Clinic vs Clinic+Community Outreach HPV Self-Collection to Increase Cervical Screening in Women With HIV (CASCADE3001A)
Comparison of Clinic-based Versus Clinic-plus Community Outreach-based Strategy Via HPV Self-Collection to Increase Uptake of Cervical Cancer Screening Among Women Living With HIV: a Cluster Randomized Trial
This Clinical Trials Network for Human Immunodeficiency Virus (HIV)-Associated Cervical Cancer Screening and Treatment Optimization (CASCADE) C3001-A trial aims to assess how the introduction of a community-health-worker-facilitated model, in addition to the existing static clinic-only model, influences the rates of cervical cancer screening uptake among women living with HIV (WLWH). This study involves offering human papillomavirus (HPV) self-collection for cervical cancer screening to eligible WLWH.
The 'CASCADE' Network is a clinical trials network aimed at improving cervical cancer screening, management, and pre-cancer treatment for WLWH, in various healthcare settings. The network will conduct implementation trials to improve the triage of HPV-positive WLWH, as well as algorithms to optimize access to and options for effective treatment. Trials will be conducted using a mixed-methods approach aimed at assessing implementation strategies and outcomes and their potential to integrate into existing health systems.
Further understanding of HPV-based community-based strategies to reach WLWH, and the acceptability, feasibility, appropriateness, and cost of these strategies will be valuable for cervical cancer screening programs serving WLWH. Inputs from various 'CASCADE' Clinical Sites (CS) regarding feasible screening outreach options available in their settings for WLWH have guided this study that focuses on evaluating a pragmatic HPV self-collection implementation model to improve access to screening.
While it is clear that HPV self-collection is a highly acceptable and feasible screening option, creating opportunities to conduct self-collection in alternative venues outside the clinic premises, and with the guidance of and facilitation by trusted community healthcare workers is an important implementation strategy that needs to be evaluated and considered for its potential benefit. Studies have not yet evaluated a community-based approach for HPV self-collection kit distribution among WLWH - who may have different characteristics, preferences, and access to screening services than women not living with HIV. Providing WLWH with the option of receiving HPV self-collection kits in their own homes or other community-based settings ('community-based HPV self-collection') is a novel implementation strategy that could improve cervical cancer screening rates among eligible women. Therefore, this novel trial aims to evaluate the feasibility and effectiveness of implementing community-based HPV self-collection among WLWH.
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Jennifer S Smith, PhD
- Phone Number: 919-966-4432
- Email: jennifers@unc.edu
Study Contact Backup
- Name: Franklin K Okwunze, MD
- Email: kokwunze@unc.edu
Study Locations
-
-
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Kampala, Uganda, 16524
- Recruiting
- Makerere University Walter Reed Program
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Principal Investigator:
- Betty Mwesigwa, MD
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Principal Investigator:
- Fred Magala
-
Contact:
- Betty Mwesigwa, MD
- Phone Number: 256-312- 330400
- Email: bmwesigwa@muwrp.org
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Principal Investigator:
- Monica Etima
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Principal Investigator:
- Grace Mirembe
-
Principal Investigator:
- Stephen Mugamba
-
Principal Investigator:
- Michael Semwogerere
-
Principal Investigator:
- Hannah Kibuuka
-
Principal Investigator:
- Robert Mutumba
-
Principal Investigator:
- Mina Nakawuka
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
Accepts Healthy Volunteers
Description
Clinic Inclusion Criteria
- Clinics selected for inclusion will include those clinics that provide Human Immunodeficiency Virus (HIV) care and distribute antiretroviral therapy (ART) to Women living with Human Immunodeficiency Virus (WLWH.
- These clinics should also have the ability to collect their own data.
- Such clinics could be supported by national programs and bilateral donor-funded initiatives
Inclusion Criteria for Medical Record Abstraction
- Are living with Human Immunodeficiency Virus (HIV)
- Are 25-49 years of age, or as recommended by Uganda's Ministry of Health Cervical Cancer Prevention and Control Guidelines
- Live in the catchment areas of or attend a study-eligible clinic
- Are eligible for Human Papillomavirus (HPV)-based cervicovaginal testing either because:
- They have never undergone cervical cancer screening before, or
- They have never undergone HPV-based testing before and are now due for Acetic Acid (VIA), per national guidelines, or
- They have previously undergone HPV-based testing, and are now due for follow-up HPV-based testing per national guidelines, and /or
- They underwent ablative or excisional treatment for presumed or confirmed cervical dysplasia >1 year ago and have not had any follow-up cervical cancer screening since treatment.
Exclusion Criteria for Medical Record Abstraction
- Have had their cervix removed
- Are pregnant or <3 months post-delivery
- Were positive on their most recent cervical cancer screening test and referred for further evaluation or treatment, but did not complete their referral
- Have previously been treated for invasive cervical cancer
Clinic Inclusion Criteria
- Clinics selected for inclusion will include those clinics that provide Human Immunodeficiency Virus (HIV) care and distribute antiretroviral therapy (ART) to Women living with Human Immunodeficiency Virus (WLWH).
