Abstract
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.
