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

 简介(由申请人提供)：Jessica Wells博士，RN，博士，Emory大学Nell Hodgson Woodruff护理学院研究助理教授，在Deborah Watkins Bruner，RN，Phd，FAan，Marcia M.Holstad，FNP，Phd，FAan博士和Hannah Cooper，ScD的指导下工作。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调查员和领导者。她之前通过博士前NRSA奖接受的研究培训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。这一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。在她的指导团队的指导下，制定了一项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)获得多水平建模和地理信息系统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，使其成为一名独立和成功的研究人员。在此授奖期结束时，Wells博士的目标是接受独特的培训，掌握广受欢迎的技能，将癌症科学和艾滋病毒科学与先进方法(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符合模型的个人、人际、邻里层面的因素，以预测该人群在肛门巴氏细胞学(Pap)异常后是否接受后续高分辨率肛门镜检查。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。如果没有积极的干预，艾滋病毒感染者的肛门癌发病率将继续上升，特别是随着这一人群的增长和老龄化。因此，对于成功的癌症预防计划，在肛门巴氏试验异常后及时进行肛门镜检查是必不可少的。本研究的具体目的是：(1)建立个人层面(抑郁、HIV相关污名、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)与坚持随访肛门检查有关的模型；(2)作为探索性目标，我们将检验邻里层面因素(贫困和种族/民族构成)在多大程度上与坚持随访肛门检查有关，如果它们相关，2b)我们开发了个人-人际-，而邻里水平因素最能预测肛门镜检查的依从性，在异常的肛门巴氏试验后进行随访。多水平分析是一种及时和创新的方法，可以检查与坚持高分辨率肛门镜检查相关的风险因素。这项研究的结果将被用于开发解决多层次风险因素的创新战略，并为干预措施提供信息，以实现减少艾滋病毒携带者与肛门癌相关的个人和临床负担这一值得称赞的目标。

 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.