WEBVTT 00:00:00.000 --> 00:00:00.173 align:middle line:90% 00:00:00.173 --> 00:00:01.590 align:middle line:84% EMMA MITCHELL: We have great tools 00:00:01.590 --> 00:00:03.090 align:middle line:90% to prevent cervical cancer. 00:00:03.090 --> 00:00:05.200 align:middle line:84% No woman should be dying of cervical cancer. 00:00:05.200 --> 00:00:06.480 align:middle line:90% We know how to detect it. 00:00:06.480 --> 00:00:08.410 align:middle line:84% We know how to identify women's risk. 00:00:08.410 --> 00:00:10.290 align:middle line:84% We know how to vaccinate against it. 00:00:10.290 --> 00:00:11.860 align:middle line:90% We know how to screen for it. 00:00:11.860 --> 00:00:15.180 align:middle line:84% And once a lesion is identified, it's a very slow growing cancer 00:00:15.180 --> 00:00:16.030 align:middle line:90% most often. 00:00:16.030 --> 00:00:18.900 align:middle line:84% And so we have good tools to provide treatment as well. 00:00:18.900 --> 00:00:22.800 align:middle line:84% We see the disease persisting in settings where access 00:00:22.800 --> 00:00:24.660 align:middle line:90% to those tools is a challenge. 00:00:24.660 --> 00:00:26.400 align:middle line:84% On the Caribbean coast of Nicaragua 00:00:26.400 --> 00:00:30.060 align:middle line:84% there's not a dense population in most of that geographic area 00:00:30.060 --> 00:00:32.369 align:middle line:84% with a few notable exceptions like Bluefields, 00:00:32.369 --> 00:00:34.680 align:middle line:84% which was the geographic target of our pilot study. 00:00:34.680 --> 00:00:37.560 align:middle line:84% It's also part of the country that's linguistically, , 00:00:37.560 --> 00:00:40.710 align:middle line:84% historically ethnically very different from the rest 00:00:40.710 --> 00:00:41.490 align:middle line:90% of the country. 00:00:41.490 --> 00:00:44.040 align:middle line:84% Nicaragua doesn't have a national HPV vaccination 00:00:44.040 --> 00:00:44.640 align:middle line:90% program. 00:00:44.640 --> 00:00:46.230 align:middle line:84% Prevention efforts are really based 00:00:46.230 --> 00:00:48.270 align:middle line:90% on pap testing or cytology. 00:00:48.270 --> 00:00:50.760 align:middle line:84% Our study was based on HPV testing, 00:00:50.760 --> 00:00:52.770 align:middle line:84% so instead of needing a provider and instead 00:00:52.770 --> 00:00:54.840 align:middle line:84% of having a speculum or in a pelvic exam, 00:00:54.840 --> 00:00:58.120 align:middle line:84% our participants were able to collect their own sample. 00:00:58.120 --> 00:01:01.770 align:middle line:84% Then that sample was processed through an assay which 00:01:01.770 --> 00:01:03.510 align:middle line:84% looks for those high risk genotypes 00:01:03.510 --> 00:01:04.885 align:middle line:90% of human papillomavirus. 00:01:04.885 --> 00:01:06.510 align:middle line:84% There's been a lot of research in a lot 00:01:06.510 --> 00:01:09.450 align:middle line:84% of diverse global settings about the acceptability 00:01:09.450 --> 00:01:12.630 align:middle line:84% and the feasibility of using HPV-based primary screening, 00:01:12.630 --> 00:01:15.450 align:middle line:84% and a lot of that has to do with the self-collected aspect 00:01:15.450 --> 00:01:16.320 align:middle line:90% of it. 00:01:16.320 --> 00:01:18.510 align:middle line:84% And pretty universally women find 00:01:18.510 --> 00:01:20.460 align:middle line:84% it acceptable to collect their own sample. 00:01:20.460 --> 00:01:23.250 align:middle line:84% It's been found in several large studies and meta analyses 00:01:23.250 --> 00:01:24.270 align:middle line:90% to actually help. 00:01:24.270 --> 00:01:27.180 align:middle line:84% When having to go to a provider to get pap tested 00:01:27.180 --> 00:01:29.310 align:middle line:84% is a barrier for women, this has been 00:01:29.310 --> 00:01:31.530 align:middle line:84% found to help those women who are underscreened 00:01:31.530 --> 00:01:34.020 align:middle line:84% in a lot of again globally diverse settings. 