Full Project 2: Determining Optimal Anal Cancer Prevention Strategies for HIV-Infected Individuals Living in Puerto Rico

完整项目2：确定最佳肛门癌预防策略 针对居住在波多黎各的艾滋病毒感染者 项目摘要/摘要 肛门鳞状细胞癌(SCCA)是艾滋病毒携带者(PLWH)中的一种流行病。研究 在美国和波多黎各(PR)，报告说在PLWH中患SCCA的风险是 普通人口。基于专家意见的指南建议对PLWH进行肛门癌筛查。至 通知循证筛查的使用，目前正在进行研究；然而，这些研究的结果 将不能推广到公共关系中的PLWH。这是因为种族和民族构成、疾病流行、 PR患者的肛门癌治疗结果，包括费用和生活质量(QOL)，有很大不同。 这增加了在PR中对PLWH进行专门和单独的肛门癌筛查评估的重要性 其中大部分是西班牙裔。此外，没有正在进行的或未来的随机对照试验(RCT) 将评估筛查的死亡率效益，因为评估“不筛查”的手臂是不道德的。因此，一个 数学模型(结合公共关系中PLWH特有的流行病学、成本和生活质量数据)可以 作为一种独特的工具来评估生存和生活质量的好处以及筛查的成本效益 目标是促进健康和以价值为基础的护理。我们的首要目标是优化肛门癌预防 公共关系中的PLWH。我们将研究SCCA的流行病学，并评估SCCA术后的成本和生活质量 治疗将通知一个数学模型，该模型将确定PR中PLWH的最佳筛查方案。我们 还寻求研究减少筛查中潜在不确定性所必需的关键障碍和促进者 采用和遵守筛查建议。我们的具体目标是：(1)确定流行病学， 在生活在PR中的PLWH中，肛门癌前病变和癌症的费用和生活质量测量。(2)找出障碍和 肛门癌筛查的促进者，坚持肛门癌筛查和高级别鳞状细胞癌 上皮内病变(HSIL)治疗。(3)构建并执行数学模型以确定有效 以及在PR的PLWH中检测肛门癌前病变的经济有效的筛查策略。(4)使用价值 信息(VOI)分析以确定高优先级的未来临床研究，以提高筛查准确性 以及坚持筛查建议。在目标1和目标2中，我们将执行以下次级数据分析 现有数据库，并开展焦点小组和三项流行病学研究(两项横断面研究 和一项队列研究)，涉及患者招募。通过这些活动确定的参数将通知 开发SCCA筛选模型和执行VOI分析(目标3和4)。结束 这项研究的结果将被用来为PR中针对PLWH的最佳肛门癌筛查方案提供信息。

FULL PROJECT 2: DETERMINING OPTIMAL ANAL CANCER PREVENTION STRATEGIES FOR HIV-INFECTED INDIVIDUALS LIVING IN PUERTO RICO PROJECT SUMMARY/ABSTRACT Squamous cell carcinoma of the anus (SCCA) is an epidemic among persons living with HIV (PLWH). Studies in the US and Puerto Rico (PR) have reported >80-fold risk of SCCA among PLWH when compared with the general population. Guidelines based on expert opinion recommend anal cancer screening for PLWH. To inform evidence-based use of screening, studies are currently underway; however, findings from those studies will not be generalizable to PLWH in PR. This is because racial and ethnic composition, disease prevalence, anal cancer treatment outcomes including cost and quality of life (QOL) substantially differ for PLWH in PR. This increases the importance of anal cancer screening evaluation specifically and separately for PLWH in PR majority of which are of Hispanic origin. Furthermore, no ongoing or future randomized controlled trials (RCTs) will evaluate mortality benefits of screening as it unethical to evaluate a “no screening” arm. As such, a mathematical model (incorporating epidemiological, cost, and quality of life data specific to PLWH in PR) could be utilized as a unique tool to evaluate survival and QOL benefits and cost-effectiveness of screening with the goal to promote health and value-based care. Our overarching goal is to optimize anal cancer prevention for PLWH in PR. We will study the epidemiology of SCCA, and evaluate the cost of and QOL after SCCA treatment to inform a mathematical model that will determine the best screening regimen for PLWH in PR. We also seek to study critical barriers and facilitators necessary to decrease potential uncertainty in screening adoption and adherence to screening recommendations. Our Specific Aims are: (1) Determine epidemiological, cost, and QOL measures of anal precancer and cancer among PLWH living in PR. (2) Identify barriers to and facilitators of screening for anal cancer, and adherence to anal cancer screening and high-grade squamous intraepithelial lesions (HSIL) treatment. (3) Construct and execute a mathematical model to determine effective and cost-effective screening strategies for the detection of anal precancer among PLWH in PR. (4) Use value of information (VOI) analysis to determine high priority future clinical studies to improve screening accuracy and adherence to screening recommendations. In Aims 1 and 2, we will perform secondary data analyses of existing databases, and conduct focus groups and three epidemiologic studies (two cross-sectional studies and one cohort study) that involve patient recruitment. Parameters identified through these activities will inform the development of the SCCA screening model and the execution of the VOI analysis (Aims 3 and 4). The end result of this study will be utilized to inform an optimal anal cancer screening regimen specific to PLWH in PR.