A Mentored Research Experience in Investigating the Socio-geographic Expansion to Liberia of a Novel Campaign-based Public Health Approach to Cervical Cancer Prevention

本申请是为了回应被确认为非CA-CA的特殊利益通知(NOSI)而提交的 23-038.撒哈拉以南非洲的妇女承受着世界上最大的宫颈癌负担，而 原因很清楚：缺乏HPV疫苗接种、癌症前筛查和治疗。为表彰 鉴于宫颈癌的全球差异和预防解决方案的存在，世卫组织通过了一项 消除宫颈癌的全球战略。它要求90%的疫苗接种覆盖率，70%的筛查 覆盖和治疗90%的宫颈疾病患者。然而，这一战略缺乏一个明确的 实施路径。此外，受影响最严重的地区研究人员短缺，例如 在撒哈拉以南非洲，这妨碍了产生针对具体情况的证据以缩小差距的能力。 通过家长奖U54 CA254571，我们在东非开发了我们所称的基于活动的 以公共卫生方法解决宫颈癌预防干预措施实施中存在的差距 控制力。我们的方法是由社区卫生工作者领导动员符合条件的社区成员 参加当地的健康博览会，在那里接种HPV疫苗和进行基于HPV的宫颈癌筛查(通过自我 收集)，然后对那些被发现通过移动治疗感染HPV的人进行消融治疗 团队在社区的一个方便的中心位置。在肯尼亚和乌干达，这些基于社区的 竞选活动得到了广泛的关注和好评。Not-CA-23-038对我们来说是一个很好的机会 将我们在东非的工作扩展到另一个资源有限的社会地理环境--西非的利比里亚 -同时为早期低收入和中等收入国家提供研究实践 利比里亚(LMIC)调查员(ESLI)。因此，我们的具体目标是： 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 通过以运动为基础的公共卫生方法在利比里亚控制宫颈癌。 目标2：确定未参与任何社区HPV的因素 在利比里亚，在少女中接种疫苗或在妇女中进行宫颈癌筛查。 目标3：为利比里亚埃斯利人Cozie Gwaikolo博士提供职业发展指导经验。 为了达到我们的目标，我们将评估以社区为基础的综合宫颈癌疫苗接种和 筛查计划(在家长资助U54 CA254571中制定)，将由我部实施 卫生部在利比里亚的合作伙伴。评估将包括以下方面的可接受性评估和后续行动 健康博览会的参与者以及完成后的基于人口的挨家挨户的社区调查 活动，这将决定该计划的接受度和不参与的原因。由此得出的结论 这项工作可能会形成最终消除该地区宫颈癌的蓝图。最后，该项目是 对于Gwaikolo博士来说，这是他寻求成为独立首席研究员的一个无与伦比的机会。

This application is being submitted in response to the Notice of Special Interest (NOSI) identified as NOT-CA- 23-038. Women in sub-Saharan Africa bear the greatest burden of cervical cancer in the world, and the reasons are clear: lack of HPV vaccination, screening for pre-cancer, and treatment. In recognition of the global disparities surrounding cervical cancer and that preventive solutions exist, the WHO has adopted a global strategy for cervical cancer elimination. It calls for 90% vaccination coverage, 70% screening coverage, and treatment of 90% of those with cervical disease. Lacking in this strategy, however, is a clear path to implementation. Furthermore, a shortage in the research workforce in areas most affected, such as sub-Saharan Africa, hinders the ability for context-specific evidence to be generated to reduce the disparities. Through parent award U54 CA254571, we have developed in East Africa what we call a campaign-based public health approach to address gaps in the implementation of preventive interventions for cervical cancer control. Our approach features Community Health Worker-led mobilization of eligible community members to attend local Health Fairs at which HPV vaccination and HPV-based cervical cancer screening (via self- collection) are offered, followed by ablative therapy for those found to be HPV-infected by a Mobile Treatment Team at a convenient central site in the community. In Kenya and Uganda, these community-based campaigns have been well-attended and well-accepted. NOT-CA-23-038 is a well-timed opportunity for us to expand our work in East Africa to another resource-limited socio-geographic context — Liberia, in West Africa — while concurrently providing a research practicum for an early-stage low- and middle-income country (LMIC) investigator (ESLI) from Liberia. Accordingly, our specific aims are to: Aim 1: Evaluate the uptake and acceptability of HPV vaccination and cervical cancer screening offered through a campaign-based public health approach to cervical cancer control in Liberia. Aim 2: Determine the factors explaining non-participation in either community-based HPV vaccination among adolescent girls or in cervical cancer screening among women in Liberia. Aim 3: Provide a mentored career development experience for Dr. Cozie Gwaikolo, a Liberian ESLI. To address our aims, we will evaluate a community-based integrated cervical cancer vaccination and screening program (developed in parent grant U54 CA254571), which will be implemented by our Ministry of Health (MOH) partners in Liberia. Evaluation will include assessment of acceptability and follow-up among Health Fair attendees as well as a population-based door-to-door community survey after completion of the campaign, which will determine uptake of the program and reasons for non-participation. Findings from this work may form a blueprint for the ultimate elimination of cervical cancer in the region. Finally, the project is an incomparable opportunity for Dr. Gwaikolo in his quest to become an independent principal investigator.