Evidence-based Approaches, Financing and Tools for Cost-Effective Scale-up Cervical Cancer Prevention in Sub-Saharan Africa

 描述(由申请人提供)：虽然在南部非洲已经开展了几个宫颈癌筛查项目和演示，但在现实世界中，只有有限的评估评估了项目的有效性、成本和障碍/促进者。此外，尽管已经启动了许多项目，但今天只有几个成功的项目在运作。从成功方案中吸取的经验教训尚未综合和传播，以促进成本效益高的执行战略的扩大。鉴于人类免疫缺陷病毒(艾滋病毒)在南部非洲的大量流行，大大增加了宫颈癌的风险，迫切需要扩大预防和筛查服务。拟议研究的具体目的如下：目标1：对赞比亚成功的子宫颈癌预防计划(CCPPZ)进行系统的过程评估，以找出在撒哈拉以南其他国家扩大服务的经验教训。目标2：对利益攸关方对当前计划运作的看法进行全面评估，以确定障碍和促进者以及创新的融资安排，以确保可持续性。目的3：开发一种新的微观模拟模型，以评估在包括预算和能力限制在内的真实世界条件下，在人群水平上扩大宫颈癌预防和筛查的干预措施和战略的成本和有效性。项目AIMS的成功实施将为最佳选择预防和筛查干预措施以减少宫颈癌发病率和死亡率提供循证执行指导方针。我们将模拟行为变化的影响(例如，性行为对艾滋病毒和人类乳头瘤病毒[HPV]感染率的影响)，通过接种HPV疫苗进行预防，以及使用目测技术和新的快速HPV检测进行筛查；所有方案都将在各种预算和能力限制下进行评估。这一综合方法将使政策制定者能够在同时关注艾滋病毒和宫颈癌的干预措施实施时，而不是在使用以单一疾病为重点的方法时，查看成本和结果的变化。CCPPZ的过程评估和利益攸关方评估将提供最佳做法、关键经验教训、创新融资选择的审查，以及指导大规模计划实施的障碍和促进者的综合。为了确保调查结果可推广到其他撒哈拉以南非洲国家，我们将积极聘请非洲国家的卫生专业人员，并将在专门为此目的召开的两个研讨会上传播和辩论调查结果。

 DESCRIPTION (provided by applicant): Although several cervical cancer screening programs and demonstrations have taken place in southern Africa, only limited evaluations in the real-world setting have assessed program effectiveness, cost, and barriers/facilitators. Furthermore, even though numerous projects have been initiated, only a few successful programs are in operation today. Lessons learned from successful programs have not been synthesized and disseminated to foster scale-up of cost-effective implementation strategies. Given the substantial prevalence of human immunodeficiency virus (HIV) in southern Africa, which significantly increases the risk for cervical cancer, there is an urgent need to scale up preventio and screening services. The specific aims of the proposed research to address the gaps in the evidence base are as follows: Aim 1: Perform systematic process evaluation of the successful Cervical Cancer Prevention Program in Zambia (CCPPZ) to identify lessons for scaling up services in other sub-Saharan countries. Aim 2: Undertake comprehensive assessment of stakeholder perspectives on current program operations to identify barriers and facilitators and innovative financing arrangements to ensure sustainability. Aim 3: Develop a novel microsimulation model to assess cost and effectiveness of interventions and strategies for scaling up cervical cancer prevention and screening at the population level under real-world conditions that include budget and capacity constraints. Successful implementation of the project aims will provide evidence-based implementation guidelines on the optimal selection of prevention and screening interventions to reduce incidence of and mortality from cervical cancer. We will model the impact of behavior change (for example, sexual behavior affects rate of HIV and human papillomavirus [HPV] infections), prevention with HPV vaccination, and screening with visual inspection techniques and the new rapid HPV test; all scenarios will be evaluated under a variety of budget and capacity constraints. This comprehensive approach will allow policymakers to view the changes in cost and outcomes when interventions focusing on both HIV and cervical cancer are implemented rather than when a single-disease-focused approach is used. The process evaluation of CCPPZ and stakeholder assessment will provide best practices, key lessons, review of innovative financing options, and synthesis of barriers and facilitators to guide large-scale program implementation. To ensure generalizability of the findings to other sub-Saharan African nations, we will actively engage health professionals from African countries, and the findings will be disseminated and debated in two symposiums specifically convened for this purpose.