Grant Details
Grant Number: |
5R01CA258590-03 Interpret this number |
Primary Investigator: |
Mugo, Nelly |
Organization: |
University Of Washington |
Project Title: |
Towards Cervical Cancer Elimination: Implementation and Scale-Up of a Single-Visit, Screen-and-Treat Approach with Thermal Ablation for Sustainable Cervical Cancer Prevention Services in Kenya |
Fiscal Year: |
2023 |
Abstract
ABSTRACT
Cervical cancer (CC) is almost entirely preventable with current technologies, yet, it remains the most common
cancer and the most common cause of cancer death among women in Eastern Africa. Globally, CC is the 4th
most common cause of cancer incidence and mortality among women, and the leading cause of cancer in 42
low- and middle- income countries (LMICs), where 90% of CC deaths occur. To achieve the 2018 World Health
Organization (WHO)'s call to action towards global CC elimination, there is an urgent need to adapt, implement,
and scale-up effective technologies in LMICs. The mainstay of CC prevention in LMICs has been the single-visit
approach using screen-and-treat (SVA-SAT) method, using visual inspection with acetic acid (VIA) and ablative
treatment with cryotherapy to manage precancerous lesions. It is a low-cost screening approach and it minimizes
loss to follow-up compared to the traditional cytology. Despite well-established effectiveness of VIA on popula-
tion-level reduction in CC burden, the estimated screening uptake among women aged 30-49 in Kenya is 16%,
far from the WHO's target of 70% twice-lifetime screening of women ages 35-45 by 2030. Additionally, there is
extremely low fidelity of SVA-SAT; up to 70% of screen-positive women do not receive treatment. The low treat-
ment rate has been attributed to programmatic and logistical challenges of implementing cryotherapy in low-
resource settings (e.g., supply chain difficulties of refrigerant gas, equipment failure, and treatment duration >10
min). Thermal ablation (TA), was recommended by the WHO in 2019 and is an effective and safe alternative to
cryotherapy. The portable device can be charged with electricity, batteries or solar panels, which is ideal for rural
settings. However, wide dissemination and adoption have been challenged by undefined drivers of successful
implementation. Our objective is to develop and evaluate a locally contextualized dissemination and implemen-
tation (D&I) strategy for SVA-SAT with TA (SVA-SAT+TA) to inform national scale-up. Our hypothesis is that
TA will enhance the feasibility, adoption, and sustainability of CC prevention services via SVA-SAT, compared
to cryotherapy. Our multidisciplinary team proposes five-year prospective, stepped-wedge, randomized trial to
implement SVA-SAT+TA in ten reproductive health (RH) clinics in central Kenya. In Aim 1, we will collaborate
with multi-level (clinic, county, national) stakeholders to develop a sustainable D&I strategy to introduce SVA-
SAT+TA that effectively accounts for the heterogeneity of the client, provider and system inputs. In Aim 2, we
will deliver and rigorously evaluate the SVA-SAT+TA intervention at scale in public RH clinics in Kenya, using
the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. In Aim 3, we
will compare the cost, cost-effectiveness and budget impact of SVA-SAT+TA to SVA-SAT using cryotherapy.
Together, the results from this project will improve wider implementation and scale-up of an evidence-based
intervention, SVA-SAT+TA, and provide the necessary evidence to guide policy and serve as a model for CC
prevention in the LMICs context.
Publications
Implementation and scale-up of a single-visit, screen-and-treat approach with thermal ablation for sustainable cervical cancer prevention services: a protocol for a stepped-wedge cluster randomized trial in Kenya.
Authors: Shin M.B.
, Oluoch L.M.
, Barnabas R.V.
, Baynes C.
, Fridah H.
, Heitner J.
, Kerubo M.B.
, Ngure K.
, Pinder L.F.
, Thomas K.K.
, et al.
.
Source: Implementation science : IS, 2023-06-26; 18(1), p. 26.
EPub date: 2023-06-26.
PMID: 37365575
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