00:01:34.020 --> 00:01:36.660 align:middle line:84% The World Health Organization has just committed to a plan 00:01:36.660 --> 00:01:39.840 align:middle line:84% to eradicate cervical cancer within the next 100 years. 00:01:39.840 --> 00:01:42.480 align:middle line:84% It's ambitious, but that's why new technology 00:01:42.480 --> 00:01:44.850 align:middle line:84% and innovative approaches are needed in order 00:01:44.850 --> 00:01:46.470 align:middle line:90% to try to meet those goals. 00:01:46.470 --> 00:01:49.140 align:middle line:84% REBECCA DILLINGHAM: mHealth is short for Mobile Health 00:01:49.140 --> 00:01:52.110 align:middle line:84% and refers to health interventions that 00:01:52.110 --> 00:01:55.800 align:middle line:84% are delivered over a mobile phone or a smartphone-- apps 00:01:55.800 --> 00:01:57.822 align:middle line:90% that support health care. 00:01:57.822 --> 00:02:00.030 align:middle line:84% EMMA MITCHELL: We worked with the Ministry of Health, 00:02:00.030 --> 00:02:01.830 align:middle line:84% the local Ministry of Health in Bluefields, 00:02:01.830 --> 00:02:03.750 align:middle line:90% to identify 10 health centers. 00:02:03.750 --> 00:02:08.039 align:middle line:84% We, in a period of five weeks, screened 1,791 women. 00:02:08.039 --> 00:02:10.830 align:middle line:84% Even with COVID, we're having a faster followup rate 00:02:10.830 --> 00:02:13.140 align:middle line:84% than previously the Ministry of Health had seen. 00:02:13.140 --> 00:02:16.320 align:middle line:84% Part of it is we're seeing areas where mHealth technology, 00:02:16.320 --> 00:02:18.090 align:middle line:84% mobile health interventions really 00:02:18.090 --> 00:02:22.290 align:middle line:84% could help to facilitate communication and patient 00:02:22.290 --> 00:02:22.905 align:middle line:90% engagement. 00:02:22.905 --> 00:02:24.780 align:middle line:84% REBECCA DILLINGHAM: Internet, like it or not, 00:02:24.780 --> 00:02:26.760 align:middle line:84% is the way that we get information, 00:02:26.760 --> 00:02:30.090 align:middle line:84% the way that we communicate, and the only way 00:02:30.090 --> 00:02:33.510 align:middle line:84% in many cases around the world that lower income people are 00:02:33.510 --> 00:02:36.180 align:middle line:84% able to access that incredible resource is 00:02:36.180 --> 00:02:37.230 align:middle line:90% through a smartphone. 00:02:37.230 --> 00:02:39.605 align:middle line:84% EMMA MITCHELL: I think that what was important about what 00:02:39.605 --> 00:02:41.760 align:middle line:84% we did was we made it regionally, 00:02:41.760 --> 00:02:45.120 align:middle line:84% culturally, linguistically appropriate in our approach. 00:02:45.120 --> 00:02:46.792 align:middle line:84% Once people do get screened and do 00:02:46.792 --> 00:02:48.750 align:middle line:84% get in the door in Nicaragua, sometimes they're 00:02:48.750 --> 00:02:51.360 align:middle line:84% lost to followup, which is true everywhere. 00:02:51.360 --> 00:02:54.120 align:middle line:84% But we are hopeful that-- by doing this pilot study 00:02:54.120 --> 00:02:56.040 align:middle line:84% and developing this mHealth intervention, 00:02:56.040 --> 00:02:57.540 align:middle line:84% we're hopeful that we're going to be 00:02:57.540 --> 00:02:59.970 align:middle line:84% able to prevent more people from being lost to followup 00:02:59.970 --> 00:03:02.190 align:middle line:84% and help usher them through the trajectory 00:03:02.190 --> 00:03:05.960 align:middle line:84% from getting your sample all the way through the treatment. 00:03:05.960 --> 00:03:14.000 align:middle line:90%