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Grant Details

Grant Number: 5R01CA190366-06 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: 2020


 DESCRIPTION (provided by applicant): Cervical cancer remains one of the leading causes of cancer among women, yet it is an entirely preventable disease. While HPV vaccination holds the greatest promise for reducing the global burden of cervical cancer, measurable reductions will not be realized for at least another 20 years. The only option for reducing cervical cancer incidence in the near term is increased accessibility of effective screening programs in regions with the highest burden of disease. The overarching goal of the Iquitos Screen-and-Treat Implementation Study (ISaTIS) is to move a strong evidence base for the use of screen-and-treat screening strategies into sustainable cervical cancer prevention programs appropriate for the health care context in the Loreto region of Peru and other middle income countries. Pilot participatory action research with key community stakeholders identified two acceptable alternative screening strategies for implementation evaluation: (1) single visit VIA- based screen-and-treat approach and (2) HPV DNA-based screening using self- or clinician-collected samples and HPV E6 oncoprotein triage-to-treatment. We will use a Participatory Action Research (PAR) approach, applying mixed methods, in an interrupted time series (ITS) design to develop, monitor, evaluate, and compare the two implementation strategies against current VIA-based standard of care screening. In Aim 1 we will conduct a community census in three communities in the Loreto region of Peru to establish cervical cancer screening registries and identify key members for working groups to facilitate our PAR approach. In Aim 2, we will use a series of focus group discussions, key informant interviews, and surveys to develop screening intervention monitoring and evaluation (M&E) criteria, objectives, methods, and instruments to be used in ongoing M&E of the implementation of each screening program using PAR processes. Our implementation strategies will be guided by the five domains outlined in the consolidated framework for implementation research (CFIR). In Aim 3 we will use the ITS design in a RE-AIM and CFIR-guided outcomes framework to evaluate the comparative effectiveness of each strategy. Qualitative and quantitative M&E methods iteratively executed in both pre- and post-implementation phases will be embedded into the overall ITS design, allowing real-time adaptation of the programs for broader sustainability. In Aim 4, we will synthesize our experience in a formal cost-effectiveness evaluation to allow policy makers to make comprehensive comparisons of each program relative to current standard of care and provide key data for future adoption in similar middle income countries. Publication of the outcomes of each process phase of our implementation research study will ensure maximal adoption of feasible and acceptable cervical cancer screening programs across a broad range of settings.


"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; 23(1), p. 2396.
EPub date: 2023-12-02.
PMID: 38042779
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"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; , .
EPub date: 2023-09-11.
PMID: 37790338
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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. , Ríos López E.J. , Prieto B.A. , Kohler-Smith A. , Gonzales Díaz K. , Figueredo Escudero M. , Del Cuadro D.L. , Vásquez Del Aguila G. , Daza Grandez H. , et al. .
Source: Research square, 2023-08-23; , .
EPub date: 2023-08-23.
PMID: 37674724
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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: Research square, 2023-07-07; , .
EPub date: 2023-07-07.
PMID: 37461540
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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.
PMID: 28170038
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