Implementation of new technologies designed to improve cervical cancer screening and completion of care in low-resource settings: a case study from the Proyecto Precancer.
Cervical cancer
Implementation science
Participatory action research
Perú
Systems-thinking
Journal
Implementation science communications
ISSN: 2662-2211
Titre abrégé: Implement Sci Commun
Pays: England
ID NLM: 101764360
Informations de publication
Date de publication:
05 Apr 2024
05 Apr 2024
Historique:
received:
30
06
2023
accepted:
09
03
2024
medline:
6
4
2024
pubmed:
6
4
2024
entrez:
5
4
2024
Statut:
epublish
Résumé
This case study details the experience of the Proyecto Precancer in applying the Integrative Systems Praxis for Implementation Research (INSPIRE) methodology to guide the co-development, planning, implementation, adoption, and sustainment of new technologies and screening practices in a cervical cancer screening and management (CCSM) program in the Peruvian Amazon. We briefly describe the theoretical grounding of the INSPIRE framework, the phases of the INSPIRE process, the activities within each phase, and the RE-AIM outcomes used to evaluate program outcomes. Proyecto Precancer iteratively engaged over 90 stakeholders in the Micro Red Iquitos Sur (MRIS) health network in the Amazonian region of Loreto, Perú, through the INSPIRE phases. INSPIRE is an integrative research methodology grounded in systems thinking, participatory action research, and implementation science frameworks such as the Consolidated Framework for Implementation Research. An interrupted time-series design with a mixed-methods RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) evaluation framework was used to examine the adoption of human papillomavirus (HPV) testing (including self-sampling), with direct treatment after visual inspection with portable thermal ablation, at the primary level. This approach, blending participatory action research, implementation science, and systems-thinking, led to rapid adoption and successful implementation of the new cervical cancer screening and management program within 6 months, using an HPV-based screen-and-treat strategy across 17 health facilities in one of the largest public health networks of the Peruvian Amazon. Monitoring and evaluation data revealed that, within 6 months, the MRIS had surpassed their monthly screening goals, tripling their original screening rate, with approximately 70% of HPV-positive women reaching a completion of care endpoint, compared with around 30% prior to the new CCSM strategy. Proyecto Precancer facilitated the adoption and sustainment of HPV testing with subsequent treatment of HPV-positive women (after visual inspection) using portable thermal ablation at the primary level. This was accompanied by the de-implementation of existing visual inspection-based screening strategies and colposcopy for routine precancer triage at the hospital level. This case study highlights how implementation science approaches were used to guide the sustained adoption of a new screen-and-treat strategy in the Peruvian Amazon, while facilitating de-implementation of older screening practices.
Sections du résumé
BACKGROUND
BACKGROUND
This case study details the experience of the Proyecto Precancer in applying the Integrative Systems Praxis for Implementation Research (INSPIRE) methodology to guide the co-development, planning, implementation, adoption, and sustainment of new technologies and screening practices in a cervical cancer screening and management (CCSM) program in the Peruvian Amazon. We briefly describe the theoretical grounding of the INSPIRE framework, the phases of the INSPIRE process, the activities within each phase, and the RE-AIM outcomes used to evaluate program outcomes.
METHODS
METHODS
Proyecto Precancer iteratively engaged over 90 stakeholders in the Micro Red Iquitos Sur (MRIS) health network in the Amazonian region of Loreto, Perú, through the INSPIRE phases. INSPIRE is an integrative research methodology grounded in systems thinking, participatory action research, and implementation science frameworks such as the Consolidated Framework for Implementation Research. An interrupted time-series design with a mixed-methods RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) evaluation framework was used to examine the adoption of human papillomavirus (HPV) testing (including self-sampling), with direct treatment after visual inspection with portable thermal ablation, at the primary level.
RESULTS
RESULTS
This approach, blending participatory action research, implementation science, and systems-thinking, led to rapid adoption and successful implementation of the new cervical cancer screening and management program within 6 months, using an HPV-based screen-and-treat strategy across 17 health facilities in one of the largest public health networks of the Peruvian Amazon. Monitoring and evaluation data revealed that, within 6 months, the MRIS had surpassed their monthly screening goals, tripling their original screening rate, with approximately 70% of HPV-positive women reaching a completion of care endpoint, compared with around 30% prior to the new CCSM strategy.
CONCLUSIONS
CONCLUSIONS
Proyecto Precancer facilitated the adoption and sustainment of HPV testing with subsequent treatment of HPV-positive women (after visual inspection) using portable thermal ablation at the primary level. This was accompanied by the de-implementation of existing visual inspection-based screening strategies and colposcopy for routine precancer triage at the hospital level. This case study highlights how implementation science approaches were used to guide the sustained adoption of a new screen-and-treat strategy in the Peruvian Amazon, while facilitating de-implementation of older screening practices.
Identifiants
pubmed: 38581011
doi: 10.1186/s43058-024-00566-z
pii: 10.1186/s43058-024-00566-z
doi:
Types de publication
Journal Article
Langues
eng
Pagination
35Subventions
Organisme : NCI NIH HHS
ID : R01CA190366
Pays : United States
Investigateurs
Joanna Brown
(J)
Lita Carrillo
(L)
Jhonny Cordova
(J)
Daniel Lenin Del Cuadro Hidalgo
(DL)
Dora Magaly Figueredo Escudero
(DM)
Karina Gonzales Diaz
(K)
José Jerónimo
(J)
Alcedo Jorges
(A)
Magdalena Jurczuk
(M)
Margaret Kosek
(M)
Gabriela Ladrón de Guevarra
(G)
Renso Lopez
(R)
Andrea Matos
(A)
Diana Maria Mattos Yap
(D)
Jaime Marín
(J)
Graciela Meza
(G)
Jessica Mori
(J)
Rachel Morse
(R)
Victor Palacios Cabrejos
(V)
Reyles Ríos
(R)
Jennifer Ríos
(J)
Gessy Salva
(G)
Patricia Raquel Rivas Saurin
(P)
Karina Román
(K)
Anne F Rositch
(AF)
Hermánn Silva
(H)
Anna Smith
(A)
Carlos Santos Ortiz
(C)
Sandra Soto
(S)
Nolberto Tangoa
(N)
J Kathleen Tracy
(JK)
Javier Vásquez
(J)
Gladys Giannina Vásquez Del Águila
(GG)
Informations de copyright
© 2024. The Author(s).
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