Caribbean immigrants (both Hispanics and blacks from Haiti) as well as low income African-American women are less likely to be screened for cervical cancer than the general population. Community Health Worker are a promising approach in increasing cervical cancer screening among such groups. Yet even in rigorous well structured CHW interventions, many women remain unscreened. Our group has shown that use of an emerging technology, HPV self-sampling devices, through home based CHW visits greatly facilitate the acceptability and ability to conduct cervical cancer screenings in our communities. Building on our existing community partnerships, we propose a randomized CBPR study among 600 women in three underserved communities in Miami-Dade County to determine optimal approaches to increase cervical cancer screening among Caribbean and other underserved women. The study is a three arm study with 200 women randomized at each site over 3 years. Women in the control group would be exposed to NCI approved culturally and linguistically appropriate outreach and educational materials on cervical cancer screening. Our two specific aims are 1) to determine if as compared to our control group, women randomized to the community health worker intervention group consisting one on one health education and facilitation of referrals to existing screening programs results in increase proportion of women who are screened 2) to determine if as compared to the CHW group, women randomized to a CHW intervention with the addition of a home based self-sampling strategy results in an additional increase in proportion of women who are screened versus the CHW group without HPV sampling. Secondary outcomes include comparisons of a) measures of access to care (health insurance, having a usual source of care, and visit to provider in six months) b) cost of providing the intervention in order to determine the cost of recruiting an individual woman into screening c) among women having abnormal screens, time to follow-up and further testing.
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