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

项目摘要/摘要 宫颈癌是一种可预防的癌症，是中国妇女癌症死亡的主要原因。 尼加拉瓜。世界卫生组织(世卫组织)通过了一项消除宫颈癌的战略 未来100年，并概述了到2030年要实现的具体目标：接种疫苗(15岁前90%的女孩)； 筛查/早期发现(70%的妇女在35岁之前接受高质量的筛查，45岁时再次接受筛查)；以及治疗(90% 癌前病变和癌前病变的治疗)。由于宫颈癌的负担大多存在于低位 和中等收入国家(LMIC)，对发展、实施和成本进行了重要研究- 使用HPV初级筛查的社区宫颈癌筛查模式的有效性 为这一模式的可接受性和可行性制定了强有力的证据基础。然而，重要的是 在成功改善患者健康结局和预防宫颈癌方面存在地理差异， 特别是在农村和偏远的地理区域。在尼加拉瓜，在以下方面存在显著的国内差异： 符合条件的妇女每年参加宫颈癌筛查的情况，以及终身筛查的可能性， 视地理区域而定。有一种明显的需求，那就是为文化量身定做，地区性的 基于证据的HPV初级宫颈筛查项目的创新。基于一项成功的试点研究 在尼加拉瓜的Bluefield招募了近2000名女性，研究人员确定了mHealth的独特角色 (移动卫生)在整合到HPV初级保健中时，干预措施可能在改善健康结果方面发挥作用 筛查计划。这里提出的创新包括开发一个mHealth平台，它结合了 以患者为中心的移动应用程序(APP)，具有以提供商为中心的门户，并集成了提供商- 国家宫颈癌监测系统(SIVIPCAN)的焦点门户。通过开发这个 针对妇女和医疗保健提供者的文化定制、区域适当的移动健康干预(R21阶段) 然后试点测试这种干预措施在整合到以社区为基础的HPV基础上的小学时的影响 宫颈癌筛查计划(R33期)，这项研究将提供相关的重要证据 新型mHealth干预措施的潜力，以改善宫颈癌筛查随访和治疗 将重点放在农村和偏远地区，这些地区往往是改善卫生结果的最困难的地理区域。

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.