El Paso County (EPC) and Hudpseth County (HC) are two border counties with a combined population of 822, 266, where women are at disproportionate cervical cancer risk and face overwhelming socioeconomic, cultural, and access barriers. Women in these counties are predominantly Hispanic (81% EPC; 79.6% HC), have a high poverty rate (26.6% EPC; 46% HC), a high proportion of uninsured (36% EPC; 54.3% HC), and have low educational attainment. Women on the Border have a higher cervical cancer incidence rate, are diagnosed at later stages, and have higher mortality compared to non-Border women. In addition, Hispanic women have almost double the incidence of all race/ethnicities and are twice as lik...

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El Paso County (EPC) and Hudpseth County (HC) are two border counties with a combined population of 822, 266, where women are at disproportionate cervical cancer risk and face overwhelming socioeconomic, cultural, and access barriers. Women in these counties are predominantly Hispanic (81% EPC; 79.6% HC), have a high poverty rate (26.6% EPC; 46% HC), a high proportion of uninsured (36% EPC; 54.3% HC), and have low educational attainment. Women on the border have a higher cervical cancer incidence rate, are diagnosed at later stages, and have higher mortality compared to non-Border women. In addition, Hispanic women have almost double the incidence of all race/ethnicities and are twice as likely to die from cervical cancer than non-Hispanic women. Resource availability is low in in these counties because they are medically underserved and the safety net is overwhelmed.

We have identified key barriers to screening through an analysis of local data, key informant interviews and focus groups and have designed a program that addresses the needs of our community, addresses gaps in services and creates a coordinated program of education, outreach, service delivery, navigation and capacity building for the future.

This is a multicomponent evidence-based program designed to reduce the cervical cancer burden among uninsured women in two Border Counties. This program is a community wide partnership led by Texas Tech University Health Sciences Center (TTUHSC), Paul L Foster School of Medicine, El Paso, in collaboration with Texas A&M Western Region Colonias program, the promotora network, four local clinic systems, the El Paso County public hospital and clinic system, TTUHSC Family and Community Medicine Center and community partnership clinics, local faith-based organizations, El Paso Public Housing Authority, the El Paso County Senior Centers, the YMCA, the ACS, Rio Grande Cancer Foundation, numerous community based organizations and non profits, the Public Health Department and the State 2-1-1 program.

Key program components are: 1) Door to door, community by community outreach to women that are community-bound and are not currently served because of insurmountable structural, socioeconomic and cultural barriers; 2) Proven theory-based and culturally tailored cervical cancer education delivered by bilingual, certified promotoras; 3) Provision of no-cost pap and HPV screening and on-site diagnostic colposcopy; 5) Increased colposcopy capacity in underserved areas through the creation of a cohort of appropriately trained primary care providers; 6) Patient navigation and tracking to facilitate screening, diagnosis, health insurance coverage, access to a PCP, and treatment; 7) Creation of sustainability through formation of a cohort of women that understand solutions to common barriers, the availability of new colposcopy services that will continue after the project period, through development and institutionalization of a colposcopy training program, through incorporation of program elements into the service learning and practicum requirements for residents, medical, and MPH students, and through the creation of ongoing partnerships; and 7) A rigorous process and outcomes evaluation.

The long term goal of De Casa en Casa is to reduce the burden of cervical cancer in our Border community by facilitating early diagnosis and access to treatment in El Paso and Hudspeth Counties. Specific goals are: 1) Increase community knowledge about cervical cancer and available resources and reduce cultural and behavioral barriers to screening, diagnosis and follow up; 2) Increase uptake of cervical cancer screening among uninsured and underinsured women in both counties; 3) Increase access by provision of no cost cervical cancer screening with pap smear and HPV co-testing; 4) Increase uptake of diagnosis and treatment services by reducing structural barriers among uninsured and underinsured women in El Paso and Hudspeth County; 5) Increase colposcopy capacity and create a pipeline of primary care physicians equipped to provide diagnostic and treatment colposcopies for cervical cancer in underserved settings; and 6)Create a sustainable screening, diagnosis and treatment network for cervical cancer.

A door to door approach for outreach, the ability to offer the full spectrum of cancer care from prevention to treatment, increasing colposcopy capacity, the continued creation of partnerships, and leveraging of resources from our partners and our previous CPRIT grant, the strategies for sustainability, and the meticulous process and outcomes evaluation.

We will meet the goals of the Texas Cancer Plan and address a CPRIT priority to reduce the impact of cervical cancer on the Texas border, through the implementation of sustainable and effective programs that target the underserved and reduce disparities in cancer throughout the State.

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