An implementation science approach to address multi-level barriers to cancer screening among women living with HIV in South Africa

一种实施科学方法，以解决南非艾滋病毒感染妇女癌症筛查的多层次障碍

• 批准号: 10242935
• 负责人: Carla J Chibwesha
• 金额: $ 14.56万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-14 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10242935
• 关键词: Acquired Immunodeficiency Syndrome; Address; Adopted; Adult; Affect; Africa; Africa South of the Sahara; African; Age; Bayesian Method; Cancer Burden; Cancer Control; Cancer Etiology; Caring; Cessation of life; Clinical; Communities; Data; Diagnosis; Drug Interactions; Early Diagnosis; Educational workshop; Enrollment; Epidemic; Focus Groups; Funding; Goals; HIV; HIV Infections; Health; Health Personnel; Health system; Human papilloma virus infection; Incidence; Intervention; Interview; Lead; Life Expectancy; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Methods; Modeling; Outcome; Participant; Patients; Phase; Policies; Policy Maker; Prevention Research; Provider; Public Health; Public Sector; Reporting; Research; Research Infrastructure; Resources; Risk; Science; Screening for cancer; Services; Site; South Africa; South African; Testing; Thinking; Time; Training; Woman; Work; acceptability and feasibility; antiretroviral therapy; base; breast and cervical cancer screening; cancer health disparity; cancer prevention; care seeking; chemotherapeutic agent; civil society; cohort; contextual factors; design; disparity elimination; experimental study; high risk population; implementation science; implementation trial; improved; innovation; low and middle-income countries; malignant breast neoplasm; men; mortality; preference; prevent; preventable death; programs; recruit; screening; screening services; simulation; social; tool; treatment program; uptake

ABSTRACT Over the next 20 years, cancer incidence and mortality are expected to rise at staggering rates worldwide, with much of the burden concentrated in low- and middle-income countries (LMICs). Despite widescale availability of antiretroviral therapy (ART) in LMICs, women living with HIV remain vulnerable to both AIDS- and non-AIDS defining cancers such as cervical and breast cancer. This is because screening coverage for breast and cervical cancer is low – and access to timely diagnosis and treatment is limited. In South Africa, for example, fewer than one-third of HIV-infected women undergo breast and cervical cancer screening at the recommended intervals. Attrition between cancer screening and treatment is also substantial among HIV-infected women in under- resourced South African settings. We seek to eliminate disparities in breast and cervical cancer outcomes among HIV-infected women in South Africa. In this application, we propose an innovative implementation science project to close the gap between cancer control policy and cancer screening practices in this high-risk population. Specific Aim 1 will use a sequential mixed-methods design consisting of focus groups, a discrete choice experiment (DCE), and in-depth interviews to study multi-level drivers of cancer screening and determine women’s preferences for cancer screening services. We will enroll 80 HIV-infected women and 32 men in 14 focus groups (8 participants in each group), 600 HIV-infected women in the DCE, and conduct 24 in- depth interviews with key stakeholders. In Specific Aim 2, we will co-create a multi-level intervention package with patients, providers, and policy makers, applying Design Thinking principles to design the package and assess its acceptability. We anticipate that the package will include training, clinical tools, and user-focused interventions applied at various levels of the Social Ecological Model to address the barriers identified in Aim 1. We will explore acceptability of the intervention package through user pre-testing workshops conducted with 6 user groups: 2 groups of HIV-infected women, 2 of healthcare providers, and 2 of policy makers. This project will provide robust preliminary data to inform larger-scale implementation trials to (1) promote uptake of cancer screening among women living with HIV and (2) improve retention in care for women who screen positive. We will leverage longstanding partnerships and a strong research infrastructure in Johannesburg to implement the proposed work.

摘要 在接下来的20年里，癌症发病率和死亡率预计将以惊人的速度在全球范围内上升， 大部分负担集中在低收入和中等收入国家(LMIC)。尽管可广泛使用 抗逆转录病毒疗法(ART)在LMICs中，携带艾滋病毒的妇女仍然容易感染艾滋病和非艾滋病 定义癌症，如宫颈癌和乳腺癌。这是因为乳房和子宫颈的筛查覆盖面 癌症发病率较低，获得及时诊断和治疗的机会有限。例如，在南非，不到 三分之一感染艾滋病毒的妇女在建议的时间间隔内接受乳腺癌和宫颈癌筛查。 在艾滋病毒感染的妇女中，癌症筛查和治疗之间的摩擦也很严重。 资源丰富的南非背景。我们寻求消除乳腺癌和宫颈癌结果之间的差异 南非感染艾滋病毒的妇女。在这一应用中，我们提出了一种创新的实施科学 缩小癌症控制政策和癌症筛查实践之间差距的项目 人口。具体目标1将使用顺序混合方法设计，由焦点小组、离散的 选择实验(DCE)和深入访谈，以研究癌症筛查和治疗的多层次驱动因素 确定女性对癌症筛查服务的偏好。我们将招收80名感染艾滋病毒的妇女和32名 14个焦点小组的男性(每组8名参与者)，DCE中的600名艾滋病毒感染妇女，并在 与关键利益相关者进行深度访谈。在具体目标2中，我们将共同创建一个多层次的干预一揽子计划 与患者、提供者和政策制定者一起，应用设计思维原则来设计包和 评估其可接受性。我们预计该套餐将包括培训、临床工具和以用户为中心 在社会生态模式的不同层面采取干预措施，以解决目标1中确定的障碍。 我们将通过与6个人举办的用户预测试研讨会来探索干预方案的可接受性 用户群体：2组感染艾滋病毒的妇女，2组医疗保健提供者，2名政策制定者。这个项目将 提供可靠的初步数据，为更大规模的实施试验提供信息，以(1)促进癌症的吸收 对感染艾滋病毒的妇女进行筛查，以及(2)改善对筛查呈阳性的妇女的护理。我们 将利用约翰内斯堡的长期合作伙伴关系和强大的研究基础设施来实施 建议的工作。