240488 Assessing the acceptability of a cervical self-sampling screening intervention in rural Haiti

Monday, October 31, 2011

Jonathan Kish, MPH , Department of Epidemiology and Public Health, University of Miami, Miami, FL
Ian Bishop, BA , Miller School of Medicine, University of Miami, Miami, FL
Sheila Kaupert , University of Miami Miller School of Medicine, National Hispanic Science Network on Drug Abuse, Miami, FL
Lacey Greathead , University of Miami, Miami, FL
Hannah Lipshultz, BA , Department of Epidemiology and Public Health, University of Miami, Miami
Sarah Marsh, CM MPH , Women Health Program Director, Zanmi Lasante/Partners in Health, Boston, MA
Maxi Raymondville, MD , Partners in Health/Zanmi Lasante, Boston, MA
Erin Kobetz, PhD, MPH , Department of Epidemiology and Public Health, University of Miami, Leonard Miller School of Medicine, Miami, FL
BACKGROUND: The annual incidence of cervical cancer in Haiti is 93.9/100,000. Pap smear screening has been demonstrated to be an ineffective screening tool in resource-poor settings. Cervical self-sampling for high-risk human Papillomavirus (HR-HPV) is a proposed alternative. METHODS: Community health workers (CHWs) in Thomonde, Haiti recruited women 18 and older who were self-reported premenopausal. CHWs administered a questionnaire that assessed demographics, reproductive and sexual health history; participants then performed the cervical self-sampling. Women were asked about their impressions of the sampler to gauge acceptability. Results of the testing were provided to the women within six weeks of self-sampling and CHWs navigated women with positive results to appropriate and timely follow-up. RESULTS: 373 women completed the self-sampling and questionnaire. Of submitted samples, 8.6% contained insufficient material for analysis, 98.3% of women reported the self-sampler as “comfortable” or “very comfortable”, 59.9% reported “no pain” and 94.3% reported no bleeding after performing the self-sampling. 80.6% stated they prefer testing at home to at a clinic, and 99.7% would recommend the test to a friend or neighbor. CONCLUSIONS: Self-sampling is an acceptable alternative to Pap smear screening for women in rural Haiti. It circumvents individual and environmental barriers including modesty and access to clinic-based healthcare. Pairing this procedure with a routine CHW visit is feasible and necessary. CHWs can address cultural barriers such as cancer fatalism and the Haitian view of disease causality. Therefore, this intervention builds local community capacity to increase cancer prevention knowledge and increase screening rates in a culturally appropriate fashion.

Learning Areas:
Administer health education strategies, interventions and programs

Learning Objectives:
Describe the efficacy among women using a cervical self-sampling device as an alternative to Pap smears in rural Haiti. Understand the importance of community health workers in implementing self-sampling screening programs in developing countries Assess the distribution of high-risk HPV infection among rural women villagers in Haiti

Keywords: Screening, Cervical Cancer

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the senior research associate/doctoral student involved in the collection and analysis of this data
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.