Remote Resilience: Novel Applications of mHealth in Nicaragua's Cancer Control Program

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PROJECT SUMMARY / ABSTRACT Cervical cancer, a preventable cancer of disparities, is the primary cause of cancer death for women in Nicaragua. The World Health Organization (WHO) adopted an elimination strategy for cervical cancer within the next 100 years, and outlined specific targets to meet by 2030: vaccination (90% of girls before age 15); screening/early detection (70% of women get a high-quality screen by 35 and again at 45); and treatment (90% of pre-cancerous and cancerous lesions treated). As the majority of the burden of cervical cancer exists in low and middle income countries (LMICs), significant research into the development, implementation, and cost- effectiveness of community-based cervical cancer screening models using HPV primary screening has developed a strong evidence-base for the acceptability and feasibility of this modality. However, significant geographic variability exists in successfully improving patient health outcomes and preventing cervical cancer, particularly in rural and remote geographic areas. In Nicaragua, significant intra-country variability exists in terms of yearly participation in cervical cancer screening by eligible women, and likelihood of lifetime screening, depending on geographic region. There is a demonstrated need for culturally-tailored, regionally specific innovations in evidence-based HPV primary cervical screening programs. Based on a successful pilot study enrolling nearly 2,000 women in Bluefields, Nicaragua, researchers have identified the unique role mHealth (mobile health) interventions may play in improving health outcomes when integrated into an HPV primary screening program. Innovations presented herein include the development of a mHealth platform that combines a patient-centered mobile application (app) with a provider-focused portal, as well as integration of the provider- focused portal with the National Cervical Cancer Surveillance System (SIVIPCAN). Through developing this culturally-tailored, regionally appropriate mHealth intervention for women and healthcare providers (R21 phase) and then pilot testing the impact of this intervention when integrated into a community-based HPV-based primary cervical cancer screening program (R33 phase), this study will provide important evidence relative to the potential for novel mHealth interventions to improve cervical cancer screening follow-up and treatment, with a focus on rural and remote settings, often the hardest geographic regions in which to improve health outcomes.