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Shin MB, Oluoch LM, Barnabas RV, Baynes C, Fridah H, Heitner J, Kerubo MB, Ngure K, Pinder LF, Thomas KK, Mugo NR, Gimbel S. 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. Implement Sci 2023; 18:26. [PMID: 37365575 PMCID: PMC10294443 DOI: 10.1186/s13012-023-01282-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND An important cervical cancer prevention strategy in low- and middle-income countries (LMICs) has been single-visit screen-and-treat (SV-SAT) approach, using visual inspection with acetic acid (VIA) and ablative treatment with cryotherapy to manage precancerous lesions. While SV-SAT with VIA and cryotherapy have established efficacy, its population level coverage and impact on reducing cervical cancer burden remains low. In Kenya, the estimated cervical cancer screening uptake among women aged 30-49 is 16% and up to 70% of screen-positive women do not receive treatment. Thermal ablation for treatment of precancerous lesions of the cervix is recommended by the World Health Organization and has the potential to overcome logistical challenges associated with cryotherapy and facilitate implementation of SV-SAT approach and increase treatment rates of screen-positive women. In this 5-year prospective, stepped-wedge randomized trial, we plan to implement and evaluate the SV-SAT approach using VIA and thermal ablation in ten reproductive health clinics in central Kenya. METHODS The study aims to develop and evaluate implementation strategies to inform the national scale-up of SV-SAT approach with VIA and thermal ablation through three aims: (1) develop locally tailored implementation strategies using multi-level participatory method with key stakeholders (patient, provider, system-level), (2) implement SV-SAT approach with VIA and thermal ablation and evaluate clinical and implementation outcomes, and (3) assess the budget impact of SV-SAT approach with VIA and thermal ablation compared to single-visit, screen-and-treat method using cryotherapy. DISCUSSION Our findings will inform national scale-up of the SV-SAT approach with VIA and thermal ablation. We anticipate that this intervention, along with tailored implementation strategies will enhance the adoption and sustainability of cervical cancer screening and treatment compared to the standard of care using cryotherapy. TRIAL REGISTRATION NCT05472311.
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Affiliation(s)
- Michelle B Shin
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, USA
| | | | - Ruanne V Barnabas
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Colin Baynes
- Department of Global Health, University of Washington, Seattle, USA
| | - Harriet Fridah
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, USA
| | - Jesse Heitner
- Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | | | - Kenneth Ngure
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Leeya F Pinder
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | | | - Nelly Rwamba Mugo
- Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, USA
| | - Sarah Gimbel
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, USA
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Oluoch LM, Roxby A, Mugo N, Wald A, Ngure K, Selke S, Chohan B, Kiptinness C, Tapia K, Micheni M, Maina SG, Casmir E. Does providing laboratory confirmed STI results impact uptake of HIV pre-exposure prophylaxis (PrEP) uptake among Kenyan adolescents girls and young women? A descriptive analysis. Sex Transm Infect 2020; 97:467-468. [PMID: 32917766 DOI: 10.1136/sextrans-2020-054637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/10/2020] [Accepted: 08/16/2020] [Indexed: 11/04/2022] Open
Affiliation(s)
- Lynda Myra Oluoch
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Alison Roxby
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Nelly Mugo
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.,Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Anna Wald
- Department of Medicine, University of Washington, Seattle, Washington, USA.,Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Kenneth Ngure
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Stacy Selke
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Bhavna Chohan
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | - Kenneth Tapia
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Murugi Micheni
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Stephen Gakuo Maina
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Edinah Casmir
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
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