Approximately 15 HPV types cause virtually all cervical cancers; however, the current HPV vaccines cover only 2 HPV types causing ~70% of invasive cervical cancer and have no therapeutic effect on established infections that place women at risk. Thus, all women will need some kind of routine cervical screening for the foreseeable future. Importantly, the majority of women alive today have not been vaccinated and therefore are at risk for cervical cancer. The US Preventive Services Task Force recommendations on cervical cancer screening have not been updated for nearly a decade and performance measures for cervical cancer screening focus on population coverage rather than on follow-up among women with positive screening and diagnostic tests. Toward improving US cervical cancer prevention, we propose multi-tiered assessments at the statewide, systems, provider and patient levels including targeted medical record review of failures in the screening process; geospatial mapping of population-based screening, diagnosis and treatment; and application of community-based participatory approaches (CBPR) in clinical settings to identify barriers and facilitators across the processes of care including those that may enable novel patient-centered screening options. The cornerstone of our coordinated, multidisciplinary program is the New Mexico HPV Pap Registry which transcends limitations of organizational monitoring by mandating statewide surveillance of all cervical cancer screening, diagnosis and treatment. New Mexico is home to a high proportion of ethnically diverse (i.e., American Indian and Hispanic), rural, impoverished, medically disenfranchised and health-disparate populations at high-risk for cervical cancer.
The specific aims of this application are to 1) Establish the New Mexico HPV Outcomes, Practice Effectiveness and Surveillance (NM-HOPES) PROSPR Research Center; 2) Establish a sustainable Screening Process Documentation Unit providing data on patients during their course of cervical cancer screening care; and 3) Integrate and fund 3 research projects with the overarching aim of informing practice and targeted interventions supported by comparative effectiveness evaluations of real-world cervical cancer screening practice and outcomes versus guidelines and innovations.
Toward improving cervical prevention efforts among rural, impoverished, medically disenfranchised and health-disparate populations of the Southwestern US, we propose a multidisciplinary research center focusing on barriers and facilitators of systems and primary care practice, cost- and comparative effectiveness evaluations and participatory research approaches to enable patient-centered solutions.
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