Factors Associated with HPV Screening and Acquisition in Young Women in Botswana

该项目的广泛、长期目标是降低博茨瓦纳和其他撒哈拉以南非洲国家的宫颈癌发病率。在博茨瓦纳，2011年15至49岁成年人的艾滋病毒感染率为23.4%，是世界上第二高的感染率。博茨瓦纳艾滋病毒传播的主要方式是异性接触。特别令人关切的是产前诊所的高流行率，2011年，15至49岁孕妇中按年龄调整的艾滋病毒流行率为30.4%。博茨瓦纳的艾滋病毒高流行率导致与艾滋病毒有关的合并症，包括宫颈癌的流行率增加。在博茨瓦纳妇女中，宫颈癌是最常见的癌症，也是癌症死亡的第二大常见原因。博茨瓦纳一般人群中约有21%的妇女患有宫颈HPV感染，相当多的证据表明艾滋病毒感染者感染HPV的风险增加。该项目解决了对影响博茨瓦纳妇女进行HPV筛查、HPV和艾滋病毒感染风险、寻求治疗和保留治疗的因素进行研究的迫切需要。该项目将利用来自3个赠款组群参与者的数据：组群1-博茨瓦纳大学第一年本科女生，组群2-在宫颈癌筛查时捕获的女性，组群3-诊断为宫颈癌并正在接受治疗的女性。增加任何与健康有关的行为的重要的第一步是确定影响这种行为的因素。这些因素中的一些将是不可变的，稳定的特征，不适合干预，如人口统计学变量（例如，年龄、家族史和社会经济背景）。确定稳定不变的预测因子有助于确定具有不同干预需求的妇女亚组。其他因素将是可修改的，易于改变的，行为干预可以针对增加健康行为的变量（例如，知识、信念和态度）。改变行为的干预措施如果能够借鉴理论框架并适合人口的情况，就可能最有效。拟议的研究将借鉴社会认知理论和理性行动方法，这些理论框架已用于各种行为改变干预措施，包括撒哈拉以南非洲的干预措施。定性研究将用于确定目标人群中感兴趣的行为的突出信念。前瞻性队列设计将使我们能够识别目标行为的预测因子，并检查理论变量是否可以解释它们。队列1和队列2中的受试者将每隔6个月完成一次保密的网络调查，为期3年，队列3中的受试者将每隔2年完成一次保密的网络调查。具体目标是确定宫颈癌筛查、艾滋病毒和人乳头瘤病毒感染的获得、宫颈癌筛查妇女寻求治疗以及诊断为宫颈癌的妇女继续接受治疗的前瞻性预测因素。

The broad, long-term objective of this project is to reduce the rates of cervical cancer in Botswana and other sub-Saharan African countries. In Botswana, the HIV prevalence rate among adults 15 to 49 years of age in 2011 was 23.4%, which was the second highest prevalence rate in the world. The primary mode of HIV transmission in Botswana is heterosexual exposure. Of particular concern is the high prevalence in antenatal clinics, where the age-adjusted HIV prevalence among pregnant women ages 15 to 49 years was 30.4% in 2011. The high HIV prevalence in Botswana contributes to an increased prevalence of HIV-associated comorbidities, including cervical cancer. Among women in Botswana, cervical cancer is the most common cancer and the second most common cause of cancer deaths. About 21% of women in the general population of Botswana harbor cervical HPV infection, and considerable evidence suggests increased risk of HPV in people living with HIV. This project addresses the urgent need for research on factors affecting screening for HPV, risk of HPV and HIV acquisition, treatment seeking, and retention in treatment among women in Botswana. The project will utilize data from participants in the 3 cohorts of the grant: Cohort 1 ^ first-year undergraduate women at the University of Botswana, Cohort 2—women captured at the time of their cervical-cancer screening, and Cohort 3—women diagnosed with cervical cancer who are undergoing treatment. An important first step in increasing any health-related behavior is the identification of factors that affect that behavior. Some of these factors will be immutable, stable characteristics that are not amenable to intervention such as demographic variables (e.g., age, family history, and socioeconomic background). Identifying stable immutable predictors helps to identify subgroups of women with differential needs for intervention. Other factors will be modifiable, amenable to change, variables that behavioral interventions can target to increase healthful behavior (e.g., knowledge, beliefs, and attitudes). Behavior-change interventions are likely to be most efficacious if they draw upon a theoretical framework and are tailored to the population. The proposed research will draw upon social cognitive theory and the reasoned action approach, which are theoretical frameworks that have been used in a wide variety of behavior-change interventions, including interventions in sub-Saharan Africa. Qualitative research will be used to identify salient beliefs about the behaviors of interest in the target populations. The prospective cohort designs will allow us to identify the predictors of the target behaviors and to examine whether theoretical variables explain them. Participants will complete confidential web-based surveys at 6-month intervals for 3 years in Cohorts 1 and 2 and for 2 years in Cohort 3. The Specific Aims are to identify prospective predictors of cervical-cancer screening, acquisition of HIV and HPV infection, treatment seeking in women screened for cervical cancer, and remaining in treatment among women diagnosed with cervical cancer.