Interventions to increase adherence to cervical cancer early detection and treatment recommendations in Mexico City clinics

项目概要/摘要 尽管宫颈癌是高度可预防的，但在全球范围内存在着明显的差异。CC是第二大 墨西哥妇女的癌症死亡原因，其中CC检测，诊断和治疗延迟导致 从次优的实施和坚持长期墨西哥早期检测，诊断， 治疗指南，自1974年以来一直存在。相比之下，CC是第12大原因。 美国女性的癌症死亡率，患者，提供者和医疗保健的证据 与坚持CC早期检测和诊断建议相关的组织因素可能 与CC控制计划的成功相关的风险已经累积。在墨西哥，筛查率不理想 （50-67%），而在美国为80%，墨西哥妇女的阴道镜检查异常 在美国，屏幕的使用率为43%，而在美国，这一比例约为66%-71%。针对NOT-CA-20-025特别通知 兴趣（NOSI）：癌症预防和控制的传播和实施科学 资源环境，我们建议，以确定障碍和促进遵守墨西哥 从一个异常的屏幕跟进的指导方针向下CC护理级联（MGMACS，墨西哥 管理异常子宫颈癌普查测试指引），并制订策略， 在墨西哥城南部地区特拉尔潘的诊所里，人们遵守这些指导方针。之后 在实施研究综合框架指导下的实施摸底办法 （CFIR），健康信念模型和实施结果框架（IOF），我们将评估 实施的决定因素和当前MGMACS实施的结果，并制定一个逻辑 模型描述了从异常屏幕向下改进MGMACS依从性的过程 级联，患者，提供者和诊所（目标1）。接下来，我们将选择和调整实施 解决已识别障碍的策略，以提高对MGMACS的依从性（目标2）。在这两个目标中，我们将 使用定性和定量方法收集数据和综合调查结果， 在多阶段集成收敛混合方法的设计和分析方法。我们的研究团队 在生物统计学、实施科学方法和实践方面具有广泛的研究专长， 在墨西哥和其他地方的预防和控制。我们的目标是收集数据，为未来的外部应用程序提供信息 进行大规模的实施研究，以提高对MGMACS的依从性。该项目将提供一个模型 实施以科学为基础的方法，以改善CC的早期发现，诊断和治疗 在拉丁美洲及其他地区类似的资源不足的情况下， 最终消除CC。

Project summary/Abstract Despite being highly preventable, stark cervical cancer (CC) disparities exist globally. CC is the second leading cause of cancer mortality among Mexican women, where CC detection, diagnosis, and treatment delays result from suboptimal implementation of and adherence to longstanding Mexican early detection, diagnosis, and treatment guidelines, which have been in existence since 1974. In contrast, CC is the 12th leading cause of cancer mortality among women in the US, where evidence about patient, provider, and health care organizational factors associated with adherence to CC early detection and diagnosis recommendations likely associated with the success of CC control programs has accrued. In Mexico, screening rates are suboptimal (50-67%), in contrast to 80% in the US, and follow-up colposcopy among Mexican women with abnormal screens is 43%, in contrast to around 66%-71% in the US. In response to NOT-CA-20-025 Notice of Special Interest (NOSI): Dissemination and Implementation Science for Cancer Prevention and Control in Low Resource Environments, we propose to identify barriers to and facilitators of adherence to the Mexican guidelines for follow-up from an abnormal screen onward down the CC care cascade (MGMACS, Mexican Guidelines for Managing Abnormal Cervical Cancer Screening Tests), and to develop strategies to increase adherence to these guidelines in clinics in Tlalpan, a Southern district of Mexico City. Following an Implementation Mapping approach, guided by the Consolidated Framework for Implementation Research (CFIR), the Health Belief Model, and the Implementation Outcomes Framework (IOF), we will evaluate the determinants of implementation and outcomes of the current MGMACS implementation and develop a logic model describing the process for improving adherence to the MGMACS from abnormal screens onwards down the cascade, among patients, providers, and clinics (Aim 1). Next, we will select and adapt implementation strategies that address the barriers identified to improve adherence to MGMACS (Aim 2). In both aims, we will use qualitative and quantitative methods for data collection and synthesis of findings, embedding them together in a multistage integrated convergent mixed methods design and analysis approach. Our study team has extensive research expertise in biostatistics, implementation science methods and practice, and CC prevention and control in Mexico and elsewhere. We aim to gather data to inform a future external application for a large-scale implementation study on improving adherence to MGMACS. This project will provide a model for an implementation science-based approach to improving CC early detection, diagnosis, and treatment programs in similar under-resourced contexts in Latin America and beyond, contributing to the reduction and ultimate elimination of CC.