Pilot of a network-driven, advocacy intervention to promote cervical cancer screening in Uganda

项目总结 宫颈癌(CC)是最常见的癌症，约占所有癌症相关死亡的25% 乌干达的妇女，这是世界上发病率最高的国家之一。增加负担的是一般的 乌干达缺乏对CC及其筛查的了解和社会耻辱，那里的终生CC筛查是 估计低至5%。迫切需要在乌干达增加CC筛查，以确保及时和 救命治疗，以及需要加强开展行为和保健服务的能力 在当地研究人员和服务提供商中与CC和其他污名化条件有关的研究。这些 需求直接符合PAR-19-059及其改善低收入人群非传染性疾病预防和治疗的目标 资源设置和当地研究能力，以实现这一目标。因此，拟议的干预试点研究 寻求(1)赋予有CC风险(WLCCR)的妇女权力，定义为接受过癌症前期治疗 或癌症损害，在其社交网络中倡导对女性进行CC筛查和早期治疗，以及 (2)聘用和培训当地公共卫生研究人员和程序员。拟议中的干预是基于理论 社会扩散、认知一致性和社会影响力，以及我们自己最近开发和测试的团队 动员乌干达艾滋病毒携带者成功地成为艾滋病毒预防的变革推动者的干预措施 在他们的社交网络中。干预的结果是减少了对艾滋病毒的污名，增加了对宣传的参与 以及在训练有素的参与者中披露艾滋病毒，并在其网络中增加艾滋病毒检测和避孕套的使用 会员。干预措施积极针对内化污名、披露决策、积极生活和 宣传沟通技能--所有这些技能在CC的背景下都是同样重要的，因此我们计划适应 在CC控制的背景下，这种前景看好的干预方法。在拟议研究的第一阶段，我们会进行 与WLCCR和社交网络中的女性组成的焦点小组，以了解促进者和障碍 成功地进行宣传，并获得干预设计方面的反馈。第二阶段借鉴了第一阶段的调查结果，以及 根据我们先前在艾滋病毒背景下对干预模式的评估，开发和调整干预措施 CC的背景。在第三阶段，我们将在40个WLCCR中试点干预，其中20个将随机 被分配参加干预的人，20人被分配到等待名单控制。评估将按基准进行管理 和6个月的索引参与者以及每个索引参与者的最多三个女性社交网络成员 (总计最多120个)。主要结果是在参与的社交网络成员中进行CC筛查。如果成功， 这种干预模式不仅有可能影响CC筛查和治疗的吸收，而且还可能建立 一种可应用于其他健康状况和非传染性疾病的范例。这项研究的主要目的是评估 团体干预促进CC筛查和治疗的可行性、可接受性和初步效果 治疗；确定与成功宣传有关的特征；并提高当地进行 公共卫生CC控制研究及基于社会网络的干预和测量方法的使用。

PROJECT SUMMARY Cervical cancer (CC) is the most common cancer and accounts for ~25% of all cancer related deaths among women in Uganda, which has one of the highest incidence rates in the world. Adding to the burden is the general lack of knowledge about, and social stigma towards CC and its screening in Uganda, where lifetime CC screening is estimated to be as low as 5%. There is a dire need to increase CC screening in Uganda to ensure timely and lifesaving treatment, as well as the need to enhance the capacity to conduct behavioral and health services research related to CC and other stigmatizing conditions among local researchers and service providers. These needs are directly in line with PAR-19-059 and its goal of improving prevention and treatment of NCDs in low resource settings, and local research capacity to target this goal. Accordingly, the proposed intervention pilot study seeks to (1) empower women living with CC risk (WLCCR), defined as having received treatment for pre-cancerous or cancerous lesions, to advocate for CC screening and early treatment among women in their social networks, and (2) engage and train local public health researchers and programmers. The proposed intervention draws on theories of social diffusion, cognitive consistency, and social influence, and our own recently developed and tested group intervention that mobilized people living with HIV in Uganda to successfully act as change agents for HIV prevention within their social networks. The intervention resulted in reduced HIV stigma, increased engagement in advocacy and HIV disclosure among the trained participants, and increased HIV testing and condom use among their network members. The intervention actively targeted internalized stigma, disclosure decision making, positive living, and advocacy communication skills– all of which are equally relevant in the context of CC, resulting in our plan to adapt this promising intervention approach to the context of CC control. In Phase 1 of the proposed study, we will conduct focus groups with WLCCR and women in their social networks to understand facilitators of and barriers to successful advocacy and elicit feedback on the intervention design. Phase 2 draws upon findings of Phase 1, and from our prior evaluation of the intervention model in the context of HIV, to develop and adapt the intervention for the context of CC. In Phase 3, we will pilot the intervention among 40 WLCCR, 20 of whom will be randomly assigned to take part in the intervention, and 20 to the wait-list control. Assessments will be administered at baseline and month 6 to index participants as well as up to three female social network members of each index participant (up to 120 total). The primary outcome is CC screening among participating social network members. If successful, this intervention model has the potential to not only impact uptake of CC screening and treatment, but also establish a paradigm that can be applied to other health conditions and NCDs. The primary aims of the study are to assess the feasibility, acceptability and preliminary efficacy of the group intervention to promote CC screening and treatment; identify characteristics associated with successful advocacy; and increase local capacity for conducting public health research on CC control and use of social network-based intervention and measurement methods.