Health Disparities: Time for Action

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Norman Grant
6 years ago
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1 Health Disparities: Time for Action Patricia J. García MD MPH PhD Former Minister of Health, Peru Professor, School of Public Health Cayetano Heredia University- Lima-Peru

2 Latin America 19% more unequal than sub- Saharan Africa 37% more unequal than East Asia 65% more unequal than developed countries

4 The Facts In the world, cervical cancer is the third most frequent cancer in women. The human papilloma virus (HPV) is the cause of cervical cancer. In Peru, it is the number one cancer affecting women 34.5 / 100,000 women (higher than the LA avg 24.1) Reasons for this high incidence: Frequent HPV infection Only 40.3 % of women have PAP (fear, poor knowledge) PAP sensitivity to detect cancer is low: 42.5 %

5 In Peru Every 5 hours a woman dies from cervical cancer

6 There are new ways of detecting the presence of the virus, which could help us to detect the problem before cancer occurs New molecular tests to detect the presence of HPV in the vagina / cervix. CareHPV (quiagen) Could be done by women in the comfort of their homes (selfadministered swab)

7 HOPE: Improving women s health using molecular self-testing for screening of Human Papilloma Virus (HPV)

8 Community health agent: HOPE Lady Self- testing at home CARE HPV (QUIAGEN) Collection Box Available 24/7 Technology Collection site Women from the community: Champions! Trained! Providing information and screening kits to women at home for self-testing Final result: Healthy women: early detection, better prognosis, empowering women Social innovation model Colposcopy & treatment according to findings If HPV + Processing at Central Lab Results and reminders by SMS Information Technology New model for Cervical Ca screening: HOPE

9 Ventanilla-Callao (30 minutes from the Lima airport)

10 Identifying potential women champions

11 Training for women champions Two-day workshop

12 Learning about self-collection of samples

13 Role playing Certification as a HOPE Lady

14 Collection sites 24/7 hours

15 Transportation of samples to lab

16 Results, reminders send through SMS El resultado de su prueba esta normal; continúe cuidando su salud con sus chequeos anuales del Papanicolaou en su CS. Universidad Peruana Cayetano Heredia Ya tenemos el resultado de su prueba. Luego le estaremos enviando el lugar, fecha y hora de su cita. Universidad Peruana Cayetano Heredia

17 Results Number of kits distributed by HOPE Ladies 2217 Number of kits (envelopes and samples) 2131 found in the collection sites (96.1%) 266 Number of positive HPV tests (12.5%) Number of HPV (+) who signed consent for 252 colposcopy, PAP and biopsy (94.7%) 49/412 Abnormal Biopsies (High grade, Cancer)* (11.9%) * A sample of HPV (-) also had PAP and Biopsies. All high grade and cancer seen in HPV(+) N

18 Learning points More 2100 women screened: 2/3 never had PAPs before: improve coverage!!!!! Women love self-testing and learn from other women! Collection sites open 24/7 critical Technology is appreciated New tests! Getting results by SMS messages! 2017: New National Guidelines in Peru included the use of HPV molecular testing and self-testing for cervical cancer screening: New Plan for the Control of Cervical Cancer Has started in the north of Peru: Tumbes, now more than 4700 women screened in 2 months! New social business model for women not covered by comprehensive insurance and other women interested

Information and screening kit, and deliver to lab Results by cel phone (including referrals) Women : Pay for testing and service (private) Pay

19 Social Business Model Scaling up Private sector: Clinics, private insurance Users: Women from private sector Support Public Sector: Health Ministry establishments and incentives for Hope ladies Users: Women from public sector Service by HOPE Ladies at home & collection sites: Information and screening kit, and deliver to lab Results by cel phone (including referrals) Women : Pay for testing and service (private) Pay for testing by MOH and service by women (public sector) In the final list for funding from GCC: still need matching funds!! Looking for angel investors!!!

20 Conclusions New technologies like HPV molecular testing and use of cel phones can improve Cervical Cancer control Self-testing improves access : WHO User-initiated interventions The HOPE ladies (women health agents-leaders) are incredible powerful to reach women (and families) that otherwise may not show to a health center. Other issues could be addressed, other technologies could be introduced! There is a need of scaling up the model Through the MOH (plan ready, Budget ready, now political will!) New model for social business with GCC (looking for angel investors) Buy one test, help one rural woman to have the test and say goodbye to cervical cancer Incentives for HOPE ladies, training on other issues e.g. HPV vaccine etc.

21 Gracias Thank you! Acknowledgments Diresa Callao Concytec

Barriers to Papanicolaou Screening among HIV-Infected Women: a cross sectional survey

Barriers to Papanicolaou Screening among HIV-Infected Women: a cross sectional survey Arya Payan M.S., B.S. Touro University, Nevada University of Nevada School of Medicine HealthySunrise Foundation Saman