Reducing cervical cancer screening disparities in Somali immigrant women through a primary care based HPV self-sampling intervention

摘要/摘要 居住在美国的索马里妇女的宫颈癌筛查率低于美国普通女性 人口。这种差异是由一系列因素造成的，包括对HPV和宫颈癌的认识不足， 文化和宗教信仰，对医疗保健提供者的不信任，对谦虚和割礼的担忧， 对接受包皮环切术的妇女进行巴氏试验的提供者自我效能感较低。人乳头瘤病毒自我采样是一种新兴的 宫颈癌筛查模式，可解决索马里妇女中常见的筛查障碍， 尤其是那些与谦虚和割礼有关的问题。人乳头瘤病毒自我采样可准确检测Pre 这是一种治疗宫颈癌变的有效方法，适用于筛查不足的妇女。此外，我们的试点工作已经 证明了在索马里妇女中进行人乳头瘤病毒自我采样的可行性和可接受性。虽然研究已经 主要专注于基于家庭的HPV自我采样，有一个尚未开发的机会来提供HPV自我采样 在初级保健环境中进行抽样。在初级保健中提供HPV自我采样可以有效地增加 通过定位提供者解决筛查障碍，提高索马里妇女的宫颈癌筛查率 使诊所能够机会性地将HPV自我采样与其他预约相结合，并提供 接受包皮环切术的妇女的另一种方式。我们提出了一种混合类型2效能实现设计 评估以患者为中心的、根据文化定制的HPV自我采样的有效性和实施情况 对索马里妇女的干预。在执行科学和社会科学综合框架的指导下 认知理论，我们将对索马里患者进行焦点小组调查，并与提供者进行访谈，以确定 患者、提供者、诊所和系统级别的因素，以改进干预材料和 制定执行战略(目标1)。在定制干预措施后，我们将实施HPV 在两个初级保健诊所进行自我抽样，并评估索马里妇女宫颈癌筛查的变化 费率为实施前一年和实施后一年(目标2)。变化将与索马里妇女进行比较 在同一时间段内，使用差异法跟踪27家对照诊所的就诊情况。最后， 使用RE-AIM，我们将对流程和策略进行实施后的混合方法分析 在索马里患者的初级保健中成功实施人乳头瘤病毒自我采样所需(目标3)，包括 与供应商和索马里妇女的面谈。我们的假设是，在中国实施HPV自我采样 初级保健将导致索马里妇女更多地接受宫颈癌筛查， 基于实施科学的对成功实施干预措施所需流程的分析将 制定可持续、新颖的战略，以支持将HPV自我采样持续整合到初级卫生保健中 关心。

SUMMARY/ABSTRACT Somali women living in the U.S. have lower cervical cancer screening rates than the U.S. general female population. This disparity is due to a range of factors, including limited awareness of HPV and cervical cancer, cultural and religious beliefs, mistrust of health care providers, concerns around modesty and circumcision, and low provider self-efficacy to perform Pap tests on circumcised women. HPV self-sampling is an emerging cervical cancer screening modality that may address common screening barriers among Somali women, particularly those related to modesty and circumcision. HPV self-sampling is accurate for detecting pre- cancerous cervical lesions and effective in reaching underscreened women. In addition, our pilot work has demonstrated the feasibility and acceptability of HPV self-sampling in Somali women. While research has focused primarily on home-based HPV self-sampling, there is an untapped opportunity to offer HPV self- sampling in the primary care setting. Offering HPV self-sampling in primary care could effectively increase cervical cancer screening rates in Somali women by positioning providers to address screening barriers, enabling clinics to opportunistically fit in HPV self-sampling with other appointments, and providing an alternative modality for circumcised women. We propose a Hybrid Type 2 effectiveness-implementation design to assess the effectiveness and implementation of a patient-centered, culturally-tailored HPV self-sampling intervention for Somali women. Guided by the Consolidated Framework for Implementation Science and Social Cognitive Theory, we will conduct focus groups with Somali patients and interviews with providers to identify patient-, provider-, clinic-, and systems-level factors to inform refinement of intervention materials and development of implementation strategies (Aim 1). After tailoring the intervention, we will then implement HPV self-sampling in 2 primary care clinics, and evaluate changes in Somali women’s cervical cancer screening rates one-year pre and one-year post implementation (Aim 2). Changes will be compared with Somali women attending 27 control clinics followed over the same time period, using difference-in-difference methods. Finally, using RE-AIM, we will conduct a post-implementation mixed methods analysis of the processes and strategies needed to successfully implement HPV self-sampling in primary care for Somali patients (Aim 3), including interviews with providers and Somali women. Our hypothesis is that implementing HPV self-sampling in primary care will lead to increased uptake of cervical cancer screening in Somali women and that an implementation science based analysis of the processes needed to successfully implement the intervention will lead to sustainable, novel strategies to support the sustained integration of HPV self-sampling into primary care.