背景:患有宫颈癌(CC)和HIV的女性,85%生活在撒哈拉以南非洲,其中21%的CC病例可归因于HIV感染。我们旨在生成国际上可接受的基于设施的指标,以监测和指导艾滋病毒诊所在现场或非现场提供的CC预防和护理服务的扩大规模。
方法:我们回顾了文献并提取了相关指标,将它们分组到沿CC控制连续体的域中。从2021年2月到2022年3月,我们进行了三轮,在线Delphi程序就指标达成共识。我们邀请了106名专家参加。通过匿名,迭代过程,参与者根据他们的背景调整了指标(第一轮),然后在5分Likert型量表(第2轮和第3轮)上对它们进行5个标准的评分,然后对其重要性进行排名(第3轮)。
结果:我们审查了来自21个非洲国家的39项政策和来自国际组织的7项政策;来自15个撒哈拉以南非洲国家或国际组织的72名专家参与了我们的德尔菲进程。第1轮中的反应率为34%,第2轮中的反应率为40%,第3轮中的反应率为44%。专家就以下领域的17项指标达成共识:一级预防(人乳头瘤病毒预防,n=2),二级预防(筛查,分诊,癌前病变的治疗,n=11),三级预防(CC诊断和护理,n=2),以及该计划的长期影响和与艾滋病毒服务的联系(n=2)。
结论:我们建议在撒哈拉以南非洲提供CC控制服务的艾滋病毒诊所逐步实施17项指标,并使其适应环境,以改善CC控制级联的监测。
Of women with cervical cancer (CC) and HIV, 85% live in sub-Saharan Africa, where 21% of all CC cases are attributable to HIV infection. We aimed to generate internationally acceptable facility-based indicators to monitor and guide scale up of CC prevention and care services offered on-site or off-site by HIV clinics.
We reviewed the literature and extracted relevant indicators, grouping them into domains along the CC control continuum. From February 2021 to March 2022, we conducted a three-round, online Delphi process to reach
consensus on indicators. We invited 106 experts to participate. Through an anonymous, iterative process, participants adapted the indicators to their context (round 1), then rated them for 5 criteria on a 5-point Likert-type scale (rounds 2 and 3) and then ranked their importance (round 3).
We reviewed 39 policies from 21 African countries and 7 from international organizations; 72 experts from 15 sub-Saharan Africa countries or international organizations participated in our Delphi process. Response rates were 34% in round 1, 40% in round 2, and 44% in round 3. Experts reached
consensus for 17 indicators in the following domains: primary prevention (human papillomavirus prevention, n = 2), secondary prevention (screening, triage, treatment of precancerous lesions, n = 11), tertiary prevention (CC diagnosis and care, n = 2), and long-term impact of the program and linkage to HIV service (n = 2).
We recommend that HIV clinics that offer CC control services in sub-Saharan Africa implement the 17 indicators stepwise and adapt them to context to improve monitoring along the CC control cascade.