Grant Number:	5U01CA190366-08 Interpret this number
Primary Investigator:	Tracy, J.
Organization:	University Of Maryland Baltimore
Project Title:	Translating Molecular Diagnostics for Cervical Cancer Prevention Into Practice
Fiscal Year:	2022

ABSTRACT/SUMMARY Cervical cancer, entirely preventable, remains the 4th most common cause of cancer incidence and mortality in women, with over 12 million new cases predicted in the next 50 years without sustained scale-up of HPV vaccination and cervical screening. More than 80% of the disease burden occurs in low- and middle-income countries (LMICs), reflecting inequitable availability and adoption of effective preventive strategies. Unfortunately, sustainable implementation of cervical screening and management for cervical cancer prevention has been elusive in LMICs, reflecting challenges of implementing complex health interventions in complex adaptive health systems. In the parent study, using participatory systems thinking as our `grand theory', we integrated various implementation science frameworks into the Integrative Systems Praxis for Implementation Research (INSPIRE) to guide multilevel stakeholders through four phases of an iterative cycle of implementation activities, enabling stakeholder-engaged adaptation of complex health technologies to local health system contexts. In Aim 1 of the continuation of this project, we will conduct a realist evaluation of stakeholders involved in the INSPIRE research, to gain an understanding of the mechanisms through which the INSPIRE activities led to successful adoption and rapid scale-up of HPV-based testing in a large health network in the Peruvian Amazon. In Aim 2 we propose to translate the INSPIRE research methodology into a generalizable implementation strategy (Aim 2) – “Adaptation, Scale-Up, Sustainability: Implementation by Systems Thinking” (ASSIST) - and develop an implementation toolkit to enable stakeholder-engaged implementation planning and context adaptation. In Aim 3, we will leverage the planned scale-up of HPV implementation plans from the Peruvian Ministry of Health to test the ASSIST implementation strategy for impact on screening coverage and management using an interrupted time series design, using the extended RE-AIM evaluation framework. In parallel, we will conduct a qualitative comparative case study to enable understanding of context-dependent mediators and modifiers to the success of the ASSIST implementation strategy (Aim 3). The realist evaluations are designed to examine `what works for whom, in what circumstances, in what respects, and how' vs assuming that one size fits all. Ultimately, meeting our proposal aims will advance public health, by providing a broadly generalizable process and toolkit for context-adaption of HPV-based screening and management that can be used in LMICs, and implementation science, by helping to reduce the evidence gap in implementation science for approaching scale-up and sustainability of complex health interventions in diverse contexts.




"The problem is not detection, it is treatment": Exploring Why Women Needing Pre-Cervical Cancer Care are Lost to Follow-Up at the Hospital in Iquitos, Peru.
Authors: Blum A.C. , Tessema R. , Nussbaum L. , Hidalgo C. , Ríos López E.J. , Meza-Sánchez G. , Morse R. , Brown J. , Reategui R.R. , Wong L. , et al. .
Source: Research Square, 2024-12-13 00:00:00.0; , .
EPub date: 2024-12-13 00:00:00.0.
PMID: 39711532
Related Citations

Catalyzing Change: Assessing Inner Setting Context of Cervical Cancer Prevention Efforts in Loreto, Peru, Prior to Transition from VIA to HPV Screen-and-Treat.
Authors: Nussbaum L. , Brown J. , Meza-Sánchez G. , Soto S. , Jurczuk M. , Vásquez J.V. , Grandez H.D. , Jara L.E.C. , Liñán R.L. , Gravitt P.E. , et al. .
Source: Research Square, 2024-09-27 00:00:00.0; , .
EPub date: 2024-09-27 00:00:00.0.
PMID: 39399675
Related Citations

Challenges associated with follow-up care after implementation of an HPV screen-and-treat program with ablative therapy for cervical cancer prevention.
Authors: Morse R.M. , Brown J. , Ríos López E.J. , Prieto B.A. , Kohler-Smith A. , Gonzales Díaz K. , Figueredo Escudero M. , Lenin Del Cuadro D. , Vásquez Del Aguila G. , Daza Grandez H. , et al. .
Source: Bmc Public Health, 2024-08-06 00:00:00.0; 24(1), p. 2121.
EPub date: 2024-08-06 00:00:00.0.
PMID: 39107728
Related Citations

