Social determinants of health associated to the cervical cancer-related care across the cancer control continuum among women living with HIV in Puerto Rico

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Program Director/Principal Investigator (Last, First, Middle): Colón-López, Vivian PROJECT SUMMARY/ABSTRACT: RESEARCH PROJECT 1 Cervical cancer is the leading cause of cancer among women living with HIV (WLWH). Although cervical cancer screening is part of routine clinical care for WLWH, this population lacks regular screening, appropriate follow- up and/or treatment for precancerous lesions and/or cervical cancer. There is no consensus on the most important social determinants of health (SDoH) associated with access to care across the cervical cancer care continuum (screening, diagnosis, and treatment) among WLWH. The overall goal of this investigation is to employ a mixed-methods approach to identify multi-level factors within the SDoH that affect timely access to cervical cancer care across the cancer care continuum (screening, diagnosis, and treatment) among WLWH in Puerto Rico (PR). PR is one of the jurisdictions within the United States (US) with a high incidence and prevalence of HIV/AIDS, and a recent significant increase in the incidence of cervical cancer (2001-2017). Our specific aims are: (1) To examine the impact of HIV status on the extent and determinants of delay in cervical cancer care (screening, diagnosis and treatment) among cervical cancer patients diagnosed in PR during the period 2013-2020; (2) Establish multi-level factors within the SDoH that affect timely cervical cancer care (screening, diagnosis and treatment) among women with high-grade cervical lesions (HSIL) or cervical cancer in PR; and (3) Estimate the use of effective primary (HPV vaccination) and secondary (screening for, and treating HSIL) prevention approaches among women diagnosed with HIV or AIDS in PR for 2023 and 2024. Our ultimate goal is that all WLWH have equitable health access to cervical cancer care, while reducing morbidity and mortality associated to this malignancy. This proposal supports a 3-year research and training plan to allow Dr. Soto to make substantial progress toward a career as an independent investigator and leader in the field of SDoH, cancer control and HIV. Results from this project will identify intervention opportunities within the SDoH along the cervical cancer care continuum. Moreover, findings will guide the development and evaluation of these interventions to reduce barriers to care and ensure health equity among WLWH in a subsequent R01 application. This information could also potentially be adapted to Hispanic WLWH in the US and in other populations. OMB No. 0925-0001/0002 (Rev. 03/2020 Approved Through 02/28/2023) Page Continuation Format Page