Georgia Consortium to Eliminate Cervical Cancer in Women Living with HIV (GaCECC-WLWH)

项目摘要/摘要 与女性相比，艾滋病毒携带者(WLWH)患宫颈癌的风险大大增加 未感染HIV(1例)。佐治亚州的艾滋病毒携带者人数在美国排名第二， 患病率是全国的1.9倍(2)。与此同时，佐治亚州的宫颈癌发病率显著 高于全国平均水平，2015-2019年每10万名女性中有8.0名确诊(3)。黑人女性 在佐治亚州，艾滋病毒(4)和宫颈癌(5)的影响不成比例，而且发病率明显更高 在宫颈癌筛查异常后，失去了随访机会，没有接受阴道镜检查或治疗 与白人女性相比(6)。因此，佐治亚州成为务实临床试验的焦点是当务之急 解决面临健康差距的妇女妇女的宫颈癌筛查和治疗问题。佐治亚州 消除艾滋病毒携带者妇女宫颈癌联盟(GaCECC)由历史悠久、组织完善的 佐治亚州资助的为WLWH提供服务的项目，并准备进行“CASCADE”网络临床 审判。GaCECC包括埃默里大学艾滋病毒研究和临床网络、城市和农村瑞安·怀特 资助的诊所，莫尔豪斯医学院(MSM)广泛的社区网络，佐治亚州癌症中心 在格雷迪卫生系统(GCCE)卓尔不凡，并尊重艾滋病毒和妇女健康社区 佐治亚州的组织。GaCECC通过各种临床站点访问数以千计的WLWH 在2020-2021年间，为9000多名WLWH服务，并在这两个地区进行了5000多次宫颈癌筛查 整个佐治亚州的城乡环境。这些网站为大部分黑人女性提供服务，她们是 不成比例地受到健康的社会决定因素的影响。GaCECC经验丰富的客户端导航 服务将致力于优化参与者获得和完成推荐筛查和治疗的机会 序列。GaCECC招聘和保留团队将确保在积极的 社区诊所的筛查和GCCE的阴道镜检查。格雷迪纪念医院将提供格雷迪移动 卫生中心的车辆将阴道镜检查带给无法前往GCCE的妇女。埃默里大学 MSM和AAPHC合作伙伴妇科医生将在 GCCE、庞塞传染病诊所和与AAPHC有关的农村妇科办公室。经验丰富 HIV和HPV临床试验的研究人员和研究人员将熟练地执行临床试验方案 并确保最佳保留率。GaCECC将利用每个协作者所利用的优势和资源 在这个联盟中为WLWH解决宫颈癌预防问题。总而言之，GaCECC将利用其临床 在艾滋病毒护理和宫颈癌预防方面的研究领导地位(目标1)，以推动宫颈癌研究 通过“CASCADE”网络临床试验在WLWH中预防癌症，(目标2)落实务实 所有四个科学重点领域的宫颈癌预防临床试验(目标3)及其网络 建立社区伙伴关系，以登记和保留WLWH，重点是公平和多样性。

PROJECT SUMMARY/ABSTRACT Women living with HIV (WLWH) have a substantially increased risk for cervical cancer when compared to women without HIV infection (1). Georgia has the second largest population of people living with HIV in the US, with a prevalence of 1.9 times the national rate (2). Simultaneously, Georgia’s rates of cervical cancer are notably higher than the national average with 8.0 per 100,000 women diagnosed between 2015-2019 (3). Black women are disproportionately impacted by HIV(4) and cervical cancer in Georgia (5) and have significantly higher rates of being lost to follow-up and not undergoing colposcopy or treatment after an abnormal cervical cancer screen when compared to white women (6). It is thus imperative that Georgia is a focal point of pragmatic clinical trials to address cervical cancer screening and treatment among WLWH who face health disparities. The Georgia Consortium to Eliminate Cervical Cancer in Women Living with HIV (GaCECC) encompasses established, well- funded programs in Georgia that service WLWH and are primed to conduct the ‘CASCADE’ Network clinical trials. The GaCECC includes Emory University HIV research and clinical networks, urban and rural Ryan White funded clinics, Morehouse School of Medicine’s (MSM’s) extensive community networks, Georgia Cancer Center for Excellence at Grady Health System (GCCE), and respected HIV and women’s health community-based organizations in Georgia. The GaCECC has access to thousands of WLWH through various clinical sites that served over 9,000 WLWH and performed over 5,000 cervical cancer screenings between 2020-2021 in both urban and rural settings across Georgia. These sites serve high proportions of Black women who are disproportionately affected by social determinants of health. The GaCECC’s experienced client navigation services will work to optimize participant access to and completion of recommended screening and treatment sequences. The GaCECC recruitment and retention team will assure seamless linkage of care between positive screens at community clinics and colposcopy at the GCCE. Grady Memorial Hospital will provide its Grady Mobile Health Center Vehicle to bring colposcopy to women who are unable to travel to the GCCE. Emory University, MSM, and AAPHC partner gynecologists will deliver ‘CASCADE’ Network protocol-based treatment at the GCCE, Ponce Infectious Disease Clinic, and rural gynecology offices associated with AAPHC. Experienced investigators and research staff in HIV and HPV clinical trials will proficiently implement clinical trials protocols and ensure optimal retention. The GaCECC will use the strengths and resources leveraged by each collaborator in this consortium to address cervical cancer prevention for WLWH. In sum, the GaCECC will harness its clinical and research leadership in HIV care and cervical cancer prevention (Aim 1) to advance research in cervical cancer prevention among WLWH through the ‘CASCADE’ Network clinical trial, (Aim 2) to implement pragmatic clinical trials in cervical cancer prevention across all four scientific focus areas (Aim 3) and to utilize its network of community partnerships to enroll and retain WLWH with an emphasis on equity and diversity.