About this trial
The goal of this clinical trial is identify an effective and implementable set of implementation strategies to increase cervical cancer prevention in Malawi. The main questions it aims to answer are:
1. Which implementation strategies produce the greatest increase in provider recommendation for, and uptake of, cervical cancer prevention tools among people receiving HIV care. 2. What is the acceptability, appropriateness, feasibility, and cost of these implementation strategies. 3. What is the sustained effect of these implementation strategies. The implementation strategies will be conducted with health workers (clinical officers, nurses, and medical assistants): training, coaching, and a reminder system.
Eligibility criteria
This trial accepts healthy volunteersQualifiers
Health workers: People who provide medical care and counseling (typically medical assistants, clinical officers, and nurses), and interact with adolescent girls and young women aged 9-24 and/or their parents/caregivers.
Clients: Non-pregnant females aged 9-24 (for those aged 9-17, their male or female parent/guardian will also be eligible for participation) who present for HIV care at a participating health facility during the study period.
Disqualifiers
Health workers: Less than 18 years of age, or not an active and regular provider of medical care or counseling at the facility, or unable or unwilling to provide informed consent.
Clients: <9 or >24 years old, or pregnancy, or unable or unwilling to provide informed consent.
Trial design
Factorial
Treatments tested in this trial
In-person training
BehavioralAn in-person educational session.
Virtual training
BehavioralA virtual educational session.
Coaching
BehavioralShort video vignettes plus reinforcing messages
Prompts
BehavioralVisual aide to remind providers to discuss cervical cancer prevention methods.
Treatment groups
8
Treatment groupsSee each treatment group below.
Trial outcomes
Primary outcomes
Difference in prevalence of discussions surrounding methods of cervical cancer prevention
Discussions about methods of cervical cancer prevention will be reported by clients following each routine HIV care visit. This rate is defined as the percentage of visits during which there is a discussion about methods of cervical cancer prevention. This rate will be compared between the groups with and without each intervention component.
Secondary outcomes
Difference in prevalence of completing a cervical cancer prevention program
Completing a cervical cancer prevention program will be reported by clients following each routine HIV care visit. This prevalence is defined as the percentage of clients who complete a cervical cancer prevention program. This prevalence will be compared between the groups with and without each intervention component.
Difference in prevalence of initiating a cervical cancer prevention program among those uninitiated
This prevalence is defined among those who have not begun a cervical cancer prevention program at study entry. This prevalence will be compared between the groups with and without each intervention component.
Other outcomes
Acceptability of the implementation strategies
Health workers will be asked a set of questions to assess their perceived acceptability of the implementation strategies, based on the Theoretical Framework of Acceptability questionnaire, and these will be combined into an acceptability score (ranging from 0-27 with a higher score indicating greater acceptability). We will compare the average acceptability score between groups with and without each intervention component.
Sponsors and contacts
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New York University
Lead sponsor
National Cancer Institute (NCI)
Collaborator
University of California, Los Angeles
Collaborator
Partners in Hope, Inc.
Collaborator