Towards Cervical cancer elimination: Implementation and scale-up of a single-visit, screen-and-treat approach with thermal ablation for sustainable cervical cancer prevention services in Kenya

摘要 本申请是根据特别利益通知（NOSI）（编号为NOT-CA-23）提交的， 038“NCI全球肿瘤学指导研究的行政补充”，并提出了一个 对我们的母公司R 01 CA 258590的行政补充。 背景 虽然有预防和治疗宫颈癌的战略，但它仍然是死亡的主要原因 于撒哈拉以南非洲的宫颈癌前病变的及时筛查、早期诊断和治疗 是减少疾病负担的关键。目前的治疗目标集中在消融方法，但 是需要不同治疗的妇女，可以是切除、子宫切除或放射治疗。我们会进行 一项关于肯尼亚妇女的混合方法研究，这些妇女患有宫颈癌前病变， 消融治疗，并通过我们的研究转介其他治疗-很少有研究可用于这一组。 妇女将从父母补助的TIBA诊所招募。我们将通过以下两个目标进行评估： 目标1：评估障碍和促进因素（卫生系统，卫生保健提供者和客户层面）， 为癌前病变筛查呈阳性且不适合接受治疗的妇女提供转诊和联系护理; 消融治疗我们将进行半结构化调查、重点小组讨论和深入研究 访谈，从卫生保健提供者和客户那里获得有关障碍和促进因素的信息。 目的2a：确定患有癌前宫颈病变且不适合消融的女性比例 在四个月内接受治疗的人。 所有筛查呈阳性且不符合消融治疗条件的女性将被邀请参加本研究。 研究并随访四个月，以确定他们是否接受治疗。 目标2b：为癌前筛查呈阳性的妇女绘制现有转诊服务流程图 病变且不适合进行消融治疗，重点是确定造成障碍的步骤 获得治疗。 四到五名癌症前病变筛查呈阳性但不适合接受 将与热消融和医疗保健提供者面谈，以进行血流标测。壁垒和 在流程图绘制过程中，将对治疗访问的促进者进行编目 本研究的目的是了解宫颈癌护理连续体的瓶颈， 这些妇女的转诊和联系。这将构成未来研究的基础， 为接受治疗的宫颈癌前期病变妇女提供综合服务。

ABSTRACT This application is submitted in response to the Notice of Special Interest (NOSI) identified as NOT-CA-23- 038 “Administrative Supplements for NCI Global Oncology Mentored Research” and proposes an administrative supplement to our parent award R01CA258590. Background While prevention and treatment strategies exist for cervical cancer, it remains the leading cause of mortality in Sub-Saharan Africa. The timely screening, early diagnosis and treatment of precancerous cervical lesions is key in reducing the disease burden. Current treatment goals have focused on ablative methods but there are women who require different treatment either by excision, hysterectomy, or radiotherapy. We will conduct a mixed methods study on Kenyan women with precancerous cervical lesions who are not amendable to ablative therapy and referred by our study for other treatment- little research is available for this group. Women will be recruited from the parent grant TIBA clinics. We will evaluate this via the following two aims: AIM 1: Evaluate the barriers and facilitators (health system, health care provider and client levels) in the referral and linkage to care for women who screen positive for pre-cancerous lesions and not amenable to ablative therapy. We shall conduct semi-structured surveys, focused group discussions and in-depth interviews to gain information on the barriers and facilitators from the health care providers and clients. AIM 2a: Determine the proportion of women with pre-cancerous cervical lesions and not amenable to ablation therapy who access treatment within a four-month period. All women who are screen-positive and not eligible for ablative therapy will be invited to participate in this study and followed up for a period of four months to determine whether they are treated or not. AIM 2b: Conduct flow mapping of existing referral services for women who screen positive for pre-cancer lesions and not amenable for ablative therapy with a focus on identifying the steps that create barriers to treatment access. A sample of four to five women who screen positive for pre-cancer lesions but who are not amenable to thermal ablation and health care providers will be interviewed to perform flow mapping. Barriers and facilitators to treatment access will be catalogued during the flow mapping process The objective of this study is to understand the bottlenecks in the cervical cancer care continuum following referral and linkage of these women. This will form the basis of future studies that will enhance seamless integration for women with precancerous cervical lesions referred for treatment.