Adaptation and implementation of a patient navigation program for cervical cancer screening across contexts in Senegal

项目摘要 到2030年，全球宫颈癌死亡率预计将增加42%，达到442，926例死亡。目前 85%的宫颈癌发病率和87%的宫颈癌死亡发生在低收入和中等收入国家 （LMIC）。在很大程度上，由于宫颈癌筛查服务的利用率低，塞内加尔在全球排名第17位。 宫颈癌的发病率。对于该国农村地区40至49岁的妇女， 筛查率很低，不到2%。因此，妇女经常出现大多数可预防的晚期 癌的二级预防计划（宫颈癌筛查）对于有效实现全球 消除人类乳头瘤病毒相关癌症的进展。然而，相当大的背景 低收入国家在地理和卫生系统水平上的差异明显阻碍了社区的发展 一个实施方案的响应。从资源较多国家吸取的经验教训表明， 发病率和死亡率下降，通过早期发现和适当的随访， 向上和治疗。先前在塞内加尔的努力和试点研究表明，采用速度缓慢，后续行动不力， 筛查呈阳性的妇女的治疗率低。 患者导航是一种消除筛查、及时诊断和随访障碍的策略， 改善弱势群体的癌症预后。在高收入国家，患者导航 在解决通信、信息、医疗系统 和情感障碍，以及时照顾所有阶段的癌症护理连续体，包括检测， 诊断、治疗和治疗后生活质量。患者导航程序增强了对护理的访问， 提高自我效能，维持患者对护理的参与，并已被证明可以改善癌症 在这方面，我们强调，我们的工作成果，特别是在边缘化群体、农村人口和贫困社区。 该项目的目标是在塞内加尔预防宫颈癌造成的不必要死亡。这种混合 方法研究对已确定的个人内部和社区层面的早期宫颈癌障碍作出反应 在那里的妇女中进行筛查、随访和治疗。我们将应用动态适应过程 研究循证宫颈癌患者导航项目在城乡的适应性 塞内加尔的具体情况，衡量干预有效性，并评估方案实施情况 结果。通过研究患者导航程序在低收入和中等收入国家的适应过程， 在这个国家，我们将把实施科学应用到一个新的环境中。特别关注如何适应 回应癌症相关的耻辱和妇女在医疗保健决策中的自主权，我们的项目 展示了更多的创新。产生的过程知识将进一步推动我们的长期目标， 塞内加尔和其他中低收入国家的宫颈癌预防和控制方案 国家

PROJECT SUMMARY ABSTRACT Cervical cancer mortality is expected to increase by 42% to 442,926 deaths worldwide by 2030. Currently 85% of incident cervical cancers and 87% of cervical cancer deaths occur in low- and middle-income countries (LMIC). Due in large part to the low utilization of cervical cancer screening services, Senegal ranks 17th in the world for cervical cancer incidence. For women ages 40 to 49 in rural regions of the country the cervical cancer screening rate is very low at less than 2%. As a result women often present with mostly preventable late stage cancers. Secondary prevention programs (cervical cancer screening) are critical to effectively achieving global progress toward the elimination of human papillomavirus related cancers. However, considerable context variation across geographic- and health system-levels in LMICs markedly obstructs the community responsiveness of an implemented program. Lessons learned from higher resource countries show that incidence and mortality rates decline and early deaths are prevented with early detection and appropriate follow- up and treatment. Prior efforts and pilot studies in Senegal show that there is slow uptake, poor follow-up, and low treatment rates for women who are screened positive. Patient navigation is a strategy to eliminate barriers to screening, timely diagnosis, and follow-up to improve cancer outcomes in vulnerable populations. In high-income countries, patient navigation has demonstrated considerable effectiveness in its ability to address communication, information, medical system, and emotional barriers to timely care across all phases of the cancer care continuum, including detection, diagnosis, treatment, and post-treatment quality of life. Patient navigation programs enhance access to care, promote self-efficacy, and sustain patient engagement with care, and have been shown to improve cancer outcomes, particularly among marginalized groups, rural populations, and impoverished communities. The goal of this project is to prevent unnecessary deaths due to cervical cancer in Senegal. This mixed methods research responds to identified intrapersonal- and community-level barriers to early cervical cancer screening uptake, follow-up, and treatment among women there. We will apply the Dynamic Adaptation Process to study the adaptation of an evidence-based cervical cancer patient navigation program in urban and rural contexts of Senegal, measure the intervention effectiveness, and evaluate programmatic implementation outcomes. By studying the process of adaptation of a patient navigation program in a low- and middle-income country, we will apply implementation science to a novel context. With a particular focus on how the adaptation responds to cancer-related stigma and women’s autonomy in healthcare decision-making, our project demonstrates additional innovation. The process knowledge generated will further our long-term goal to inform the national cervical cancer prevention and control programs in Senegal and other low- and middle-income countries.