Grant Details
Grant Number: |
1R21CA267900-01A1 Interpret this number |
Primary Investigator: |
Spiegelman, Donna |
Organization: |
Yale University |
Project Title: |
Interventions to Increase Adherence to Cervical Cancer Early Detection and Treatment Recommendations in Mexico City Clinics |
Fiscal Year: |
2022 |
Abstract
Project summary/Abstract
Despite being highly preventable, stark cervical cancer (CC) disparities exist globally. CC is the second leading
cause of cancer mortality among Mexican women, where CC detection, diagnosis, and treatment delays result
from suboptimal implementation of and adherence to longstanding Mexican early detection, diagnosis, and
treatment guidelines, which have been in existence since 1974. In contrast, CC is the 12th leading cause of
cancer mortality among women in the US, where evidence about patient, provider, and health care
organizational factors associated with adherence to CC early detection and diagnosis recommendations likely
associated with the success of CC control programs has accrued. In Mexico, screening rates are suboptimal
(50-67%), in contrast to 80% in the US, and follow-up colposcopy among Mexican women with abnormal
screens is 43%, in contrast to around 66%-71% in the US. In response to NOT-CA-20-025 Notice of Special
Interest (NOSI): Dissemination and Implementation Science for Cancer Prevention and Control in Low
Resource Environments, we propose to identify barriers to and facilitators of adherence to the Mexican
guidelines for follow-up from an abnormal screen onward down the CC care cascade (MGMACS, Mexican
Guidelines for Managing Abnormal Cervical Cancer Screening Tests), and to develop strategies to increase
adherence to these guidelines in clinics in Tlalpan, a Southern district of Mexico City. Following an
Implementation Mapping approach, guided by the Consolidated Framework for Implementation Research
(CFIR), the Health Belief Model, and the Implementation Outcomes Framework (IOF), we will evaluate the
determinants of implementation and outcomes of the current MGMACS implementation and develop a logic
model describing the process for improving adherence to the MGMACS from abnormal screens onwards down
the cascade, among patients, providers, and clinics (Aim 1). Next, we will select and adapt implementation
strategies that address the barriers identified to improve adherence to MGMACS (Aim 2). In both aims, we will
use qualitative and quantitative methods for data collection and synthesis of findings, embedding them
together in a multistage integrated convergent mixed methods design and analysis approach. Our study team
has extensive research expertise in biostatistics, implementation science methods and practice, and CC
prevention and control in Mexico and elsewhere. We aim to gather data to inform a future external application
for a large-scale implementation study on improving adherence to MGMACS. This project will provide a model
for an implementation science-based approach to improving CC early detection, diagnosis, and treatment
programs in similar under-resourced contexts in Latin America and beyond, contributing to the reduction and
ultimate elimination of CC.
Publications
Factors associated with receiving results and attending colposcopy in patients with positive HPV screens in Mexico City.
Authors: León-Maldonado L.
, Hernández-Ramírez R.U.
, Torres-Ibarra L.
, Spiegelman D.
, Sheth S.S.
, Lazcano E.
, Cadena-Fiscal J.D.
, Salmerón J.
.
Source: Preventive medicine reports, 2023 Oct; 35, p. 102347.
EPub date: 2023-07-24.
PMID: 37593354
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