title: Pairing community health workers with HPV self-sampling for cervical cancer prevention in rural Haiti.
abstract: OBJECTIVE
  To assess a program in which community health workers (CHWs) provided women with self-sampling devices to detect high-risk human papillomavirus (HPV).
  
  
  METHODS
  In a cross-sectional study, 13 CHWs visited homes in a rural area in Haiti's Central Plateau to recruit premenopausal women aged 30-50 years between July 2009 and April 2010. Eligible women had not undergone a cervical smear in the previous 3 years. Participants learned about cervical cancer and self-sampling for HPV testing before using a self-sampler in private. They then completed a questionnaire. CHWs later returned to provide results and advice about follow-up care.
  
  
  RESULTS
  CHWs enrolled 493 women. Among the 485 women for whom questionnaires were received, 468 (96.5%) were comfortable using the self-sampler and 484 (99.8%) stated they would recommend it to others. Among 426 analyzed samples, 54 (12.7%) were positive for high-risk HPV, of whom 46 (85.2%) received follow-up care and 17 (31.5%) had precursor lesions and were treated.
  
  
  CONCLUSIONS
  Using a CHW-led intervention, women at high risk for developing cervical cancer were identified and navigated to preventive care. Therefore, pairing CHWs with HPV self-sampling is a promising strategy to combat cervical cancer in rural Haiti and similar settings.
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Morgan
authors.initials: M
authors.lastname: Mandigo
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Frett
authors.affiliation: Partners in Health/Zanmi Lasante, Port-au-Prince, Haiti.
authors.forename: Jean Robert
authors.initials: JR
authors.lastname: Laurent
authors.affiliation: Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Ian
authors.initials: I
authors.lastname: Bishop
authors.affiliation: Partners in Health/Zanmi Lasante, Port-au-Prince, Haiti.
authors.forename: Maxi
authors.initials: M
authors.lastname: Raymondville
authors.affiliation: Partners in Health/Zanmi Lasante, Port-au-Prince, Haiti.
authors.forename: Sarah
authors.initials: S
authors.lastname: Marsh
authors.affiliation: Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA. Electronic address: ekobetz@med.miami.edu.
authors.forename: Erin
authors.initials: E
authors.lastname: Kobetz
mesh_terms: D000328:Adult; D003150:Community Health Workers / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D005260:Female; D006205:Haiti; D006801:Humans; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000150:complications / Q000175:diagnosis*; D010342:Patient Acceptance of Health Care; D012424:Rural Population; D012648:Self Care / Q000379:methods*; D013048:Specimen Handling / Q000379:methods; D011795:Surveys and Questionnaires; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control* / Q000821:virology; D014626:Vaginal Smears
keywords: Cervical cancer; Community health workers; Human papillomavirus (HPV); Screening; Self-sampling