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Grant Details

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.


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; , .
EPub date: 2023-08-23.
PMID: 37674724
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"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; 23(1), p. 293.
EPub date: 2023-05-31.
PMID: 37259075
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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; 22(1), p. 414.
EPub date: 2022-10-10.
PMID: 36217187
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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; 3(1), p. 65.
EPub date: 2022-06-17.
PMID: 35715830
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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.
PMID: 33956803
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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 Mar; 144, p. 106322.
EPub date: 2021-03-04.
PMID: 33678230
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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 Sep; 29(9), p. 1710-1719.
EPub date: 2020-06-19.
PMID: 32561563
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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
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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-Aug; 61(4), p. 456-460.
PMID: 31430087
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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 Sep; 114, p. 188-192.
EPub date: 2018-07-05.
PMID: 29981791
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Unraveling the Epidemiology of Oral Human Papillomavirus Infection.
Authors: Gravitt P.E. .
Source: Annals of internal medicine, 2017-11-21; 167(10), p. 748-749.
EPub date: 2017-10-17.
PMID: 29049824
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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; 216(5), p. 604-611.
PMID: 28931221
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Human Papillomavirus: The Equal Opportunity Pathogen.
Authors: Gravitt P.E. .
Source: The Journal of infectious diseases, 2017-04-01; 215(7), p. 1014-1016.
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