HIV/Cervical Cancer Prevention ‘CASCADE’ Clinical Trials Network
Global partnership focused on optimizing the cervical cancer screening, management, and pre-cancer treatment cascade for women living with HIV
What is ‘CASCADE’?
The U.S. National Cancer Institute (NCI)-supported HIV/Cervical Cancer Prevention ‘CASCADE’ Clinical Trials Network conducts pragmatic clinical trials evaluating the clinical effectiveness of prevention interventions in intended-use settings with a goal to optimize the cervical cancer screening, management, and pre-cancer treatment cascade for women living with HIV.
Learn More ➞How Does ‘CASCADE’ Function?
‘CASCADE’ is a cooperative agreement-funded clinical trials program that brings together stakeholders groups with complementary roles and responsibilities working collaboratively to contribute evidence to inform clinical practice guidelines and improve implementation of cervical cancer prevention and control programs globally for women living with HIV.
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Global Impact
‘CASCADE’ network trials are conducted in resource-constrained settings in low- and middle-income countries as well as in areas of high disease burden and healthcare disparities within the United States
Areas of Scientific Focus
Increase Screening Uptake
Given the complexity and evolution in clinical care delivery for women with HIV, there is a need for developing innovative approaches that balance the need for maximizing the sensitivity for pre-cancer detection while balancing costs and efficiency in screening.
Improve Management of Abnormal Screenings
Women with HIV have high cervical HPV prevalence, emphasizing the need for better methods to triage HPV-positive results to differentiate those with clinically important HPV infections (i.e., those that are associated with or will develop into cervical pre-cancer and cancer) versus benign HPV infections destined to clear.
Access to Treatment
A lack of well-trained healthcare providers in many regions is a key constraint in implementing successful clinical and public health screening programs. Innovative approaches such as task shifting models and telemedicine that rely on nurses and non-physician healthcare providers are being widely adopted globally, emphasizing the need for evaluating the comparative effectiveness of these approaches.
Optimizing Treatment
Variations in definitions of treatability of lesions lead to variable treatment performance and can increase the risk of precancer recurrence. Additionally, the multifocal nature of anogenital disease and the relative immunosuppressive state in women with HIV affects post-treatment recurrences. Evaluation of different treatment algorithms can provide evidence to optimize implementation for preventive therapy interventions among women living with HIV.