Evidence-Based Approach to Empower Asian American Women in Cervical Cancer Screening

项目总结 巴氏试验的引入大大降低了#年宫颈癌的发病率和死亡率。 美国。然而，在许多亚裔美国人亚群中，筛查率并不理想，而且一直保持不变 低于非西班牙裔白人、非西班牙裔黑人和西班牙裔女性的比率。研究报告称，韩国人 尤其是越南裔美国女性，与其他女性相比，她们的筛查率最低。 民族/种族群体。亚裔美国女性没有进行筛查的原因可能有多种。 尴尬、成本、缺乏保险或常规医疗服务提供者、缺乏时间和语言困难 是在这个人群中进行筛查的关键障碍。支持人类自我采样的新兴技术 乳头瘤病毒(HPV)检测可能为赋予亚裔美国人权力提供一种有价值的、基于证据的策略 抵抗--或无法--获得基于临床的宫颈癌筛查的妇女。全国 现在的指导方针包括每5年进行一次初步HPV筛查，作为适当的宫颈癌筛查 策略。因为非临床环境中的HPV自我采样具有与HPV检测相当的准确性 临床医生获得的样本，自我收集可能是提高筛查率的重要策略 在筛查不足的人群中。在美国，提供自我采样试剂盒改善了筛查 在资源有限的妇女中，这一比例很高，是可以接受的。值得注意的是，女性报告说经历了 减少自我采样的尴尬，一些研究发现，它提高了随后的临床参与度- 基于筛查。尽管先前的研究表明，HPV自我采样可以在 在资源匮乏的社区环境下，没有一项研究关注服务不足的亚裔美国女性，尽管 这一人群是宫颈癌筛查率最低的人群之一。因此，我们的目标是 拟议的项目是在一项以社区为基础的研究中检查HPV自我采样，研究对象为800名亚裔美国女性。 使用配对设计，12个社区站点(n=400名妇女)将获得我们先前测试的社区 关于宫颈癌筛查的教育方案，加上导航，以及HPV自我采样试剂盒；以及12 社区站点(n=400)将接受我们之前测试过的社区教育计划以及导航至 基于诊所的筛查。拟议项目的目的是：(1)比较提供自我收集的 在800名亚裔美国女性中进行样本和获得临床筛查的对比；(2)检查 参与；以及(3)评估HPV自我采样与临床筛查的相对成本效益。 人口统计、社会/文化环境和自然环境因素将在基线、后 干预，6个月随访。参加自我抽样或以诊所为基础的筛查的评估时间为6- 一个月的随访。拟议中的项目将是第一个评估HPV自我采样的大规模研究 未得到充分服务的亚裔美国女性。研究结果将为未来的循证计划提供信息，旨在 在全国范围内提高亚裔美国女性的筛查参与度。

PROJECT SUMMARY The introduction of the Pap test has led to significant reductions in cervical cancer incidence and mortality in the US. However, screening rates are suboptimal in many Asian American subgroups, and remain persistently lower than rates in non-Hispanic White, non-Hispanic Black, and Hispanic women. Studies report that Korean and Vietnamese American women, in particular, have among the lowest rates of screening compared to other ethnic/racial groups. Multiple factors may contribute to non-screening among Asian American women. Embarrassment, cost, lack of insurance or regular healthcare provider, lack of time, and language difficulties are key barriers to screening in this population. Emerging technologies supporting self-sampling for human papillomavirus (HPV) testing may offer a valuable, evidence-based strategy for empowering Asian American women who have been resistant -- or unable -- to obtain clinic-based cervical cancer screening. National guidelines now include primary HPV screening every 5 years as an appropriate cervical cancer screening strategy. Because HPV self-sampling in non-clinical settings has comparable accuracy to HPV-testing on clinician-obtained samples, self-collection may represent an important strategy for increasing screening rates among underscreened populations. In the United States, the provision of self-sampling kits improved screening rates among women with limited resources and was highly acceptable. Notably, women reported experiencing less embarrassment with self-sampling, and some studies found it improved subsequent participation in clinic- based screening. Although prior studies have demonstrated that HPV self-sampling can be feasibly offered in low-resource community settings, not one study has focused on underserved Asian American women, despite the fact that this population has among the lowest cervical cancer screening rates. Therefore, the goal of the proposed project is to examine HPV self-sampling in a community-based study of 800 Asian American women. Using a matched-pair design, 12 community sites (n=400 women) will receive our previously tested community education program on cervical cancer screening plus navigation, along with HPV self-sampling kits; and 12 community sites (n=400) will receive our previously tested community education program plus navigation to clinic-based screening. The aims of the proposed project are to: (1) Compare rates of providing a self-collected sample vs. obtaining clinic-based screening among 800 Asian American women; (2) Examine mediators of participation; and (3) Assess the relative cost-effectiveness of HPV self-sampling vs. clinic-based screening. Demographics, social/cultural environment, and physical environment factors will be assessed at baseline, post- intervention, and 6-month follow-up. Participation in self-sampling or clinic-based screening will be assessed at 6- month follow-up. The proposed project will be the first large-scale study to evaluate HPV self-sampling among underserved Asian American women. Study findings will inform future evidence-based programs designed to enhance screening participation among Asian American women nationally.