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

项目摘要 COVID-19大流行导致世界各地的常规和非紧急护理中断， 包括癌症筛查。在高收入国家，远程医疗减轻了这些疾病的影响， 干扰然而，在低收入和中等收入国家，远程医疗的广泛使用面临着 这是一个重大障碍，包括高成本和缺乏技术专门知识和监管指导。在同一 与此同时，这一流行病为采用远程医疗方法提供了动力， 利用现有的基础设施。在萨尔瓦多，卫生部（MOH）实施了一项 基于移动的手机短信的COVID-19结果交付方法。本补充文件将试行类似的 宫颈癌筛查的结果交付策略，并将其性能与目前的方法进行比较， 到诊所就诊的人数。这是对父母补助金（R 01 CA 218195）的补充， 创新以增加中低收入国家获得宫颈癌预防服务的机会。 目前，大约40%的筛查阴性妇女和20%的筛查阳性妇女没有得到 他们的子宫颈癌检查结果。我们将开发一个试点远程医疗干预， 给萨尔瓦多的中央地区的病人。我们将使用一种商用的自动短信 服务（Twilio Inc.，San弗朗西斯科，CA），并将其嵌入到与 国家卫生部的癌症部门。一项横向比较研究将比较远程医疗 这是对目前成果交付模式的一种挑战。一个由550名妇女组成的小组将被分配到 干预筛查阴性的患者将被告知他们的结果，并给出未来的建议。 筛选。筛查呈阳性的女性将收到一条信息，指示她们致电指定的当地卫生部门 诊所安排预约，以获得他们的结果。在对照组中，550名妇女将被要求 在筛选后30天返回诊所，亲自接受结果，无论是阳性还是阴性， 目前的做法。两组中的女性都将接受一份简短的可接受性调查问卷来评估 对交付方法的看法和态度。分配进行干预的诊所的方案一级指标 也将收集对照组。我们假设远程医疗干预将允许更多的 妇女在更短的时间内收到结果，从而增加了对后续服务的坚持。

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.