Implementation of new technologies designed to improve cervical cancer screening and completion of care in low-resource settings: a case study from the Proyecto Precancer.
Authors: Gilman S.D. , Gravitt P.E. , Paz-Soldán V.A. , Proyecto Precancer Study Group .
Source: Implementation Science Communications, 2024-04-05 00:00:00.0; 5(1), p. 35.
EPub date: 2024-04-05 00:00:00.0.
PMID: 38581011
Related Citations

"Easy women get it": pre-existing stigma associated with HPV and cervical cancer in a low-resource setting prior to implementation of an HPV screen-and-treat program.
Authors: Morse R.M. , Brown J. , Gage J.C. , Prieto B.A. , Jurczuk M. , Matos A. , Vásquez Vásquez J. , Reátegui R.R. , Meza-Sanchez G. , Córdova L.A.D. , et al. .
Source: Bmc Public Health, 2023-12-02 00:00:00.0; 23(1), p. 2396.
EPub date: 2023-12-02 00:00:00.0.
PMID: 38042779
Related Citations

"Easy women get it": Pre-existing stigma associated with HPV and cervical cancer in a low-resource setting prior to implementation of an HPV screen-and-treat program.
Authors: Morse R.M. , Brown J. , Gage J.C. , Prieto B.A. , Jurczuk M. , Matos A. , Vásquez J.V. , Reátegui R.R. , Meza-Sanchez G. , Córdova L.A.D. , et al. .
Source: Research Square, 2023-09-11 00:00:00.0; , .
EPub date: 2023-09-11 00:00:00.0.
PMID: 37790338
Related Citations

Challenges associated with follow-up care after implementation of an HPV screen-and-treat program with ablative therapy for cervical cancer prevention in Iquitos, Peru: a mixed methods study.
Authors: Morse R. , Brown J. , López E.J.R. , Prieto B.A. , Kohler-Smith A. , Díaz K.G. , Escudero M.F. , Del Cuadro D.L. , Del Aguila G.V. , Grandez H.D. , et al. .
Source: Research Square, 2023-08-23 00:00:00.0; , .
EPub date: 2023-08-23 00:00:00.0.
PMID: 37674724
Related Citations

Implementation of new technologies designed to improve cervical cancer screening and completion of care in low-resource settings: A case study from the Proyecto Precancer.
Authors: Gilman S.D. , Gravitt P.E. , Paz-Soldán V.A. , Group P.P.S. .
Source: Research Square, 2023-07-07 00:00:00.0; , .
EPub date: 2023-07-07 00:00:00.0.
PMID: 37461540
Related Citations

"Day or night, no matter what, I will go": Women's perspectives on challenges with follow-up care after cervical cancer screening in Iquitos, Peru: a qualitative study.
Authors: Morse R.M. , Jurczuk M. , Brown J. , Jara L.E.C. , Meza G. , López E.J.R. , Tracy J.K. , Gravitt P.E. , Paz-Soldan V.A. , Proyecto Precancer Study Group .
Source: Bmc Women's Health, 2023-05-31 00:00:00.0; 23(1), p. 293.
EPub date: 2023-05-31 00:00:00.0.
PMID: 37259075
Related Citations

Women's perspectives on the acceptability and feasibility of an HPV screen-and-treat approach to cervical cancer prevention in Iquitos, Peru: a qualitative study.
Authors: Morse R.M. , Brown J. , Noble H.E. , Ríos López E.J. , Kohler-Smith A. , Soto S. , Del Cuadro D.L. , Gonzales Díaz K. , Figueredo Escudero M. , Vásquez Del Aguila G. , et al. .
Source: Bmc Women's Health, 2022-10-10 00:00:00.0; 22(1), p. 414.
EPub date: 2022-10-10 00:00:00.0.
PMID: 36217187
Related Citations