- These clinics should also have the ability to collect their own data.
- Such clinics could be supported by national programs and bilateral donor-funded initiatives
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Screening
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Participants enrolled at Model 1 Clinics
Women living with Human Immunodeficiency Virus (WLWH) enrolled at Model 1 Clinic.
|
Model 1 involves only the recommended standard-of-care of cervical cancer screening Human Papillomavirus (HPV) self-collection, if available, or Visual Inspection with Acetic Acid (VIA), if HPV-based testing is not available) to clients who are due for screening at clinics that distribute Antiretroviral Therapy (ART) to Women living with Human Immunodeficiency Virus (WLWH).
Efforts will be made to ensure availability of HPV kits for Model 1 clinics.
|
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Experimental: Participants enrolled at Model 2 Clinic s
Women living with Human Immunodeficiency Virus (WLWH) enrolled at Model 2 Clinics.
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Model 2 will include clinic-based Human Papillomavirus (HPV) self-collection, as well as the implementation strategy of providing community-based distribution for HPV self-collection via Facility-link facilitator (FLF)s.
Women living with Human Immunodeficiency Virus (WLWH) who are due and overdue for cervical cancer screening will be identified via line lists and appointment directories.
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What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Cervical cancer monthly screening rates
Time Frame: Up to 1 month
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Monthly cervical cancer screening rates among Women living with Human Immunodeficiency Virus (WLWH) will be compared between two models: (1) standard-of-care screening at static clinics only (Model 1) , and (2) Human Papillomavirus (HPV) self-collection offered at static clinics and through a community-based strategy by facility link facilitators (FLFs)(Model 2). Standard-of-care for Model 1 is defined as HPV self-collection when available or Visual Inspection with Acetic Acid (VIA) when HPV-based screening is not available. |
Up to 1 month
|
Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Investigators
Investigators
- Study Director: Michael Hudgens, PhD, University of North Carolina, Chapel Hill
- Study Chair: Jennifer Tang, MD, UNC Lineberger Comprehensive Cancer Center
- Study Director: Katie Mollan, PhD, University of North Carolina, Chapel Hill
- Study Director: Vikrant Sahasrabuddhe, MBBS, MPH, DrPH, Division of Cancer Prevention (DCP), NCI
- Study Chair: Jennifer Smith, PhD, UNC Lineberger Comprehensive Cancer Center
- Principal Investigator: Betty Mwesigwa, MD, Makerere University Walter Reed Program
- Study Director: Monica Etima, MD, Makerere University Walter Reed Program
- Study Director: Grace Mirembe, MD, Makerere University Walter Reed Program
- Study Director: Fred Magala, MD, Makerere University Walter Reed Program
- Study Director: Stephen Mugamba, MD, Makerere University Walter Reed Program
- Study Director: Michael Semwogerere, MD, Makerere University Walter Reed Program
- Study Director: Hannah Kibuuka, MD, Makerere University Walter Reed Program
- Study Director: Robert Mutumba, MD, Ministry of Health, Uganda
- Study Director: Mina Nakawuka, MD, Ministry of Health, Uganda
- Study Director: Lameck Chinula, MD, University of North Carolina, Chapel Hill
- Study Director: Lisa Spees, PhD, University of North Carolina, Chapel Hill
- Study Director: Chemtai Mungo, MD MPH, University of North Carolina, Chapel Hill
- Study Director: Sue Siminski, MS MBA, Frontier Science Foundation
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Blood-Borne Infections
- Urogenital Diseases
- Genital Diseases
- Pathologic Processes
- Urogenital Neoplasms
- Neoplasms by Site
- Neoplasms
- Female Urogenital Diseases
- Female Urogenital Diseases and Pregnancy Complications
- Disease Attributes
- Immune System Diseases
- Infections
- RNA Virus Infections
- Virus Diseases
- Uterine Diseases
- Genital Diseases, Female
- Communicable Diseases
- Sexually Transmitted Diseases, Viral
- Sexually Transmitted Diseases
- Lentivirus Infections
- Retroviridae Infections
- Immunologic Deficiency Syndromes
- DNA Virus Infections
- Genital Neoplasms, Female
- Uterine Cervical Diseases
- Uterine Neoplasms
- Tumor Virus Infections
- Pathological Conditions, Signs and Symptoms
- HIV Infections
- Uterine Cervical Neoplasms
- Papillomavirus Infections
Other Study ID Numbers
Other Study ID Numbers
- 24-0684
- U24CA275417 (U.S. NIH Grant/Contract)
- UG1CA275412 (U.S. NIH Grant/Contract)
- UG1CA275403 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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