Project 1

尽管在撒哈拉以南非洲地区普及抗逆转录病毒疗法已有十多年， 非洲（SSA），卡波西肉瘤（KS）仍然是艾滋病毒/艾滋病患者最常见的恶性肿瘤 （PLWH），造成严重的发病率和死亡率。与美国相比，撒哈拉以南非洲地区的抗逆转录病毒治疗实施情况 导致KS病例显著减少。对于撒哈拉以南非洲的许多艾滋病毒携带者来说，与卫生保健的唯一联系是 艾滋病护理和治疗中心（CTC）。CTC护理提供者对早期KS缺乏认识 和PLWH，以及当疾病出现在 CTC的艾滋病毒管理设置可能会导致延迟报告，最终导致不良结果。相比 宫颈癌，筛查和早期检测方法已成功纳入艾滋病毒 由于缺乏对PLWH的护理，因此缺乏早期检测、诊断和治疗KS的努力。由于KS主要表现为 皮肤，将KS检测与HIV管理相结合，如在宫颈癌中所做的那样，以进行早期检测 应该很容易提高早期KS检测，明确诊断，并与护理的联系。作为艾滋病毒服务 管理是通过整个SSA的CTC进行的，这些社区相关的结构是 整合知识共享干预措施的最佳平台，可用于增加早期展示、早期知识共享 诊断和早期治疗。在这项研究中，我们会推行一套综合教育方案， 提高认识，并向艾滋病毒携带者、卫生保健提供者传授早期检测和诊断KS的技能， 和社区工作者。这套方案包括在儿童技术中心举办的经常性教育课程， 检测，诊断，并启动KS治疗早期，以改善PLWH的结果。还将包括一个 以社会网络为基础的战略，以提高这种实施方案的可持续性。我们 假设综合护理方法将增加检测到的PLWH的数量和比例， 早期KS，从而改善早期KS诊断和治疗，以改善KS结果。有3个具体 目标。1)在坦桑尼亚的社区治疗中心实施知识共享教育、早期发现、诊断和与护理方案的联系 和赞比亚2)加强和维持早期KS检测，诊断，并通过护理计划的联系， 在坦桑尼亚和赞比亚实施基于社区网络的响应者驱动抽样战略。3)到 评估在现有的艾滋病护理中整合早期KS检测、诊断和RDS策略的有效性 为坦桑尼亚和赞比亚的艾滋病毒携带者和艾滋病患者提供服务。总之，这将决定是否敏感的供应商， 和PLWH相结合的艾滋病毒护理和早期KS检测方法是有效的，可行的设置。 这项研究是重要的，因为它将增加比例PLWH检查早期KS检测，诊断， and linked关联to cancer癌症care护理.它还将侧重于授权和装备供应商和PLWH， 知情的健康决定。坦桑尼亚和赞比亚可以很容易地采用和扩大这一做法， 随后在其他SSA中，以促进KS的早期诊断和治疗。

Despite more than a decade of implementing universal access to antiretroviral therapy (ART) in sub-Saharan Africa (SSA), Kaposi’s sarcoma (KS) remains the most common malignancy in people living with HIV/AIDS (PLWH), causing significant morbidity and mortality. Compared to the US, ART implementation in SSA has not resulted in a significant reduction of KS cases. For many PLWH in SSA, the only connection to health care is through HIV care and treatment centers (CTC). Lack of recognition of early KS by both CTC care providers and PLWH, and ineffective connection to diagnosis, care, and treatment when the disease presents in the setting of HIV management at CTC may foster late presentation and ultimately, poor outcomes. Compared to cervical cancer, where screening and early detection approaches have been successfully integrated into HIV care for PLWH, efforts to detect, diagnose, and treat KS early are lacking. Since KS presents mostly cutaneous, coupling KS detection to HIV management as has been done in cervical cancer for early detection should readily improve early KS detection, definitive diagnosis, and linkage to care. As services for HIV management are conducted through CTCs throughout SSA, these community-associated structures are the best platform to integrate KS interventions and can be leveraged to increase early-stage presentation, early KS diagnosis, and early treatment initiation. In this study, we will implement an integrated education package to raise awareness and to impart the skills for early KS detection and diagnosis to PLWH, health care providers, and community workers. This package includes recurrent educational sessions at CTCs in order to enhance detection, diagnosis, and to initiate KS treatment early to improve outcomes of PLWH. It will also include a social network-based strategy to enhance the sustainability of such an implementation program. We hypothesize that an integrated care approach will increase the number and proportion of PLWH detected with early KS, thereby improving early KS diagnosis and treatment to improve KS outcomes. There are 3 Specific Aims. 1) Implement KS education, early detection, diagnosis, and linkage to care program at CTCs in Tanzania and Zambia. 2) To enhance and sustain early KS detection, diagnosis, and linkage to care program through a community network-based respondent-driven sampling (RDS) strategy in Tanzania and Zambia. 3) To evaluate the effectiveness of integrating early KS detection, diagnosis, and RDS strategy in existing HIV care services for PLWH in Tanzania and Zambia. Together, this will determine whether sensitization of providers and PLWH to a combined HIV care and early KS detection approach is efficacious and viable in the setting. This study is significant, as it will increase the proportion of PLWH examined for early KS detection, diagnosed, and linked to cancer care. It will also focus on empowering and equipping providers and PLWH to make more informed health decisions. This can be readily adopted and scaled up in Tanzania and Zambia, and subsequently in other SSA to facilitate early KS diagnosis and treatment.