Although cervical cancer rates have sharply declined over the last century due to early screening, up to 40% of invasive cancers are still attributed to lack of follow-up for abnormal screening results,(1,2) with the lowest rates of follow-up seen in urban, minority, uninsured individuals.(3) Intervention is urgently needed to improve health equity for these individuals beyond screening alone, as much of the lack of adherence stems from poor understanding and anxiety regarding the necessary follow-up procedures.(4-7) The screening rate of Hispanic individuals in Texas is 74.1% (statewide 78%), and the mortality is 2.9/100,000 (statewide 1.6).(8) However, the Harris County incidence of late-s...

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Although cervical cancer rates have sharply declined over the last century due to early screening, up to 40% of invasive cancers are still attributed to lack of follow-up for abnormal screening results,(1,2) with the lowest rates of follow-up seen in urban, minority, uninsured individuals.(3) Intervention is urgently needed to improve health equity for these individuals beyond screening alone, as much of the lack of adherence stems from poor understanding and anxiety regarding the necessary follow-up procedures.(4-7) The screening rate of Hispanic individuals in Texas is 74.1% (statewide 78%), and the mortality is 2.9/100,000 (statewide 1.6).(8) However, the Harris County incidence of late-stage cervical cancer among Hispanic individuals is one of the highest in the state at 7.2/100,000 (state-wide incidence is 5.8/100,000),(9) likely due to poor access to preventative medical care, which can diagnose and treat precancer, or dysplasia. To meet this need, the Houston Prevenir, Ayudar, Poder (PAP) Project was established in 2018 and provides cervical cancer screening, diagnosis, and treatment of precancer/dysplasia through colposcopy and LEEP (Loop Electrosurgical Excisional Procedure). This population is at remarkably high risk for cervical cancer and has the lowest adherence rates of follow-up after abnormal screening. Therefore, it is critical to meet the needs of this underserved population with accessible specialty services and education. We aim to expand the Houston PAP Project to reach more vulnerable Hispanic individuals in medically underserved areas (MUAs) of the greater Houston area, including Harris and all surrounding counties, to provide increased access to cervical dysplasia diagnosis and treatment, and to build an educational and counseling model for colposcopy and LEEP. We will provide high-value education and counseling delivered by peer health advocates, thereby increasing follow up of abnormal cervical cancer screening in MUAs in the greater Houston area, increasing the diagnosis and treatment of cervical dysplasia, and preventing more cervical cancers. Significance and Impact: Specialty services, including colposcopy and LEEP, are critical to comprehensive cervical cancer screening objectives. Furthermore, evidenced-based education on cervical dysplasia diagnosis and treatment will empower more individuals to proceed with treatment to prevent cervical cancer development. The Houston PAP Project's proposed intervention directly targets (A) the imperative need for specialty colposcopy and precancer treatment after abnormal screens among Hispanic individuals in MUAs of greater Houston, and (B) the need to provide education and counseling to increase adherence to follow-up. These interventions will build on other CPRIT-funded programs that provide cervical cancer screening to maximize the impact. We aim for this education and service model to be able to be replicated by other providers across the state, to decrease statewide incidence and mortality of cervical cancer.

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