Identifying and Addressing Barriers to Retention in the Cervical Cancer Treatment Cascade Among Women With HIV in South Africa: Part 2
试验速览
- 阶段
- 不适用
- 状态
- 进行中（未招募）
- 发起方
- 入组人数
- 80
- 试验地点
- 3
- 主要终点
- Feasibility of the intervention
研究概览
简要总结
The investigators will conduct the formative work that is necessary to develop a novel, multi-level intervention (inclusive of patient- and provider-level components), which will increase awareness of and modify the complex, intersecting factors that contribute to cervical cancer development among cisgender women with HIV (WWH). In Aim 1a, the investigators will explore the multi-level barriers and facilitators to follow-up appointment attendance among WWH who have had a recent high-risk abnormal Pap smear in the past six months, via qualitative interviews with WWH who have either attended at least one follow-up visit (n<10) or have not yet attended a follow-up visit (n<10). In Aim 1b, the investigators will explore provider awareness of the HIV-cervical cancer relationship and perspectives on barriers to retention in care via qualitative interviews (n<8). For Aim 2, The study team will leverage the Aim 1 data, develop a patient-level intervention (2 sessions) and a provider toolkit, with the goal of increasing retention in care among WWH who are at heightened risk for cervical cancer. In Aim 3a, the investigators will test the feasibility and acceptability of the intervention in a pilot randomized control trial (RCT) (n<60). The study team will also assess (1) changes in self-efficacy to attend cervical cancer-related healthcare appointments at baseline, end of intervention, and three-months post-baseline, (2) the proportion of women who attend a follow-up appointment, and, of those participants, (3) the proportion of women who complete the next phase of treatment. In Aim 3b, the investigators will explore the feasibility of intervention implementation in the clinic and acceptability of the provider-level intervention components in qualitative interviews with providers and clinic staff (n<10).
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Single Group
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- Female
- 接受健康志愿者
- 否
入选标准
- •Aim 1 criteria:
- •Inclusion Criteria:
- •Having a cervix
- •Living with HIV
- •Recent high-risk abnormal Pap results within the last month (if needed, we may increase the range by up to 6 months to ensure that we meet our targets).
排除标准
- •Younger than 18 years old
- •HIV-negative
- •No cervix/history of hysterectomy
- •Recent normal or low-risk abnormal Pap results
- •Unable to provide informed consent or assent in English or isiZulu and/or have a significant psychiatric illness (e.g., active psychotic disorder or untreated bipolar disorder) that could interfere with participation will be excluded. Potential participants will also be asked if they have any health conditions that make it difficult for them to travel to the clinic.
- •Aim 3 criteria:
- •Inclusion Criteria:
- •Having a cervix
- •Living with HIV
- •Recent Pap smear test (within the past two months).
- •Exclusion Criteria:
- •Younger than 18 years old
- •HIV-negative
- •No cervix/history of hysterectomy
- •Unable to provide informed consent in English or isiZulu and/or have a significant psychiatric illness (e.g., active psychotic disorder or untreated bipolar disorder) that could interfere with participation will be excluded. Potential participants will also be asked if they have any health conditions that make it difficult for them to travel to the clinic.
研究组 & 干预措施
Participant intervention
The intervention group will consist of two sessions, conducted in-person, coupled with text-based client navigation.The intervention group will complete three major assessments: baseline (T1), at the conclusion of the intervention (T2), and a three-month follow-up (T3). Until the follow-up assessment, the interventionist will send participants 2-3 SMS messages (one-way) per month. The content of these messages will be developed collaboratively between the participant and the interventionist during each session; messages could include reminders about follow-ups and/or prompts to use new skills and resources for navigating specific barriers.
干预措施: Retention in cervical cancer care intervention (Behavioral)
Enhanced treatment as usual
The enhanced treatment as usual (ETAU) group will receive treatment as usual, including being notified of their Pap results and instructed to set up a follow-up appointment if needed, as is typical in routine care. They will additionally receive an information sheet describing Pap smears and the relationship between HIV, HPV, and cervical cancer. The ETAU group will complete the T1, T2, and T3 assessments.
结局指标
主要结局
Feasibility of the intervention
时间窗: About 1 month after the start of intervention and at about 3 months after the start of the intervention
Feasibility will be demonstrated if all three are met by participants: (1) 50% of participants who are approached choose to enroll; (2) 70% of participants complete the intervention; and (3) 60% complete the 3-month follow-up. Feasibility of the implementation of the intervention will be explored in interviews with providers and clinic staff. To assess fidelity, each intervention session with be audio recorded; an assessor will review 20% of the session transcripts and determine whether all key session themes were addressed using checklists developed by the study team for the intervention.
Acceptability of the intervention
时间窗: About 1 month after the start of intervention and at about 3 months after the start of the intervention
Acceptability will be measured using the seven component constructs of the acceptability of health care interventions framework using a five-point Likert style scale. The seven components include affective attitude (i.e., how an individual feels about the intervention), burden, ethicality (i.e., the extent to which the intervention aligns with one's value system), intervention coherence, opportunity costs, perceived effectiveness, and self-efficacy. Acceptability will be demonstrated if, on average, at least 75% of the participants rate five or more of the items on the eight-item Acceptability of Healthcare Interventions Questionnaire with a 4 or a 5 on the Likert-style scale. Acceptability of the intervention will also be explored in interviews with providers, clinic staff, interventionalists, and other relevant stakeholders.
次要结局
- Follow-up appointment attendance(about 1 month after the start of intervention and about 3 months after the start of the intervention)
- Self-efficacy to attend cervical cancer-related health care appointment(At the start of the intervention, about 1 month after the start of intervention, and at about 3 months after the start of the intervention)
- Self-efficacy to attend cervical cancer-related health care appointment(Start of the intervention and about 1-2 months after the start of intervention)
研究者
Amelia M. Stanton
Assistant Professor
Boston University Charles River Campus