Multilevel Predictors of Follow-up after Anal Cancer Screening in HIV-infected Individuals

HIV 感染者肛门癌筛查后随访的多级预测因素

• 批准号: 9149034
• 负责人: Jessica Wells
• 金额: $ 8.89万
• 依托单位: EMORY UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-09-25 至 2018-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9149034
• 关键词: Address; Adherence; Anal canal; Anus; Area; Award; Behavior; Behavior Therapy; Behavioral; Cancer Control; Cancer Science; Cancerous; Censuses; Cervical; Chronic Disease; Clinic; Clinical; Communities; Cytology; Data Analyses; Development Plans; Diagnosis; Disease; Doctor of Philosophy; Drug abuse; Dysplasia; Economics; Environmental Risk Factor; Future; General Population; Goals; Growth; HIV; Health behavior; Healthcare; Incidence; Individual; Intervention; K-Series Research Career Programs; Knowledge; Lead; Lesion; Life; Life Style; Malignant Neoplasms; Malignant neoplasm of anus; Malignant neoplasm of cervix uteri; Medical Records; Mental Depression; Mentorship; Methodology; Modeling; Morbidity - disease rate; National Research Service Awards; Neighborhoods; Pap smear; Patients; Pattern; Persons; Pilot Projects; Population; Population Heterogeneity; Positioning Attribute; Poverty; Premalignant; Primary Prevention; Reporting; Research; Research Assistant; Research Design; Research Personnel; Research Training; Resolution; Risk; Risk Factors; Sampling; School Nursing; Science; Scientist; Screening procedure; Secondary Prevention; Shapes; Social support; Staging; Statistical Methods; Testing; Time; Training; Universities; Visit; Vulnerable Populations; Woman; Work; aging population; anticancer research; cancer prevention; career; career development; compliance behavior; experience; follow-up; health belief; high risk; improved; innovation; meetings; men; mortality; multilevel analysis; pre-doctoral; prevent; professor; programs; public health relevance; racial and ethnic; research and development; research study; screening; skills; social; social stigma; successful intervention; trend

 DESCRIPTION (provided by applicant): Dr. Jessica Wells, RN, PhD is a Research Assistant Professor at Emory University Nell Hodgson Woodruff School of Nursing working under the mentorship of Drs. Deborah Watkins Bruner, RN, PhD, FAAN, Marcia M. Holstad, FNP, PhD, FAAN, and Hannah Cooper, ScD. Her long-term career goal is to be an independent investigator and leader at the forefront of cancer and HIV research. Her previous research training through her pre-doctoral NRSA award provided scientific knowledge and skills in research design, implementation, and basic statistical methods related to cancer research. This K01 career development award will provide an opportunity to merge and expand her cancer research training to the HIV population. Under the guidance of her mentorship team, a training and research development plan was created to facilitate attainment of her career development goals and competencies. Her career development goals include: 1) develop knowledge and skills in performing cancer research in the HIV population; and 2) gain advance statistical skills in multilevel modeling and GIS analysis; and 3) enhance and refine research skills and program of research to position career as an independent and successful investigator. At the end of this award period, Dr. Wells aims to be uniquely trained with sought after skills that integrate cancer science and HIV science with in-depth experience in advanced methodology such as multi-level analysis and geo-spatial analysis. To take a first step toward these goals, the current study will examine the individual-, interpersonal-, neighborhood-level factors that best fit a model to predict adherence to follow-up high-resolution anoscopy after an abnormal anal Papanicolaou (Pap) cytology in this population. HIV-infected persons are 28 times more likely to be diagnosed with anal cancer than the general population. Without active intervention, the incidence of anal cancer will continue to grow among HIV-infected individuals especially with the growth and aging of this population. Therefore, timely anoscopy follow up after an abnormal anal Pap test is imperative for a successful cancer prevention plan. The specific aims of the proposed study are: (1) to build a model of individual-level (depression, HIV-related stigma, health beliefs, substance/drug abuse) and interpersonal-level (social support and marital or partner status) factors related to adherence to follow up anoscopy, and (2) as an exploratory aim, we will examine the extent to which neighborhood-level factors (% poverty and racial/ethnic composition) are 2a) are related to adherence to follow up anoscopy, and if they are related, 2b) we develop a model of individual-, interpersonal-, and neighborhood level factors that best predict adherence to anoscopy follow up after an abnormal anal Pap test. Multilevel analysis is a timely and innovative approach to examine risk factors related to adherence to high resolution anoscopy. Findings from this study will be used to develop innovative strategies that address multilevel risk factors and inform interventions that will meet the laudable goal of reducing the personal and clinical burden associated with anal cancer in individuals living with HIV.

 描述（由申请人提供）： Jessica Wells 博士，注册护士，博士，是埃默里大学 Nell Hodgson Woodruff 护理学院的研究助理教授，在 Drs. 的指导下工作。 Deborah Watkins Bruner，注册护士、博士、FAAN、Marcia M. Holstad、FNP、博士、FAAN 和 Hannah Cooper，科学博士。她的长期职业目标是成为癌症和艾滋病毒研究前沿的独立研究者和领导者。她之前通过博士前 NRSA 奖项获得的研究培训为她提供了与癌症研究相关的研究设计、实施和基本统计​​方法方面的科学知识和技能。该 K01 职业发展奖将提供一个机会，将她的癌症研究培训合并并扩展到艾滋病毒人群。在她的导师团队的指导下，制定了培训和研究发展计划，以促进她实现职业发展目标和能力。她的职业发展目标包括：1）培养在艾滋病毒人群中进行癌症研究的知识和技能； 2) 获得多层次建模和 GIS 分析方面的高级统计技能； 3）增强和完善研究技能和研究计划，将职业定位为独立且成功的研究者。在此奖励期结束时，Wells 博士的目标是接受独特的培训，掌握将癌症科学和艾滋病毒科学相结合的技能，并在多层次分析和地理空间分析等先进方法方面拥有丰富的经验。为了向这些目标迈出第一步，当前的研究将检查最适合模型的个人、人际、邻里层面因素，以预测该人群肛门巴氏 (Pap) 细胞学检查异常后对后续高分辨率肛门镜检查的依从性。 HIV 感染者被诊断患有肛门癌的可能性是普通人群的 28 倍。如果不积极干预，艾滋病毒感染者中肛门癌的发病率将继续上升，特别是随着该人群的增长和老龄化。因此，肛门巴氏涂片检查异常后及时进行肛门镜检查随访对于成功的癌症预防计划至关重要。拟议研究的具体目标是：（1）建立个人层面（抑郁、艾滋病毒相关耻辱、健康信念、物质/药物滥用）和人际层面（社会支持和婚姻或伴侣状况）与坚持进行肛门镜检查相关的因素的模型，（2）作为探索性目标，我们将检查社区层面因素（贫困百分比和种族/民族构成）2a）的程度 与对肛门镜检查随访的依从性相关，如果它们相关，2b）我们开发了一个个人、人际和邻里层面因素的模型，该模型可以最好地预测异常肛门巴氏试验后对肛门镜检查随访的依从性。多层次分析是一种及时且创新的方法，用于检查与坚持高分辨率肛门镜检查相关的风险因素。这项研究的结果将用于制定创新策略，解决多层次风险因素，并为干预措施提供信息，以实现减少艾滋病毒感染者与肛门癌相关的个人和临床负担这一值得称赞的目标。