# ENHANcing CErvical cancer screening and treatment in women LIviNg with HIV in KenyA (ENHANCE LINKAge)

> **NIH NIH U01** · EMORY UNIVERSITY · 2024 · $622,558

## Abstract

ABSTRACT
In sub-Saharan Africa (SSA), human papillomavirus (HPV) and HIV create a dual burden of disease that
causes significant morbidity and mortality in the form of cervical cancer (CC). Women living with HIV (WLWH)
have a six-fold higher risk of developing precancerous lesions that persist and progress to CC, which is the
leading cause of cancer mortality among women in Kenya. Significant support from the Go Further campaign,
represented by donors such as the President’s Emergency Plan for AIDS Relief (PEPFAR), the George W.
Bush Institute, UNAIDS, Merck, and Roche, to integrate CC screening into HIV clinics represents an
exceptional opportunity to scale CC impact across SSA, but only if implementation science evidence is
available to inform strategy. Currently, the impact of Go Further has been undermined by fractured linkages to
care and insensitive screening methods; in Kenya, less than 2% of WLWH screened have received appropriate
treatment. Implementation science studies are needed to better understand and surmount barriers to
integrated care in publicly funded HIV clinics. Specifically, we need to explore and innovate strategies to
overcome patient-, provider-, and system-level barriers to implementing CC screening and referral guidelines,
link WLWH who require further diagnostic testing and/or treatment with effective and accessible care, and
document services for accountability and quality improvement. In this proposal, our team will apply our
extensive implementation science expertise and partnerships with Kenya Ministry of Health (MOH) to adapt
and test evidence-based strategies (e.g., HPV self-testing, care navigators, and the WEMA mHealth app
[tested and scaled in Tanzania]) that address key multi-level barriers identified through a formative,
stakeholder-engaged research phase. Using the EPIS framework to guide our project, we will: Aim 1a),
Explore (engage a multi-disciplinary stakeholder advisory board to co-design the intervention package and
prioritize implementation strategies that align with local capacity, opportunities, and motivations; Aim 1b),
Prepare (develop tools and strengthen capacity at clinics to implement the strategies; Aim 2), Implement and
evaluate the package of implementation strategies via a cluster-randomized stepped wedge trial in 9 clinics
(assessing implementation [provision of CC screening with HPV self-testing] and effectiveness [proportion of
HPV-positive WLWH who receive subsequent diagnostic triage and/or treatment] over months 0-12; and Aim
3), assess Sustainability (costs, cost-effectiveness, and transfer of delivery from study to local staff over
months 13-18. The overall goal of this study is to employ rigorous empirical methods to adapt and test
implementation strategies that expand the scope of HIV care to screen for and treat early precancerous CC
lesions in a sustainable, scalable way. Through partnering with Kenya’s MOH, this project will have critical
institutional support and disseminat...

## Key facts

- **NIH application ID:** 11001702
- **Project number:** 1U01CA275120-01A1
- **Recipient organization:** EMORY UNIVERSITY
- **Principal Investigator:** Mohammed Kumail Ali
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $622,558
- **Award type:** 1
- **Project period:** 2024-09-01 → 2029-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11001702

## Citation

> US National Institutes of Health, RePORTER application 11001702, ENHANcing CErvical cancer screening and treatment in women LIviNg with HIV in KenyA (ENHANCE LINKAge) (1U01CA275120-01A1). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/11001702. Licensed CC0.

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