Project 1: A Public Health Approach to Cervical Cancer Prevention in East Africa

撒哈拉以南非洲的妇女，特别是东非的妇女，承受着最大的宫颈负担 世界上的癌症，原因很清楚：缺乏广泛的HPV疫苗接种，缺乏前期筛查 癌症，缺乏早期发现，以及宫颈癌最有力的促进剂之一的高流行率 -艾滋病毒感染。值得注意的是，尽管在过去的几年中在艾滋病毒感染控制方面取得了很大进展 在非洲的十年里，宫颈癌控制方面的进展一直停滞不前。事实上，不断发生的 艾滋病毒的恶性并发症，如宫颈癌，有可能破坏成功。在……里面 认识到宫颈癌的相关性，世界卫生组织起草了一份全球宫颈癌战略 淘汰赛。它要求90%的HPV疫苗接种覆盖率，70%的筛查覆盖率，90%的 那些患有宫颈疾病的人。然而，这一战略缺乏一条通向实施的明确道路。 通过U54 CA190153的资助，解决有效预防措施实施方面的差距 对于宫颈癌的干预，我们开始在乌干达开发我们所称的公共卫生方法，以 预防宫颈癌。村卫生队主导的社区动员与社区动员相结合的方法 以社区为基础的自我收集的阴道样本用于HPV检测，并成立流动团队提供社区- 对HPV感染者进行基础消融治疗。这些基于社区的活动是可行的，很好- 出席并被广泛接受。鉴于这一方法取得了初步成功，乌干达卫生部 肯尼亚寻求与我们合作，将HPV疫苗接种添加到这种公共卫生方法中，该模式称为 宫颈癌综合预防计划(ICCPP)。卫生部将执行 当前提案的首要目标是对其进行评估。我们提出了三个具体目标： 目的1：评价HPV疫苗接种和宫颈癌筛查的接种率和可接受性 东非气候变化框架公约的组成部分； 目标2：确定未参加HPV疫苗接种的原因 在东非妇女中对少女或宫颈癌进行筛查和治疗；以及 目标3：评估HPV疫苗接种的综合公共卫生方法的成本和效率 以及东非的宫颈癌筛查。 为了达到我们的目标，我们将评估由我们的社区实施的完全基于社区的综合计划 卫生部在乌干达和肯尼亚的合作伙伴，在那里妇女接受宫颈癌筛查和 治疗和未完全接种HPV的青春期女孩接种疫苗。评估将 包括接受、可接受性、探索不参加的原因和费用。该项目测试了一种新的 非洲宫颈癌预防的范例--一种公共卫生方法，以达到最大数量的 女孩和妇女以最低的成本。这些发现可能会形成最终消除宫颈癌的蓝图。

Women in sub-Saharan Africa, and particularly East Africa, bear among the greatest burden of cervical cancer in the world, and the reasons are clear: lack of widespread HPV vaccination, lack of screening for pre- cancer, lack of early detection, and high prevalence of one of the most potent accelerants of cervical cancer — HIV infection. It is of note that while great strides have been made in HIV infection control in the last decade in Africa, progress in cervical cancer control has languished. Indeed, continued occurrence of malignant complications of HIV  such as cervical cancer  threaten to undermine the successes. In recognition of the relevance of cervical cancer, the WHO has drafted a global strategy for cervical cancer elimination. It calls for 90% HPV vaccination coverage, 70% screening coverage, and treatment of 90% of those with cervical disease. Lacking in this strategy, however, is a clear path towards implementation. Through funding from U54 CA190153, to address the gap in implementation of effective preventive interventions for cervical cancer, we began to develop, in Uganda, what we call a public health approach to cervical cancer prevention. The approach combined Village Health Team-led community mobilization with community-based self-collected vaginal specimens for HPV testing and a mobile team to provide community- based ablative treatment for those HPV-infected. These community-based campaigns were feasible, well- attended and well-accepted. Given the initial success of this approach, the Ministries of Health in Uganda and Kenya seek to partner with us to add HPV vaccination to this public health approach in a model called the Integrated Cervical Cancer Prevention Program (ICCPP). The Ministries of Health will implement the ICCPP, and the overarching goal of the current proposal is to evaluate it. We propose 3 specific aims: Aim 1: Evaluate the uptake and acceptability of the HPV vaccination and cervical cancer screening components of the ICCPP in East Africa; Aim 2: Determine the factors explaining non-participation in either HPV vaccination among adolescent girls or in cervical cancer screening and treatment among women in East Africa; and Aim 3: Assess the costs and efficiency of the integrated public health approach to HPV vaccination and cervical cancer screening in East Africa. To address our aims, we will evaluate an entirely community-based integrated program implemented by our Ministry of Health partners in Uganda and Kenya in which women undergo cervical cancer screening and treatment and adolescent girls who have not been fully HPV-immunized get vaccinated. Evaluation will include uptake, acceptability, exploration of reasons for non-participation and costs. The project tests a new paradigm in cervical cancer prevention in Africa — a public health approach to reach the greatest number of girls and women at lowest cost. Findings may form a blueprint for the ultimate elimination of cervical cancer.