collection (individually and in combination) compared to patient reminders alone in increasing cervical cancer screening, timely colposcopy, and cervical precancer treatment (Aim 1). The secondary aim will evaluate key implementation outcomes, including patient and provider receptivity, reach, level of implementation and fidelity, and sustainment intentions. We will then develop an open-cohort microsimulation model to evaluate the population impact, cost-effectiveness, and budget impact of alternative strategies (Aim 2) to inform their potential applicability at delivery organization, community, and territory levels. This study will provide much-needed knowledge that is necessary to successfully facilitate the adoption and sustained integration of optimal strategies that will improve cervical cancer screening participation and reduce magnifying disparities in Puerto Rico.

项目摘要 波多黎各（PR）的宫颈癌发病率正在急剧增加（每年2.5％），随着增加 区域性（每年1.7％）和遥远（每年4.7％）阶段癌症发生，这反映了真正的增加 并表示错过的筛选机会。不幸的是，在PR中诊断出的宫颈癌中有80％ 在医疗补助或医疗保险覆盖的低收入妇女中发生，她们的可能性也高70％ 被诊断出患有宫颈癌。宫颈癌筛查摄取的摄取量继续下降，尤其是 在低收入的医疗补助参与者中，主要由政府诊所看到。宫颈癌的障碍 公关中的筛查主要是由于个人（缺乏交通，与肥胖相关的尴尬）和 环境（反复的灾难事件阻碍了筛查的吸收并使恢复缓慢）。 缺乏有关患者导航员的有效性，成本效益和预算影响的证据 限制了其在美国领土上的政府诊所的收养。多组分干预措施可以 解决常见的筛查障碍并改善筛查参与基于诊所的环境或避免 需要基于临床的访问可以帮助改善筛查的吸收和后续护理。我们的初步工作 提出了PR中HPV自我采样的可行性和可接受性。我们现在提出了一种混合类型1 使用四臂多站点随机对照试验（RCT）进行有效性实施研究 在PR的政府obgyn诊所内。我们将评估患者提醒和患者的有效性 与仅患者提醒相比，导航和HPV自我收集（单独和组合） 增加宫颈癌筛查，及时的阴道镜和宫颈预科治疗（AIM 1）。这 次要目标将评估关键实施结果，包括患者和提供者的接受性，触及， 实施和忠诚程度以及维持意图。然后，我们将开发一个开放式霍特 微仿真模型以评估人口影响，成本效益和替代性的预算影响 策略（AIM 2），以告知其在交付组织，社区和地区水平的潜在适用性。 这项研究将提供急需的知识，以成功地促进采用和 持续整合最佳策略，以改善宫颈癌筛查并减少 波多黎各的放大差异。