Document text
Principal Investigator: Megan J. Huchko
Organization: DUKE UNIVERSITY
Fiscal Year: 2024
Award: $180,639
Funding agency: John E. Fogarty International Center for Advanced Study in the Health Sciences
ABSTRACT
Women living with HIV (WLWH) are at increased biologic risk for infection with human papillomavirus (HPV) and
development of pre-invasive and invasive cervical cancer. The World Health Organization has recently called for
HIV-programs to bolster their efforts to prevent cervical cancer through integrated screening services.
Understanding and addressing stigma, including the intersection of HIV, HPV and cervical cancer-related stigma,
will be crucial to designing interventions that will facilitate the uptake of cancer screening among WLWH and
women in high HIV prevalence settings like western Kenya. Cancer-related stigma negatively influences several
determinants of cancer screening uptake, including perception of cancer risk, cancer screening benefit, and
acceptability of screening methods. In our prior work to evaluate HPV-based screening in Kenya, we found that
lack of education about cervical cancer and low awareness of screening benefits, both of which can potentiate
cancer-related stigma, were major barriers to screening uptake. Our team also found that misperceptions and
stigma about an HPV diagnosis and cancer were associated with reduced rates of follow-up among women who
tested positive for HPV. Our team developed a stigma framework to inform and validate a measurement tool for
HPV-, cervical cancer- and HIV-related stigmas. We found that educational messages focused on cancer-related
outcomes and HPV epidemiology, including risks related to sexual behavior and HIV, were stigmatizing, while
support from social networks and emphasis on the availability of effective treatment reduced stigma and
promoted screening uptake. We used this data to develop a stigma-responsive educational intervention which
includes simplified scripts for multiple cadres of health workers that provide clear messages about HPV and the
benefits of screening and a video aimed at addressing fears and misperceptions from a peer perspective. We
propose to incorporate these educational components into “Elimisha HPV,” a multilevel stigma-responsive
cervical cancer prevention service delivery model for integration within clinics providing HIV-care in western
Kenya. Elimisha HPV, which in Kiswahili means to increase understanding of HPV, will include the following
components: HPV-testing via self-collection, simplified scripts and video, peer navigators for women with
screening or treatment hesitancy, and the option to receive results and information via text messages. To adapt,
implement and test the effectiveness of this model, we will: 1) work with key stakeholders to finalize Elimisha
HPV 2) compare cervical cancer prevention outcomes and engagement in HIV care in clinics offering the
Elimisha HPV model to clinics providing standard of care outreach, education and screening strategies; and 3)
identify individual and institutional factors that moderate the effects of Elimisha HPV on cervical cancer
prevention outcomes. If effective, this may represent a new model for HPV-based cervical cancer screening as
well as a new paradigm for comprehensive, stigma-responsive service delivery packages for people living with
HIV.
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