EMMA MITCHELL: We have great tools
to prevent cervical cancer.
No woman should be dying of cervical cancer.
We know how to detect it.
We know how to identify women's risk.
We know how to vaccinate against it.
We know how to screen for it.
And once a lesion is identified, it's a very slow growing cancer
most often.
And so we have good tools to provide treatment as well.
We see the disease persisting in settings where access
to those tools is a challenge.
On the Caribbean coast of Nicaragua
there's not a dense population in most of that geographic area
with a few notable exceptions like Bluefields,
which was the geographic target of our pilot study.
It's also part of the country that's linguistically, ,
historically ethnically very different from the rest
of the country.
Nicaragua doesn't have a national HPV vaccination
program.
Prevention efforts are really based
on pap testing or cytology.
Our study was based on HPV testing,
so instead of needing a provider and instead
of having a speculum or in a pelvic exam,
our participants were able to collect their own sample.
Then that sample was processed through an assay which
looks for those high risk genotypes
of human papillomavirus.
There's been a lot of research in a lot
of diverse global settings about the acceptability
and the feasibility of using HPV-based primary screening,
and a lot of that has to do with the self-collected aspect
of it.
And pretty universally women find
it acceptable to collect their own sample.
It's been found in several large studies and meta analyses
to actually help.
When having to go to a provider to get pap tested
is a barrier for women, this has been
found to help those women who are underscreened
in a lot of again globally diverse settings.
The World Health Organization has just committed to a plan
to eradicate cervical cancer within the next 100 years.
It's ambitious, but that's why new technology
and innovative approaches are needed in order
to try to meet those goals.
REBECCA DILLINGHAM: mHealth is short for Mobile Health
and refers to health interventions that
are delivered over a mobile phone or a smartphone-- apps
that support health care.
EMMA MITCHELL: We worked with the Ministry of Health,
the local Ministry of Health in Bluefields,
to identify 10 health centers.
We, in a period of five weeks, screened 1,791 women.
Even with COVID, we're having a faster followup rate
than previously the Ministry of Health had seen.
Part of it is we're seeing areas where mHealth technology,
mobile health interventions really
could help to facilitate communication and patient
engagement.
REBECCA DILLINGHAM: Internet, like it or not,
is the way that we get information,
the way that we communicate, and the only way
in many cases around the world that lower income people are
able to access that incredible resource is
through a smartphone.
EMMA MITCHELL: I think that what was important about what
we did was we made it regionally,
culturally, linguistically appropriate in our approach.
Once people do get screened and do
get in the door in Nicaragua, sometimes they're
lost to followup, which is true everywhere.
But we are hopeful that-- by doing this pilot study
and developing this mHealth intervention,
we're hopeful that we're going to be
able to prevent more people from being lost to followup
and help usher them through the trajectory
from getting your sample all the way through the treatment.