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

 描述（由申请人提供）：Jessica威尔斯博士，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Deborah Watkins Bruner博士的指导下工作，注册护士，博士，FAAN，Marcia M。Holstad，FNP，PhD，FAAN和Hannah库珀，ScD。她的长期职业目标是成为癌症和艾滋病研究前沿的独立研究者和领导者。她以前的研究培训，通过她的博士前NRSA奖提供科学知识和研究设计，实施和基本的统计方法与癌症研究的技能。这个K 01职业发展奖将提供一个机会，合并和扩大她的癌症研究培训艾滋病毒人群。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）发展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分析的高级统计技能; 3）增强和完善研究技能和研究计划，以定位职业生涯作为一个独立和成功的研究者。在这个奖项期结束时，威尔斯博士的目标是接受独特的培训，将癌症科学和艾滋病毒科学与先进方法学（如多层次分析和地理空间分析）的深入经验相结合。为了朝着这些目标迈出第一步，目前的研究将检查最适合模型的个人，人际，邻里水平的因素，以预测该人群在异常肛门巴氏（Pap）细胞学检查后对随访高分辨率肛门镜检查的依从性。艾滋病毒感染者被诊断为肛门癌的可能性是普通人群的28倍。如果不积极干预，肛门癌的发病率将继续在艾滋病毒感染者中增长，特别是随着这一人群的增长和老龄化。因此，肛门巴氏试验异常后及时进行肛门镜检查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）建立个体层次的模型（抑郁症、与艾滋病毒有关的耻辱感、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）与坚持随访肛门镜检查相关的因素，和（2）作为探索性目的，我们将研究社区层面的因素在多大程度上（贫困率和种族/民族组成）是2a）与坚持随访肛门镜检查有关，如果它们相关，2b）我们开发了一个模型，其中包括个人、人际和邻里水平的因素，这些因素最能预测异常肛门巴氏试验后是否坚持肛门镜检查。多水平分析是一种及时和创新的方法来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，解决多层次的风险因素，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的值得称赞的目标。

 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.