Clinical Performance Validation of 4 Point-of-Care Cervical Cancer Screening Tests in HIV-Infected Women in Zambia

We sought to determine the clinical performance of visual inspection with acetic acid (VIA), digital cervicography (DC), Xpert HPV, and OncoE6 for cervical cancer screening in an HIV-infected population

Availability of palliative care services in Zambia: A nationwide provincial and tertiary hospital survey

creasingly need palliative care. While efforts are underway to grow Zambia’s palliative care system, the most recent situational analysis of palliative care in Zambia, conducted in 2008, revealed substantial gaps in availability. Methods: To provide an updated appraisal of breast and cervical cancer services in Zambia, including palliative care, we conducted a nationwide provincial and tertiary hospital survey. All 9 provincial hospitals and the University Teaching Hospital and Cancer Diseases Hospital in Lusaka Province participated (N=11). The survey was conducted between August 2014 and January 2015 and administered in-person at each facility. Data regarding the availability of inpatient, outpatient, and community-based palliative care services, palliative medications, and psychosocial supports was obtained at each facility. The reported results are descriptive in nature. Results: Although the need for palliative care services was recognized, many facilities (64%) lack palliative care policies and only 18% offer palliative care in a coordinated program. The majority of services are only available to inpatients and rarely include community-based programs. While all facilities had adequate supplies of acetaminophen, 82% reported unavailability of codeine and 45% reported no access to oral morphine. Conclusions: This assessment confirms the dearth of palliative care services across Zambia. Less than half of its provincial hospitals offer community- or home-based services and only 55% offer opioid analgesics. Immediate and substantial improvements in policy, drug procurement and distribution, and service expansion are needed to ensure high-quality palliative care is available throughout Zambia

Pairing community health workers with HPV self-sampling for cervical cancer prevention in rural Haiti

To assess a program in which community health workers (CHWs) provided women with self-sampling devices to detect high-risk human papillomavirus (HPV). In a cross-sectional study, 13 CHWs visited homes in a rural area in Haiti’s Central Plateau to recruit premenopausal women aged 30–50years between July 2009 and April 2010. Eligible women had not undergone a cervical smear in the previous 3years. Participants learned about cervical cancer and self-sampling for HPV testing before using a self-sampler in private. They then completed a questionnaire. CHWs later returned to provide results and advice about follow-up care. CHWs enrolled 493 women. Among the 485 women for whom questionnaires were received, 468 (96.5%) were comfortable using the self-sampler and 484 (99.8%) stated they would recommend it to others. Among 426 analyzed samples, 54 (12.7%) were positive for high-risk HPV, of whom 46 (85.2%) received follow-up care and 17 (31.5%) had precursor lesions and were treated. Using a CHW-led intervention, women at high risk for developing cervical cancer were identified and navigated to preventive care. Therefore, pairing CHWs with HPV self-sampling is a promising strategy to combat cervical cancer in rural Haiti and similar settings

Community Health Workers Paired With Human Papillomavirus Self-Samplers: A Promising Method to Reduce Cervical Cancer

INTRODUCTION:Cervical cancer is the second most common malignancy among women in developing countries with a 53% mortality rate. Human papillomavirus (HPV) is the principal cause of cervical cancer. We have tested an innovative approach to cervical cancer screening, using community health workers and self-samplers for detecting high-risk HPV. METHODS:Community health workers visited homes and recruited 493 women, ages 18–50 years, from two rural villages in Haiti. Participants were instructed about cervical cancer and the self-sampler before privately performing the test in their homes. Community health workers then surveyed women about their experiences. After specimen processing, community health workers returned to womenʼs homes to provide test results and navigation to follow-up care. At the end of the 3-year study, semistructured interviews were conducted with community health workers to identify strengths and weaknesses of the program. RESULTS:Nearly all women (98.1%) were comfortable using the self-sampler with 99.8% stating they would recommend the method. Qualitative survey responses and community health worker feedback were also overwhelmingly positive. Of the women screened, 11.6% were positive for high-risk HPV, and 46 of these 54 women received follow-up care. Only 17 women had evidence of dysplasia, and all 17 received curative treatment. Community health workers reported that transportation was the primary obstacle to follow-up. CONCLUSION:Women at high risk for developing cervical cancer were identified and 85% received preventive care. This method circumvents barriers to clinic-based screening and was preferred by Haitian women. Therefore, pairing community health workers with HPV self-samplers is a promising strategy to reduce the cervical cancer burden in rural Haiti and similar settings

Abstract B52: Utilizing media to reduce the burden of cervical cancer in Little Haiti: A community-based participatory research (CBPR) approach

