Rural community health center partnerships to develop and implement process for HPV self-collection and follow-up among women overdue for cervical cancer screening

摘要 2021年，亨斯迈癌症研究所（HCI）正式向整个5州山区提供长期服务。 西（MW）。五个州中的三个：爱达荷州、内华达州和犹他州，都名列增长最快的前五名 在2020年美国人口普查中。与此同时，我们所服务的地区以其广阔的边境地区而闻名。的 在西部山区的169个县中，有104个是边境县（每平方英里不到7人），占全国人口的74%。 另有54个被划为农村（每平方英里人口少于100人）。结合起来，边境和 农村县占国土面积的97%。超过10%的西部山区人口生活在边境地区， 超过40%的人居住在边境和农村县。这些人口经历了不平等 主要是因为距离太远。HCI致力于通过确保前沿和 农村病人不论在何处，都能平等地获得优质的护理和预防服务。宫颈 犹他州农村的癌症发病率较高（与犹他州城市相比）， 农村宫颈癌患者低于城市患者。此外，犹他州也是 全国各州的宫颈癌筛查率最低，农村社区的比例最低。 本研究对犹他州农村妇女（N=900）进行了邮寄HPV自我收集程序的试点测试。本研究 目的是建立一个农村社区卫生中心提供家庭为基础的人乳头瘤病毒（HPV）自我， 针对逾期未进行宫颈癌筛查的妇女的收集外联方案，以及 HPV筛查结果呈阳性的女性。具体来说，我们将向女性推出HPV自我采集计划 宫颈癌筛查逾期，修订相关的说明视频和打印交付的指示， 英语和西班牙语关于如何完成测试，并制定一个有效的后续方法HPV 筛查阳性的病人通过调查，我们将评估患者为什么不返回HPV自我检测的障碍， 收集试剂盒以及为什么HPV筛查阳性的妇女没有接受后续护理。我们亦会评估 农村社区卫生中心的组织、提供者和诊所工作人员层面的因素促进了 实施、评估和跟踪HPV自我采集试点计划。这些临床水平 评估将通过工作流程分析、调查和半结构化访谈完成。结果 本研究的结果将用于制定农村社区卫生的邮寄HPV自我收集方案 这些中心可以在其他农村社区卫生中心进行调整和复制。

ABSTRACT In 2021, Huntsman Cancer Institute (HCI) formalized our long-standing service to the entire 5-state Mountain West (MW). Three of the five states: Idaho, Nevada, and Utah, all ranked among the top five fastest growing states in the 2020 U.S. Census. At the same time, the area we serve is notable for its vast frontier areas. Of the 169 counties in the Mountain West, 104 are frontier (< 7 people per square mile), covering 74% of the landmass and an additional 54 classify as rural (< 100 people per square mile). Combined, the frontier and rural counties account for 97% of the landmass. Over 10% of the Mountain West population lives in frontier counties and over 40% lives in frontier and rural counties combined. These populations experience disparities due primarily to distance to care. HCI is committed to overcome distance as a disparity by ensuring frontier and rural patients have equal access to excellent care and prevention services, regardless of location. Cervical cancer incidence rates are higher in rural Utah (compared to urban Utah) and 5-year relative survival rates are lower among rural cervical cancer patients than among urban patients. Furthermore, Utah ranks as one of the lowest states in the nation for cervical cancer screening with rural communities demonstrating the lowest rates. This study pilot tests a mail-delivered HPV self-collection program for rural Utah women (N=900). This study aims to develop a rural community health center delivered home-based human papillomavirus (HPV) self- collection outreach program for women overdue for cervical cancer screening and a follow-up program for women with HPV screen-positive results. Specifically, we will launch an HPV self-collection program to women overdue for cervical cancer screening, revise related illustrated video- and print-delivered instructions in English and Spanish on how to complete the test, and develop an effective follow-up approach for HPV screen-positive patients. Through surveys, we will assess barriers for why patients do not return the HPV self- collection kits and why HPV screen-positive women do not receive follow-up care. We will also assess the organizational, provider, and clinic staff level factors at rural community health centers that facilitate the implementation, assessment and follow-up for the pilot HPV self-collection program. These clinic-level assessments will be completed through work-flow analyses, surveys, and semi-structured interviews. Findings from this study will be used to develop a mail-delivered HPV self-collection protocol for rural community health centers that can be adapted and replicated in other rural community health center settings.