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. Some of the highest incidence and mortality rates in Texas are found along the Texas-Mexico border and Northeast Texas. These populations are less likely to receive cervical cancer screening and the necessary preventive services are limited due to a lack of trained personnel.

We propose to expand our current CPRIT-funded project (PP15...

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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. Some of the highest incidence and mortality rates in Texas are found along the Texas-Mexico border and Northeast Texas. These populations are less likely to receive cervical cancer screening and the necessary preventive services are limited due to a lack of trained personnel.

We propose to expand our current CPRIT-funded project (PP150012) in the RGV to additional MUAs in the RGV, Laredo, Northeast Texas, Bastrop and Brazoria counties. We propose a comprehensive approach to deliver public education about cervical cancer screening and HPV vaccination through community outreach and clinic inreach, coupled with patient navigation. We propose to increase local capacity to deliver evidence-based cervical cancer prevention services through professional education and training of local providers. Our project will expand from our current 3 clinical sites in the RGV to 8 additional sites.

Specific Goals: Goal 1: Increase cervical cancer screening rates by 30% among medically-underserved women at participating sites through clinic inreach and community outreach educational programs and patient navigation services. • Objective 1: Increase the number of women undergoing cervical cancer screening with Pap and/or HPV testing at participating sites by at least 30% from a baseline of 21,889 to 28,456 women per year for a total of 65,667 to 85,368 women over the three-year project period. • Objective 2: Expand the number of clinics providing inreach education on cervical cancer screening and HPV vaccination from a baseline of one to 11 clinics (1,000% increase). This initiative will target women already receiving care for other conditions within the participating clinics who are eligible for cervical cancer screening, and will be coupled with navigation to Pap and/or HPV testing. • Objective 3: Educate 15,000 women in participating regions on cervical cancer screening through the implementation of AMIGAS (Ayudando a las Mujeres con Informacion, Guia y Amor para su Salud), an evidence-based community outreach educational program. 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 participating regions. • 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 at least 30% over the three-year project period (from a baseline of 22 to 29 providers for colposcopy/biopsy and from a baseline of 14 to 18 providers for LEEP). • Objective 2: Expand the Project ECHO telementoring program from a baseline of 6 to 11 participating sites (83% increase). • Objective 3: Increase the number of locally-held hands-on training courses to teach colposcopy, cervical biopsy and LEEP in the participating regions from a baseline of two to six courses (200% increase) over the three-year project period.

We estimate that the overall project will result in 94,115 unique people served. This includes 85,368 women undergoing cervical cancer screening, diagnosis and treatment; 47 professional providers receiving education, training and mentoring; and an estimated 8,700 (58%) of the 15,000 women who will receive outreach education and will be ineligible or unwilling to undergo screening and therefore not already included in the above numbers. The project involves only direct contact (education and clinical care) and therefore no unique people reached through indirect contact.

We expect to demonstrate that this comprehensive approach of public education and patient navigation will increase cervical cancer screening rates in MUAs of Texas. This will be combined with professional education, training and mentoring to increase local capacity to manage women with abnormal screening results. We anticipate that these interventions will result in increased rates of detection and treatment of preinvasive cervical disease, ultimately decreasing cervical cancer incidence and mortality in the regions proposed. This program is designed to be sustainable by developing a local cadre of expert providers able to train and mentor others. If successful, our combined interventions can be further adapted and disseminated across Texas, the U.S., and globally to improve cervical cancer prevention efforts.

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