Abstract This video project is part of a larger, ongoing Community-based Participatory Research (CBPR) initiative aimed to reduce the burden of cervical cancer among Haitian women living in South Florida. Haitian women in this region, particularly those who reside in Little Haiti, the largest enclave of Haitian settlement in the United States, experience excess cervical cancer incidence and mortality. Since 2004 key community stakeholders, community health workers, and academic investigators from the University of Miami Miller School of Medicine (UMMSM) have worked collaboratively to address this disparity through complementary, community-based primary and secondary prevention efforts. The partnership has also enabled an in-depth exploration of the risk factors and risk conditions that account, in large part, for the high rate of cervical cancer observed in Little Haiti, including socioeconomic marginalization, language barriers, distrust of researchers, humoral conceptions of illness, and immigration status. Successful prevention efforts must address these multiple barriers to ensure timely screening and treatment for cervical cancer among women in Little Haiti. The United States Preventative Services Task Force recommends Pap screening every 3 years for women 21-65 while the Community Preventative Services Task Force recommends the use of small media including videos and printed materials to promote knowledge of and action on cervical cancer screening. Blending these recommendations with the knowledge obtained through nearly ten-years of campus-community collaboration, we created two ten-minute educational films on cervical cancer prevention for a Haitian audience. The films focus on prevention through HPV vaccination and Pap testing. The dialogue is exclusively in Haitian Kreyol with English subtitles. The films were written and produced by a Haitian writer and producer, with significant community input, star Kreyol-speaking actors, and incorporate medical and public health knowledge shared by the UMMSM partners. Reflective of community feedback regarding how to best structure health messages, the films revolve around a storyline of a Haitian family and how they approach a cervical cancer diagnosis and options for screening and prevention. The films address specific issues that have been raised over the course of the CBPR project including clarifying the difference between HPV and HIV, discussing the HPV vaccine and its unfounded association with sexual promiscuity, and the proactive role Haitian men can play in promoting cervical cancer awareness within the community at large. As we enter the dissemination phase of the project, our community advisory board and production team will collaborate to optimize a plan for circulating the videos throughout Little Haiti, including pairing viewing with ongoing screening and vaccination efforts. Via the internet, the videos will be made available to other Haitian audiences throughout the United States and around the world to promote widespread awareness and action on cervical cancer. These videos are a novel approach to cervical cancer prevention among Haitian women that draw on community knowledge to ensure cultural and linguistic relevance. Because Haitian Kreyol is traditionally a spoken language whose orthography was only recently solidified, this video approach shows particular promise in reaching a monolingual Kreyol-speaking audience to better promote cervical cancer prevention efforts in Little Haiti, Haiti, and throughout the Haitian Diaspora. Citation Format: Brigitte Frett, Myra Aquino, Marie Fatil, Michele Fievre, James LaPierre, Dinah Trevil, Olveen Carrasquillo, Erin Kobetz. Utilizing media to reduce the burden of cervical cancer in Little Haiti: A community-based participatory research (CBPR) approach. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B52. doi:10.1158/1538-7755.DISP13-B52</jats:p

Abstract B53: A case study on differences on cervical cancer screening knowledge and prevention practices among Latinas at two sites in a community-based participatory randomized control trial in South Florida

Abstract Immigrant Latinas are less likely to be screened for cervical cancer. With National Cancer Institute (NCI) support, we are examining the effectiveness of community health workers (CHWs) at increasing cervical cancer screening using self-sampling for the Human Papilloma virus (HPV, done free) versus clinic referral for traditional Pap Smear screening (nominal co-payments). Out of 455 participants enrolled to date, one site (Hialeah) serves mostly Cuban women (N=152) and the other site (Southern Miami-Dade County, SMD) serves a predominantly non-Cuban Latino population (N=112 plus 39 non Hispanic). Using a mixed methods quantitative/qualitative approach, we examined differences in demographics, cervical cancer knowledge and prevention practices among participants at these sites. Latino participants in Hialeah were younger, more recent immigrants, more educated, insured, higher literacy (SAHLSA), and higher cervical cancer knowledge that those in SMD. Most participants in Hialeah (95%) preferred HPV self-sampling citing familiarity with home based vaginal screening in Cuba and preferences for health services that were free as main reason for choosing HPV self-sampling. In SMD only half the population chose the HPV self-sampler. Cultural discomfort with vaginal self-sampling, preference for a doctor to perform a vaginal exam, and greater willingness to pay for health care services (despite lower SES) were found be major reasons why many women in SMD preferred being referred to a clinic for a traditional Pap smear. This study again highlights major differences in health knowledge and behaviors among different Latino subgroups. It also emphasizes the need for community based health programs to be tailored to the specific needs and practices of distinct Latino communities. Citation Format: Brendaly Rodriguez, Olveen Carrasquillo, Erin Kobetz, Martha Gonzalez, Tulay Koru-Sengal, Feng Miao, Shelia McCann, Anthony Amofah, Brigitte Frett. A case study on differences on cervical cancer screening knowledge and prevention practices among Latinas at two sites in a community-based participatory randomized control trial in South Florida. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B53. doi:10.1158/1538-7755.DISP13-B53</jats:p

Clinical Performance Validation of 4 Point-of-Care Cervical Cancer Screening Tests in HIV-Infected Women in Zambia

We sought to determine the clinical performance of visual inspection with acetic acid (VIA), digital cervicography (DC), Xpert HPV, and OncoE6 for cervical cancer screening in an HIV-infected population