Over 69,000 women living with HIV, (WLWH) in Ghana have a six-fold increased risk of
developing cervical cancer and require early and frequent cervical cancer screening
(CCS). However, available data in Ghana show that the CCS rate among eligible women is as
low as 2.7%, and there is no evidence that WLWH screen at higher rates. In response to
the need to increase the uptake of CCS among WLWH, the investigators developed a
Home-based self-sampling for cervical cancer Prevention Education (HOPE) intervention.
HOPE consists of HPV self-sampling combined with a 3R (Reframing, Reprioritizing, and
Reforming) communication model for promoting CCS. In a randomized controlled trial (RCT)
in Ghana, the investigators demonstrated that HOPE significantly increased CCS among WLWH
(100%) vs routine clinic-based screening (14.64%). Participating women found the
self-sampling and 3R communication model acceptable and culturally appropriate.
High-impact implementation strategies are needed to integrate and scale up HPV
self-sampling into women's healthcare in Ghana. The investigators propose to develop
and/or adapt implementation strategies to maximize the success of the HOPE intervention
in increasing its health system adoption, patient uptake, and the sustainment of CCS
among WLWH. The investigators' proposed hybrid type 2 effectiveness-implementation RCT
trial will leverage existing relationships with secondary-level health facilities in
Ghana. The investigators will select four secondary-level health facilities with
comparable infrastructure and WLWH patient enrollment. Using the Exploration,
Preparation, Implementation, and Sustainment (EPIS) framework, the investigators will
address the following specific aims.
Aim 1: To develop a culturally appropriate, evidence-based health system implementation
plan and provider training content for successful HOPE implementation (Preparation
phase). Through nominal group techniques (NGTs), the investigators will support engaged
stakeholders in selecting, prioritizing, and adapting culturally appropriate
implementation support strategies (ISS) for HOPE. Through NGTs, the investigators will
modify HOPE and adopt HOPE 2.0
Aim 2: Assess the effectiveness of the HOPE 2.0 intervention and the success of the
implementation plan in a hybrid type 2 trial (Implementation phase). The investigators
will conduct a hybrid type 2 effectiveness-implementation RCT to evaluate the impact of
implementation strategies. Four HIV secondary-level clinics will be cluster-randomized
1:1 in a two-arm RCT. Healthcare providers in the intervention group (IG, Arm 1) will
receive evidence-based training validated in Aim 1. After training, trained providers
will recruit WLWH (n = 576) from their HIV facilities and implement HOPE. Providers in
the control group (CG, Arm 2) who will not be trained with our ISS materials will recruit
WLWH (n = 576) and implement HOPE in their clinics.
Aim 3: Assess the impact of the implementation plan on the sustainment of the HOPE
intervention at study sites (Sustainment phase). The investigators will assess the impact
of HOPE on WLWH screening behaviors and the impact of strategy material on providers'
self-efficacy for implementing HOPE across the study arms.
