Abnormal cervical screen follow-up among low-income Latinas: Project SAFe

Area of Science:

• Public Health
• Gynecologic Oncology
• Health Services Research

Background:

• Cervical cancer disproportionately affects low-income women, linked to poor follow-up after Pap tests.
• Barriers to adherence include personal, systemic, and psychosocial factors.
• The Screening Adherence Follow-Up Program (SAFe) was developed to address these barriers.

Purpose of the Study:

• To pilot the SAFe program, an individualized case management intervention.
• To assess the impact of SAFe on follow-up adherence after abnormal Pap results.
• To evaluate patient satisfaction with the SAFe program.

Main Methods:

• A pilot study involving 196 low-income women with low-grade (LGSIL) or high-grade (HGSIL) squamous intraepithelial lesions.
• SAFe utilized a clinical decision-making algorithm for tailored interventions: health education, counseling, and systems navigation.
• Adherence rates were compared between SAFe participants and a non-enrolled comparison group.

Main Results:

• Initial adherence post-intervention was 83% for LGSIL and 93% for HGSIL.
• Over one year, full adherence was 41% (LGSIL) and 61% (HGSIL); partial adherence was 42% (LGSIL) and 32% (HGSIL).
• SAFe participants showed comparable or improved adherence to non-enrollees (58% LGSIL, 67% HGSIL) and reported 93% satisfaction.

Conclusions:

• SAFe effectively addressed psychosocial and system barriers to adherence through a multidisciplinary team.
• The program demonstrated high acceptability and potential to improve medical care management for at-risk women.
• SAFe may enhance follow-up adherence for women with abnormal cervical screening results.