Need: In the US, cervical cancer incidence and mortality rates have decreased by 70% due to implementation of screening programs based on Pap and human papillomavirus (HPV) testing. However, women living in medically underserved areas (MUAs) still experience significant health disparities including a higher burden of cervical cancer. Texas has one of the highest rates of cervical cancer incidence and mortality in the US and women in MUAs are less likely to receive cervical cancer screening and appropriate follow up. Overall Project Strategy: We propose a Maintenance Expansion of our current CPRIT-funded project (PP190014), which is an Initial Expansion of PP150012. We will continue to off...
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Need: In the US, cervical cancer incidence and mortality rates have decreased by 70% due to implementation of screening programs based on Pap and human papillomavirus (HPV) testing. However, women living in medically underserved areas (MUAs) still experience significant health disparities including a higher burden of cervical cancer. Texas has one of the highest rates of cervical cancer incidence and mortality in the US and women in MUAs are less likely to receive cervical cancer screening and appropriate follow up. Overall Project Strategy: We propose a Maintenance Expansion of our current CPRIT-funded project (PP190014), which is an Initial Expansion of PP150012. We will continue to offer cervical cancer prevention services to women at our existing 10 collaborating sites in the Rio Grande Valley (RGV), Laredo, Northeast Texas, Bastrop and Alvin, and include new sites in Corpus Christi, Waxahachie and Pasadena. We propose to continue our comprehensive approach which includes public education about screening and HPV vaccination through community outreach and clinic in-reach, coupled with patient navigation to services. We will also provide education and training to local providers to build capacity to deliver quality cervical cancer prevention services through hands-on colposcopy and LEEP training courses and telementoring using Project ECHO. Specific Goals: Goal 1: Increase cervical cancer screening rates in MUAs through clinic inreach and community outreach educational programs coupled with patient navigation services. Objective 1: Increase the number of women undergoing cervical cancer screening with Pap and/or HPV testing at participating sites by 30% from a baseline of 13,122 to 17,059 women per year, for a total of 51,177 women over the 3-year project period. Objective 2: Expand the number of partnering sites providing inreach education on cervical cancer screening and HPV vaccination from a baseline of 10 to 13 (23% increase). Objective 3: Educate 15,000 women (5,000 per year) in participating regions on cervical cancer screening through the implementation of Salud en Mis Manos (SEMM), an evidence-based community outreach educational program to increase cervical cancer screening. Eligible women will be navigated to participating clinics for screening. Goal 2: Increase local capacity to deliver evidence-based cervical cancer prevention services through professional education, training and support of local providers in MUAs. Objective 1: Increase the number of local providers managing abnormal cervical cancer screening tests including independently performing colposcopy, cervical biopsies and/or LEEP at participating sites by 30% over the three-year project period (from a baseline of 20 to 26 providers). Objective 2: Expand the Project ECHO telementoring program from a baseline of 10 to 13 participating sites (23% increase). Objective 3: Provide 6 hands-on and/or virtual/blended training courses (two per year) to teach colposcopy, cervical biopsy and LEEP to medical providers from partner sites (25 participants per course). Goal 3: Improve coordination of cervical cancer prevention efforts through community events that combine cervical cancer screening and HPV vaccination for women and their family members. Objective 1: Hold 6 one-day events (two per year) that offer both cervical cancer screening and HPV vaccination services for women and their family members. These events will be rotated among participating clinics and performed in collaboration with the Area Health Education Center (AHEC). We will screen 20 women and vaccinate 50 eligible individuals per event, for a total of 120 women screened and 300 individuals vaccinated over the three-year project period. We estimate that we will provide 113,816 services and that the overall project will result in 96,552 unique people served (32,184 individuals per year). This includes 51,177 women undergoing cervical cancer screening. We estimate that we will reach 90,000 individuals through outreach activities, flyer distributions, publications and/or public service announcements. Significance and Impact: We expect to demonstrate that a comprehensive approach of public education and patient navigation will increase cervical cancer screening rates. Professional education, training and mentoring will increase local capacity to manage women with abnormal test results. We anticipate that these interventions will result in increased rates of detection and treatment of women with preinvasive cervical disease, ultimately decreasing cervical cancer incidence and mortality. This program is designed to be sustainable through building local cadres of providers able to train and mentor others. If successful, our intervention can be adapted and disseminated across Texas, the US, and globally to improve cervical cancer prevention efforts.
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