Implementing and Evaluating the Cancer Tracking System (CATSystem): A systems level intervention to improve Cervical Cancer screening, treatment referral and follow up in Kenya

摘要 在肯尼亚，宫颈癌（CC）占女性生殖道癌症的80%以上，4但只有16.4%。 5这远远低于世界卫生组织（世卫组织）的目标，即70%的符合条件的妇女接受CC筛查。 筛查覆盖率;优先考虑感染艾滋病毒的妇女，因为她们患CC的风险更高。 接受筛查并转诊接受现场（癌前病变）或非现场（癌性）治疗的妇女 病变）在治疗期间经历高失访率（30-60%）。许多系统和患者水平 各种障碍继续存在，导致发病率和死亡率居高不下，而这本来是可以预防的。创新和 可行的电子卫生战略改善了临床结果，并在资源匮乏的情况下留住了病人， 可能是实现肯尼亚CC筛查和治疗覆盖率全球目标的关键。以帮助解决 系统层面的障碍，CC筛选，治疗和后续行动，我们的团队与最终用户（供应商和 开发癌症跟踪系统（CATSystem），这是一个基于网络的算法生成工具， 通过治疗促进遵循指南的CC筛查和保留。我们在一个 肯尼亚一家医院，发现癌症前病变的现场治疗率和 与服役期相比，试验期间筛查阳性的妇女更高（提高2.5至5倍） 六个月前的规定。该项目的目标是严格评估有效性，实施， CAT系统的成本效益，以提高筛查率，治疗，转介，和后续护理在一个 在10家肯尼亚政府医院进行的配对、整群随机对照试验（5种干预措施，5种标准干预措施， 护理（SOC））。本研究的具体目标是（1）实施和评估CAT系统的有效性， 改善遵循指南的CC筛查、治疗、转诊和随访，（2）评估可行性， 在政府运营的设施中采用以人为本的设计实施CAT系统的可接受性 方法，和（3）计算成本和成本效益的CAT系统，以提高质量调整后的生活 年获得。CC癌症死亡可以通过早期发现和治疗来预防。本研究将评估 CAT系统在改善CC筛查、治疗、转诊、随访方面的公共卫生影响， 扩大到其他低资源环境的可行性。

Abstract In Kenya, cervical cancer (CC) contributes to over 80% of female reproductive-tract cancers,4 yet only 16.4% of eligible women are screened for CC.5 This is far below the World Health Organization's (WHO) target if 70% screening coverage; prioritizing access among women living with HIV given their higher risk of developing CC. Women who are screened and referred for treatment onsite (precancerous lesions) or off-site (cancerous lesions) experience high rates of loss to follow up (30-60%) during treatment. Many system and patient level barriers continue to exist resulting in significant morbidity and mortality that could be prevented. Innovative and feasible eHealth strategies have improved clinical outcomes and patient retention in low resource settings and could be key to reaching global targets for CC screening and treatment coverage in Kenya. To help address system level barriers to CC screening, treatment, and follow-up, our team worked with end-users (providers and patients) to develop the Cancer Tracking System (CATSystem), a web-based, algorithm generated tool to promote guideline adherent CC screening and retention through treatment. We piloted the CATSystem in a Kenyan hospital and found that rates of onsite treatment for precancerous lesions and referral for treatment for women with positive screens were higher (2.5 to 5-fold improvement) during the pilot compared to service provision six months prior. The goal of this project is to rigorously evaluate the efficacy, implementation, and cost-effectiveness of the CATSystem to improve rates of screening, treatment, referral, and follow-up care in a matched, cluster randomized controlled trial in 10 Kenyan government hospitals (5 intervention, 5 standard of care (SOC)). Specific aims (SA) of the study are to (1) Implement and evaluate the efficacy of CATSystem to improve guideline adherent CC screening, treatment, referral and follow up, (2) Assess feasibility and acceptability of implementation of CATSystem in government run facilities using a human centered design approach, and (3) Calculate the costs and cost-effectiveness of the CATSystem to increase quality adjusted life years gained. CC cancer deaths can be prevented with early detection and treatment. This study will evaluate the public health impact of the CATSystem in improving CC screening, treatment, referral, follow-up, and the feasibility of scale up to other low resource settings.