Planning for resilience in screening operations using discrete event simulation modeling: example of HPV testing in Peru.
Authors: Rositch A.F. , Singh A. , Lahrichi N. , Paz-Soldan V.A. , Kohler-Smith A. , Gravitt P. , Gralla E. .
Source: Implementation Science Communications, 2022-06-17 00:00:00.0; 3(1), p. 65.
EPub date: 2022-06-17 00:00:00.0.
PMID: 35715830
Related Citations

Misuse, perceived risk, and safety issues of household insecticides: Qualitative findings from focus groups in Arequipa, Peru.
Authors: Larson A.J. , Paz-Soldán V.A. , Arevalo-Nieto C. , Brown J. , Condori-Pino C. , Levy M.Z. , Castillo-Neyra R. .
Source: Plos Neglected Tropical Diseases, 2021 May; 15(5), p. e0009251.
EPub date: 2021-05-06 00:00:00.0.
PMID: 33956803
Related Citations

Achieving equity in cervical cancer screening in low- and middle-income countries (LMICs): Strengthening health systems using a systems thinking approach.
Authors: Gravitt P.E. , Silver M.I. , Hussey H.M. , Arrossi S. , Huchko M. , Jeronimo J. , Kapambwe S. , Kumar S. , Meza G. , Nervi L. , et al. .
Source: Preventive Medicine, 2021 03; 144, p. 106322.
EPub date: 2021-03-04 00:00:00.0.
PMID: 33678230
Related Citations

Understanding Geospatial Factors Associated With Cervical Cancer Screening Uptake in Amazonian Peruvian Women.
Authors: Barrett B.W. , Paz-Soldan V.A. , Mendoza-Cervantes D. , Sánchez G.M. , Córdova López J.J. , Gravitt P.E. , Rositch A.F. , Proyecto Precancer Study Group .
Source: Jco Global Oncology, 2020 Aug; 6, p. 1237-1247.
PMID: 32755481
Related Citations

Integrative Systems Praxis for Implementation Research (INSPIRE): An implementation methodology to facilitate the global elimination of cervical cancer.
Authors: Gravitt P.E. , Rositch A.F. , Jurczuk M. , Meza G. , Carillo L. , Jeronimo J. , Adsul P. , Nervi L. , Kosek M. , Tracy J.K. , et al. .
Source: Cancer Epidemiology, Biomarkers & Prevention : A Publication Of The American Association For Cancer Research, Cosponsored By The American Society Of Preventive Oncology, 2020-06-19 00:00:00.0; , .
EPub date: 2020-06-19 00:00:00.0.
PMID: 32561563
Related Citations

Barriers and innovative interventions for early detection of cervical cancer.
Authors: Baezconde-Garbanati L. , Agurto I. , Gravitt P.E. , Luciani S. , Murphy S. , Ochoa C. , Gallegos K. , Barahona R. , Rodríguez Y. .
Source: Salud Publica De Mexico, 2019 Jul-Ago; 61(4), p. 456-460.
PMID: 31430087
Related Citations

How confident can we be in the current guidelines for exiting cervical screening?
Authors: Gravitt P.E. , Landy R. , Schiffman M. .
Source: Preventive Medicine, 2018 09; 114, p. 188-192.
EPub date: 2018-07-05 00:00:00.0.
PMID: 29981791
Related Citations

Unraveling the Epidemiology of Oral Human Papillomavirus Infection.
Authors: Gravitt P.E. .
Source: Annals Of Internal Medicine, 2017-11-21 00:00:00.0; 167(10), p. 748-749.
EPub date: 2017-10-17 00:00:00.0.
PMID: 29049824
Related Citations

Modeling of US Human Papillomavirus (HPV) Seroprevalence by Age and Sexual Behavior Indicates an Increasing Trend of HPV Infection Following the Sexual Revolution.
Authors: Ryser M.D. , Rositch A. , Gravitt P.E. .
Source: The Journal Of Infectious Diseases, 2017-09-01 00:00:00.0; 216(5), p. 604-611.
PMID: 28931221
Related Citations

Human Papillomavirus: The Equal Opportunity Pathogen.
Authors: Gravitt P.E. .
Source: The Journal Of Infectious Diseases, 2017-04-01 00:00:00.0; 215(7), p. 1014-1016.
PMID: 28170038
Related Citations