TeleMed: Comparison of cervical intraepithelial neoplasia 2/3 treatment outcomes with a portable LMIC-adapted thermal ablation device vs. gas-based cryotherapy

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Project Summary The COVID-19 pandemic has resulted in the interruption of routine and non-emergency care around the world, including cancer screening. In high-income countries, telemedicine has mitigated the impact of these disruptions. In low- and middle-income countries (LMICs), however, the widespread use of telemedicine faces significant barriers, including high costs and lack of technical expertise and regulatory guidance. At the same time, the pandemic has provided the impetus for introducing telemedicine approaches that can be implemented using existing infrastructure. In El Salvador, the Ministry of Health (MOH) has implemented a COVID-19 result delivery method based on mobile phone text messaging. This Supplement will pilot a similar result delivery strategy for cervical cancer screening and compare its performance to the current method of in- person visits to health clinics. This complements parent grant (R01CA218195) in utilizing technological innovation to increase access to cervical cancer prevention services in LMICs. Currently, approximately 40% of screen-negative women and 20% of screen-positive women do not receive their cervical cancer screening results. We will develop a pilot telemedicine intervention to communicate results to patients in the Paracentral region of El Salvador. We will use a commercially available automated texting service (Twilio Inc., San Francisco, CA) and embed it in a patient database created in collaboration with the country's Cancer Unit at the MOH. A comparative cross-sectional study will compare the telemedicine intervention against the current result delivery model. A group of 550 women will be assigned to the intervention. Screen-negative patients will be informed of their results and given recommendations for future screenings. Screen-positive women will receive a message directing them to call their assigned local health clinic to schedule an appointment to receive their results. In the control group, 550 women will be asked to return to the clinic 30 days after screening to receive their results in person, both positive or negative, as per current practice. Women in both groups will be administered a brief acceptability questionnaire to assess perceptions and attitudes of the delivery method. Program-level indicators for clinics assigned to intervention and control groups will also be collected. We hypothesize that the telemedicine intervention will allow more women to receive their results in a shorter time period and result in increased adherence to follow-up services.