Establishing a Cervical Cancer Prevention and Treatment Program for Human Immunodeficiency Virus (HIV)-positive adolescent girls and women receiving care at Hôpital Foyer Saint Camille, Haïti Open Access
Delva, Glavdia Greatchens (Summer 2019)
Abstract
Cervical cancer is the fourth leading cause of cancer-related mortality in women worldwide, with more than 600,000 cervical cancer cases reported yearly, of which 90% occur in low and middle-income countries. In developed countries, 33% of females aged 9 to 26 years old received all recommended doses of human papillomavirus (HPV) vaccination, while only 2.7% females aged 9 to 26 years old completed the full HPV vaccine doses in low-and middle-income countries (LMICs). The scaling-up of HPV vaccination at a rate of 10% per year in low-middle-countries, would reach an estimated 163 million girls, and could avert 3.3 million cervical cancer cases, 2.4 million deaths, and 9.5 million disability‐adjusted life years (DALYs) over their lifetimes. HPV vaccination coupled with at least three screening tests in their lifetimes reaching a 70% coverage, could reduce by 60% women lifetime risk of cervical cancer.
Haiti has the highest incidence of cervical cancer in the Western Hemisphere, with an annual aged-standardized incidence and mortality rate estimated at 87.3 and 48.1 per 100,000 women, respectively. An estimated 3.64 million Haitian women aged 15 years and older are at risk of developing cervical cancer each year. The prevalence of cervical cancer is even higher among women infected with the Human Immunodeficiency Virus (HIV) living in Haiti. HPV vaccines have not yet been integrated in the national vaccination program. Low government investment in healthcare, poor health infrastructure, lack of funding, and absence of nationally organized primary and secondary HPV prevention programs are the main barriers to address the high incidence of morbidity and mortality related to cervical cancer in the country.
This Grant Proposal is in response to a call for proposals for optimizing management of coinfections and comorbidities in people living with HIV in order to address the global burden of HPV-associated cancers in LMICs. This proposal will implement an integrative approach encompassing HPV vaccination for HIV-positive female adolescents aged 9 to 26 years old, and “See, Diagnose, and Treat”, point-of-care (POC) molecular testing methods for screening, and treatment of pre-cancerous and cancerous cervical lesions in HIV-positive female adolescents 18 years old and up sexually active and women seeking care at the HIV primary care unit at Hôpital Foyer Saint Camille (HFSC), a health facility located in the northern area of Port-au-Prince in Haiti, and less than two miles from two major urban slums.
This proposal is a five-year project that will bring innovative approaches to address access barriers, support adoption of improved tools for preventing cervical cancer and managing the disease at the pre-cancer stage. The project will involve multistage implementation, starting by improving the infrastructure, building capacity and establishing a training program on primary and secondary cervical cancer prevention for healthcare providers, patients and the community. The implementation phase will focus on identifying HIV-positive women at risk of cervical cancer and providing them with early detection and treatment including clinical and laboratory diagnostic services. This Cervical Cancer Prevention and Treatment Program will contribute to reducing the morbidity and mortality due to cervical cancer for HIV-positive females seeking care at HFSC.
Table of Contents
Chapter I: Introduction ........................................................................................................ 3
Introduction and Rationale .............................................................................................. 3
Problem Statement .......................................................................................................... 4
Purpose Statement ........................................................................................................... 5
Research Questions ......................................................................................................... 6
Significance Statement.................................................................................................... 6
Public health framework for intervention ....................................................................... 7
Definition of terms .......................................................................................................... 8
Chapter II: Review of the literature ................................................................................. 13
Introduction ................................................................................................................... 13
Body of Review of the literature ................................................................................... 13
Chapter III: Methodology ................................................................................................. 22
Funding Agency ............................................................................................................ 22
Description of the Grant Announcement ...................................................................... 23
Context .......................................................................................................................... 23
The grant review process .............................................................................................. 24
Grant proposal reviewers .............................................................................................. 25
Protection of human subjects ........................................................................................ 29
Chapter IV: Incorporation of reviewers’ comments ......................................................... 30
Chapter V: Grant Proposal ................................................................................................ 42
Executive Summary ...................................................................................................... 42
Project narrative ............................................................................................................ 43
Problem statement ......................................................................................................... 44
Background ................................................................................................................... 44
Goals and Objectives .................................................................................................... 53
Target population for intervention ................................................................................ 55
Strategic Approach ........................................................................................................ 56
Research Methodology ................................................................................................. 68
Project Approach: Theory of Change ........................................................................... 73
Innovation and Affordability ........................................................................................ 74
Expected Impact ............................................................................................................ 75
Timeline ........................................................................................................................ 77
Organizations ................................................................................................................ 78
Evaluation and Dissemination ...................................................................................... 79
Sustainability and multiplying impact .......................................................................... 80
Ethical considerations ................................................................................................... 80
References ..................................................................................................................... 82
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