An integrated community-clinic model of optimized implementation strategies to increase early detection of breast and cervical cancers in Kenya

项目摘要/摘要 肯尼亚的乳腺癌和宫颈癌发病率很高，大多数妇女被诊断为晚期- 阶段性疾病。实施有效的计划在早期阶段筛查和检测这些癌症可能会 大大降低了高死亡率。肯尼亚一直在增加癌症筛查的机会，但更少 超过六分之一的合格女性曾接受过乳腺癌和宫颈癌筛查。 这项研究的目标是评估多组成部分战略的有效性和成本效益 增加乳腺癌和宫颈癌筛查的摄取率。延续低点的关键缺口 肯尼亚的筛查率是缺乏社区和诊所之间的联系。有证据表明，女性通常 不知道设施中提供的筛查服务，即使在那些知道的人中，也缺乏 动机、预期或感知到的耻辱，以及接受筛查的自我效能降低。我们会 进行务实的整群随机试验，评估筛查结果，包括筛查 摄取、诊断测试完成以及治疗启动和实施结果，以支持规模- 向上。我们将测试两个多组分的策略包：(1)癌症社区-诊所联系(C3Link) 核心：社区卫生志愿者(CHV)-为妇女和家庭成员提供团体教育，以 增加社区环境中的筛查接受度和实践便利化，以改善筛查 (2)C3Link Plus：C3Link 核心战略和一系列连续的个人战略，在3个月后强度增加 间隔时间；未接受筛查的女性将首先接受一对一的教育；第二，激励 采访；最后，导航以解决特定的障碍。 我们将在肯尼亚的27个社区实施这项研究，以解决以下三个具体问题 目标：目标1：进行一项整群随机试验以评估短期(干预实施阶段) 以及两组多组分策略对乳房的长期影响(维持期) 与增强的标准相比，连续护理过程中的宫颈癌筛查结果 关怀(仅接受宣传活动的社区)；目标2：使用混合方法进行评估 并比较侧重于可接受性的一揽子战略的多层次实施结果， 可行性、适当性、保真度和可持续性；目标3：实现成本效益和回报- 投资分析，以支持在肯尼亚各地扩大有效的一揽子实施战略 和其他撒哈拉以南非洲国家。肯尼亚卫生部可以利用这项研究的结果 设计最佳方法并计划对筛选基础设施的投资，以扩大实施 指南建议。吸取的经验教训可以应用于撒哈拉以南非洲的其他环境。

PROJECT SUMMARY/ABSTRACT Kenya has a high incidence of breast and cervical cancers, and most women are diagnosed with late- stage disease. Implementing effective programs to screen and detect these cancers at an early stage could substantially decrease the high mortality. Kenya has been increasing access to cancer screening, but less than one-sixth of eligible women have ever received breast and cervical cancer screening. The goal of the study is to assess the effectiveness and cost-effectiveness of multicomponent strategies to increase the uptake of breast and cervical cancer screeening. A key gap that perpetuates the low screening rates in Kenya is the lack of community–clinic linkages. There is evidence that women are often unaware of the screening services offered in facilities, and, even among those who are aware, there is lack of motivation, anticipated or perceived stigma, and reduced self-efficacy to undergo screening. We will conduct a pragmatic cluster randomized trial to evaluate the screening outcomes, including screening uptake, diagnostic test completion, and treatment initiation and implementation outcomes to support scale- up. We will test two multicomponent packages of strategies: (1) Cancer Community–Clinic Linkage (C3Link) Core: Community health volunteer (CHV)-delivered group education for women and family members to increase screening uptake in the community setting and practice facilitation to improve the screening process and develop team-based care with CHV participation in the clinic setting; (2) C3Link Plus: C3Link Core strategies along with a sequential series of individual strategies that increase in intensity at 3-month intervals; women who remain unscreened will first receive one-on-one education; second, motivational interviewing; and, finally, navigation to address specific barriers. We will implement the study across 27 communities in Kenya to address the following three specific aims: Aim 1: Conduct a cluster randomized trial to assess short-term (intervention implementation phase) and longer-term impacts (maintenance phase) of the two packages of multicomponent strategies on breast and cervical cancer screening outcomes along the continuum of care compared to enhanced standard of care (communities receiving a messaging campaign only); Aim 2: Use a mixed-methods approach to assess and compare multilevel implementation outcomes of the package of strategies focusing on acceptability, feasibility, appropriateness, fidelity, and sustainability; Aim 3: Perform cost-effectiveness and return-on- investment analysis to support scale-up of an effective package of implementation strategies across Kenya and other sub-Saharan African countries. The Kenyan Ministry of Health can use the findings from this study to design optimal approaches and plan investments in screening infrastructure to scale up implementation of guideline recommendations. The lessons learned can be applied to other sub-Saharan African settings.