Project 1: A Public Health Approach to Cervical Cancer Prevention in East Africa

项目 1：东非预防宫颈癌的公共卫生方法

• 批准号: 10899809
• 负责人: Miriam Nakalembe
• 金额: $ 20.24万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-13 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10899809
• 关键词: Address; Africa; Africa South of the Sahara; Cancer Burden; Cancer Control; Cervical; Cervical Cancer Screening; Communities; Community based prevention; Cost Analysis; Data; Disease; Dose; Early Diagnosis; Evaluation; Female Adolescents; Funding; Goals; HIV; HIV Infections; Hand; Health; Health Services Accessibility; High Prevalence; Human Papilloma Virus Vaccination; Human Papilloma Virus-Related Malignant Neoplasm; Human Papillomavirus; Immunize; Incidence; Infection Control; Kenya; Literature; Malignant - descriptor; Malignant Neoplasms; Malignant neoplasm of cervix uteri; Measurement; Methods; Modeling; Motion; Prevention; Prevention program; Primary Prevention; Public Health; Recommendation; Research; Research Project Grants; Residual state; Screening for cancer; Secondary Prevention; Series; Specimen; Testing; Time; Uganda; Vaccinated; Vaccination; Vagina; Woman; Work; World Health Organization; access disparities; cervical cancer prevention; cost; cost comparison; cost effectiveness; girls; improved; microcosting; mortality; premalignant; preventive intervention; programs; screening; social stigma; success; tool; uptake

Women in sub-Saharan Africa, and particularly East Africa, bear among the greatest burden of cervical cancer in the world, and the reasons are clear: lack of widespread HPV vaccination, lack of screening for pre- cancer, lack of early detection, and high prevalence of one of the most potent accelerants of cervical cancer — HIV infection. It is of note that while great strides have been made in HIV infection control in the last decade in Africa, progress in cervical cancer control has languished. Indeed, continued occurrence of malignant complications of HIV  such as cervical cancer  threaten to undermine the successes. In recognition of the relevance of cervical cancer, the WHO has drafted a global strategy for cervical cancer elimination. It calls for 90% HPV vaccination coverage, 70% screening coverage, and treatment of 90% of those with cervical disease. Lacking in this strategy, however, is a clear path towards implementation. Through funding from U54 CA190153, to address the gap in implementation of effective preventive interventions for cervical cancer, we began to develop, in Uganda, what we call a public health approach to cervical cancer prevention. The approach combined Village Health Team-led community mobilization with community-based self-collected vaginal specimens for HPV testing and a mobile team to provide community- based ablative treatment for those HPV-infected. These community-based campaigns were feasible, well- attended and well-accepted. Given the initial success of this approach, the Ministries of Health in Uganda and Kenya seek to partner with us to add HPV vaccination to this public health approach in a model called the Integrated Cervical Cancer Prevention Program (ICCPP). The Ministries of Health will implement the ICCPP, and the overarching goal of the current proposal is to evaluate it. We propose 3 specific aims: Aim 1: Evaluate the uptake and acceptability of the HPV vaccination and cervical cancer screening components of the ICCPP in East Africa; Aim 2: Determine the factors explaining non-participation in either HPV vaccination among adolescent girls or in cervical cancer screening and treatment among women in East Africa; and Aim 3: Assess the costs and efficiency of the integrated public health approach to HPV vaccination and cervical cancer screening in East Africa. To address our aims, we will evaluate an entirely community-based integrated program implemented by our Ministry of Health partners in Uganda and Kenya in which women undergo cervical cancer screening and treatment and adolescent girls who have not been fully HPV-immunized get vaccinated. Evaluation will include uptake, acceptability, exploration of reasons for non-participation and costs. The project tests a new paradigm in cervical cancer prevention in Africa — a public health approach to reach the greatest number of girls and women at lowest cost. Findings may form a blueprint for the ultimate elimination of cervical cancer.

撒哈拉以南非洲，特别是东非的妇女， HPV疫苗接种缺乏普及，缺乏筛查， 癌症，缺乏早期检测，以及宫颈癌最强有力的促进因素之一的高患病率 - 艾滋病毒感染。值得注意的是，虽然过去几年在艾滋病毒感染控制方面取得了巨大进展， 在非洲，宫颈癌控制的进展已经停滞了十年。事实上，持续发生的 艾滋病毒的恶性并发症，如宫颈癌，可能会破坏成功。在 由于认识到宫颈癌的重要性，世界卫生组织起草了一项宫颈癌全球战略 淘汰它要求90%的HPV疫苗接种覆盖率，70%的筛查覆盖率，以及90%的 患有宫颈疾病的人。然而，缺乏这一战略是一条明确的执行道路。 通过U 54 CA 190153的资助，解决在实施有效预防措施方面的差距， 在乌干达，我们开始发展我们所谓的公共卫生方法， 预防宫颈癌该方法将村保健队领导的社区动员与 以社区为基础的自我收集阴道样本进行HPV检测，并设立一个移动的小组，为社区提供- HPV感染者的基础消融治疗。这些以社区为基础的运动是可行的，好- 出席并接受。鉴于这一办法的初步成功，乌干达卫生部 和肯尼亚寻求与我们合作，在一个名为 宫颈癌综合预防计划（ICCPP）。卫生部将执行 ICCPP，当前提案的首要目标是对其进行评估。我们提出3个具体目标： 目的1：评估HPV疫苗接种和宫颈癌筛查的接受率和可接受性 ICCPP在东非的组成部分; 目的2：确定解释不参加HPV疫苗接种的因素， 东非的少女或妇女宫颈癌筛查和治疗;以及 目标3：评估HPV疫苗接种综合公共卫生方法的成本和效率 和子宫颈癌筛查。 为了实现我们的目标，我们将评估一个完全以社区为基础的综合方案， 卫生部与乌干达和肯尼亚的伙伴合作，让妇女接受宫颈癌筛查， 治疗和未完全接种HPV疫苗的少女接种疫苗。评价将 包括吸收、可接受性、探讨不参加理由和费用。该项目测试了一个新的 非洲预防宫颈癌的范例-一种公共卫生方法， 以最低的成本为女孩和妇女提供服务。这些发现可能会为最终消除宫颈癌提供蓝图。