The Empilisweni Center for Women's Health - Advancing Implementation of Equitable Cervical Cancer Control

抽象(总体)。宫颈癌是低收入和低收入地区妇女癌症相关死亡的主要原因 中等收入国家(LMIC)，而且几乎完全可以预防。1、2-4 2020年，世界卫生组织 世界卫生组织(WHO)宣布了一项全球战略，以加快在今年年底之前消除宫颈癌 千年发展目标，在15岁之前为90%的女孩接种疫苗，对70%的妇女进行筛查，并治疗90%的治疗 世卫组织建议，基于有效性和安全性的强有力的经验证据，符合条件的女性增加2030.5 基于人乳头状瘤病毒(HPV)的检测，然后立即治疗癌前病变，以及 在LMIC中实现宫颈癌控制的称为筛选和治疗(SAT)的方法。6我们的研究团队 在哥伦比亚大学欧文医学中心(CUIM)和开普敦大学(UCT)，通过近 在Khayelitsha宫颈癌筛查计划(KCCP)下进行了30年的合作 证明基于HPV的筛查和治疗的安全性和有效性的开创性临床试验。7-9 虽然在全球和国家准则中得到认可，但SAT办法尚未得到广泛实施。 像大多数LMIC一样，南非正在努力解决如何运作和促进普遍和公平的 在医疗保健环境中整合和采用HPV筛查。利益相关者表示，缺乏针对具体情况的信息 实施、成本和融资是重要的实施障碍。与RFA-CA-22-019和 KCCP和西开普省卫生部(WCDoH)之间的伙伴关系，我们建议 Empiisweni(IsiXhosa是治疗场所)妇女健康中心，主要任务是 加速整合和扩大以循证为基础的干预措施，以公平消除宫颈癌 在资源有限的环境中的妇女中。由MPI领导；Denny(UCT)和Kuhn(CUIMC)，他创立了 加入KCCSP的还有MPI Castor(联系方式：CUIMC)、Mbatani(UCT)、Saidu(UCT)、Shelton(CUIMC)、 特赫拉尼法(CUIMC)；通过实施通知Arendse(UCT/WCDoH)和协作者Cloete(WCDoH) 科学框架和利益攸关方参与方法，我们建议：目标1：支持世卫组织的全球 在本世纪末通过公平融合加速消除宫颈癌的战略 可扩展、经济实惠的基于HPV的护理点筛查和治疗(POC-SAT)策略，以实现次要目标 到2030年筛查阳性妇女接受70%筛查和90%治疗的预防级联目标 南非西开普省；和目标2.促进公平一体化和可持续扩大 POC-SAT通过促进以下领域的有效协作、协调、能力建设和知识共享 多个关键利益相关者。到五年结束时，POC SAT将增加以下女性的比例 区域筛查和治疗，将补充集中的HPV检测，在经济上是可行的。我们会 在本区域领导执行研究和推进战略工作的能力得到加强 为宫颈癌控制的可扩展交付和创新筹资提供信息，以产生人口层面的影响。

Abstract (Overall). Cervical cancer is a leading cause of cancer-related deaths among women in low- and middle-income countries (LMICs), and it is almost entirely preventable.1,2-4 In 2020, the World Health Organization (WHO) announced a global strategy to accelerate the elimination of cervical by the end of this millennium by vaccinating 90% of girls by aged 15 and screening 70% of women and treating 90% of treatment eligible women by 2030.5 Based on strong empirical evidence of effectiveness and safety, the WHO recommends Human Papillomavirus (HPV)-based testing followed by immediate treatment of pre-cancerous lesions, an approach called screen-and-treat (SAT) for achieving cervical cancer control in LMICs.6 Our investigator team at Columbia University Irving Medical Center (CUIM) and the University of Cape Town (UCT), through a nearly thirty-year collaboration under the Khayelitsha Cervical Cancer Screening Program (KCCP), have conducted seminal clinical trials demonstrating the safety and effectiveness of HPV-based screening and treatment.7-9 Although endorsed in global and national guidelines, the SAT approach has not yet been widely implemented. Like most LMICs, South Africa is grappling with how to operationalize and promote the widespread and equitable integration and uptake of HPV screening in healthcare settings. Stakeholders cite a lack of context-specific implementation, costs, and financing as important implementation barriers. Aligned with RFA-CA-22-019 and in partnership between the KCCP and the Western Cape Department of Health (WCDoH), we propose the Empilisweni (isiXhosa for a place of healing) Center for Women’s Health with the overarching mission to accelerate the integration and scale-up of evidence-based interventions for equitable cervical cancer elimination among women in resource-constrained settings. Led by MPIs; Denny (UCT), and Kuhn (CUIMC), who founded KCCSP, will be joined by MPI Castor (Contact: CUIMC), Mbatani (UCT), Saidu (UCT), Shelton (CUIMC), Tehranifar (CUIMC); and Arendse (UCT/WCDoH) and collaborator Cloete (WCDoH) Informed by implementation science frameworks and stakeholder engagement approaches, we propose to: Aim 1: Support the WHO’s global strategy to accelerate the elimination of cervical cancer by the end of this millennium by equitably integrating scalable, affordable HPV-based point-of-care screen-and-treat (POC-SAT) strategies to achieve the secondary prevention cascade goal of 70% screening and 90% treatment of women who screen positive by 2030 in the Western Cape Province of South Africa; and Aim 2. Catalyze equitable integration and sustainable scale-up of POC-SAT by fostering effective collaboration, coordination, capacity-building, and knowledge sharing across multiple key stakeholders. By the end of the five years, POC SAT will increase the proportion of women who are screened and treated regionally, will complement centralized HPV testing, and be economically feasible. We will have a strengthened capacity for leading implementation research in the region and advanced work on strategies to inform scalable delivery and innovative financing of cervical cancer control for population-level impact.