Full Project 2: Determining Optimal Anal Cancer Prevention Strategies for HIV-Infected Individuals Living in Puerto Rico

完整项目2：制定最佳肛门癌预防策略 为生活在波多黎各的艾滋病毒感染者 项目总结/摘要 肛门鳞状细胞癌（SCCA）是艾滋病毒感染者（PLWH）中的一种流行病。研究 在美国和波多黎各（PR），报告PLWH中SCCA的风险是 一般人口。基于专家意见的指南建议对PLWH进行肛门癌筛查。到 告知基于证据的筛查使用，目前正在进行研究;然而，这些研究的结果 将不会推广到公共关系中的PLWH。这是因为种族和民族组成，疾病患病率， 肛门癌治疗结果，包括成本和生活质量（QOL）在PR中与PLWH有显著差异。 这增加了肛门癌筛查评估的重要性，特别是在PR中单独针对PLWH 其中大多数是西班牙裔。此外，没有正在进行或未来的随机对照试验（RCT） 将评估筛查的死亡率益处，因为评估“无筛查”组是不道德的。 数学模型（结合流行病学，成本和生活质量数据，具体到PLWH在PR）可以 作为一种独特的工具来评估生存和QOL的好处和成本效益的筛选与 目标是促进健康和基于价值的护理。我们的首要目标是优化肛门癌预防， 我们将研究SCCA的流行病学，并评估SCCA的成本和术后生活质量 治疗，以告知一个数学模型，将确定最佳的筛选方案PLWH在公关。我们 还寻求研究关键的障碍和必要的促进因素，以减少筛查中的潜在不确定性 采纳并遵守筛查建议。我们的具体目标是：（1）确定流行病学， 成本和生活质量的措施，肛门癌前病变和癌症之间的PLWH生活在PR。（2）确定的障碍， 肛门癌筛查的促进者，以及坚持肛门癌筛查和高级别鳞状细胞癌筛查 上皮内病变（HSIL）治疗。(3)构建并执行数学模型，以确定有效的 结论：（1）在PLWH患者中，直肠癌前病变的检出率较高，且具有成本效益 信息量（VOI）分析，以确定未来高优先级的临床研究，从而提高筛查准确性 并遵守筛查建议。在目标1和2中，我们将对以下数据进行二次数据分析： 现有的数据库，并进行焦点小组和三项流行病学研究（两项横断面研究 和一项队列研究），涉及患者招募。通过这些活动确定的参数将告知 开发SCCA筛选模型和执行VOI分析（目标3和4）。年底 这项研究的结果将被用来告知一个最佳的肛门癌筛查方案，具体到PLWH在PR。

FULL PROJECT 2: DETERMINING OPTIMAL ANAL CANCER PREVENTION STRATEGIES FOR HIV-INFECTED INDIVIDUALS LIVING IN PUERTO RICO PROJECT SUMMARY/ABSTRACT Squamous cell carcinoma of the anus (SCCA) is an epidemic among persons living with HIV (PLWH). Studies in the US and Puerto Rico (PR) have reported >80-fold risk of SCCA among PLWH when compared with the general population. Guidelines based on expert opinion recommend anal cancer screening for PLWH. To inform evidence-based use of screening, studies are currently underway; however, findings from those studies will not be generalizable to PLWH in PR. This is because racial and ethnic composition, disease prevalence, anal cancer treatment outcomes including cost and quality of life (QOL) substantially differ for PLWH in PR. This increases the importance of anal cancer screening evaluation specifically and separately for PLWH in PR majority of which are of Hispanic origin. Furthermore, no ongoing or future randomized controlled trials (RCTs) will evaluate mortality benefits of screening as it unethical to evaluate a “no screening” arm. As such, a mathematical model (incorporating epidemiological, cost, and quality of life data specific to PLWH in PR) could be utilized as a unique tool to evaluate survival and QOL benefits and cost-effectiveness of screening with the goal to promote health and value-based care. Our overarching goal is to optimize anal cancer prevention for PLWH in PR. We will study the epidemiology of SCCA, and evaluate the cost of and QOL after SCCA treatment to inform a mathematical model that will determine the best screening regimen for PLWH in PR. We also seek to study critical barriers and facilitators necessary to decrease potential uncertainty in screening adoption and adherence to screening recommendations. Our Specific Aims are: (1) Determine epidemiological, cost, and QOL measures of anal precancer and cancer among PLWH living in PR. (2) Identify barriers to and facilitators of screening for anal cancer, and adherence to anal cancer screening and high-grade squamous intraepithelial lesions (HSIL) treatment. (3) Construct and execute a mathematical model to determine effective and cost-effective screening strategies for the detection of anal precancer among PLWH in PR. (4) Use value of information (VOI) analysis to determine high priority future clinical studies to improve screening accuracy and adherence to screening recommendations. In Aims 1 and 2, we will perform secondary data analyses of existing databases, and conduct focus groups and three epidemiologic studies (two cross-sectional studies and one cohort study) that involve patient recruitment. Parameters identified through these activities will inform the development of the SCCA screening model and the execution of the VOI analysis (Aims 3 and 4). The end result of this study will be utilized to inform an optimal anal cancer screening regimen specific to PLWH in PR.