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A Model for Empowering Rural Solutions for Cervical Cancer Prevention (He Tapu Te Whare Tangata): Protocol for a
Beverley Lawton1, Evelyn Jane MacDonald1, Francesca Storey1
1National Women's Health Research Centre, Faculty of Health, Victoria University of Wellington, Wellington, New Zealand.
JMIR Research Protocols
|September 14, 2023
Summary
A new community-controlled cervical cancer screening pathway improved timeliness for Māori women, utilizing point-of-care high-risk human papillomavirus (hrHPV) testing. This Māori-centered approach aims to reduce cervical cancer inequities.
Area of Science:
- Public Health
- Gynecologic Oncology
- Health Services Research
Background:
- Wāhine Māori (Māori women) experience higher rates of cervical cancer and mortality compared to non-Māori women.
- Rural Māori residents face significant healthcare access barriers, leading to worse cervical cancer outcomes.
- Existing screening and referral processes contribute to delays in care for high-risk human papillomavirus (hrHPV) detection.
Purpose of the Study:
- To compare the acceptability, feasibility, timeliness, and referral/attendance rates for colposcopy following hrHPV detection between a community-controlled pathway and standard care.
- To evaluate a Māori-centered approach integrating self-testing, point-of-care (POC) diagnostics, and immediate referral.
Main Methods:
- A cluster randomized crossover trial involving two primary care practices.
- Pathway 1: HPV self-testing with 1-hour POC results, face-to-face support, and immediate colposcopy referral.
- Pathway 2: HPV self-testing with laboratory analysis and standard referral pathways. Primary outcome: colposcopy within 20 working days for hrHPV-positive results.
Main Results:
- In the initial 15 months, 743 eligible HPV self-tests were conducted (370 in Pathway 1, 373 in Pathway 2).
- The high-risk human papillomavirus (hrHPV) positivity rate was 7.3% (54/743).
- Data collection for the second period and qualitative interviews are ongoing.
Conclusions:
- This Māori-centered study compares two clinical pathways for cervical cancer screening from hrHPV detection to colposcopy.
- The community-controlled pathway leverages rural strengths and a whānau ora approach, incorporating face-to-face engagement and community health workers.
- Findings will inform rural models for innovative technology use, addressing cervical cancer inequities and promoting Māori wellness, with potential applicability to other Indigenous and rural populations.
Keywords:
Indigenous peopleMāoriNew Zealandcervical intraepithelial neoplasiacolposcopyearly detection of cancerhealth equitypapillomavirus infectionspoint-of-care systemsprimary health careself-testinguterine cervical neoplasmsMore Related Videos
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