Community Health Workers Paired With Human Papillomavirus Self-Samplers

Abstract

INTRODUCTION:A short interpregnancy interval is associated with poor maternal and neonatal outcomes. We sought to determine rates of interpregnancy intervals among Pacific Islanders and Asian subgroups, populations that are often understudied.METHODS: Records of California births were linked with hospital discharge data. For women with a first birth in 1999-2000 and a second before 2005, interpregnancy intervals were calculated as the interval between the first birth and conception of the next pregnancy. We used multivariable modeling to determine whether specific Asian ethnicities are at greater risk of short interpregnancy interval. RESULTS:Our sample included 178,000 women. In multivariable analyses adjusted for maternal demographic, social, and clinical factors, Pacific Islanders and all other Asian subgroups were more likely to have an interpregnancy interval less than 6 months than were white women (Pacific Islanders: odds ratio (OR) 3.31 (95% confidence interval [CI] 2.7-4.1); Filipinas: OR 1.51 (95% CI 1.33-1.71); Southeast Asians: 1.93 (95% CI 1.73-2.1); East Asians: OR 1.65 (95% CI 1.48-1.84); and other Asians: OR 2.04 (95% CI 1.70-2.4). Other risk factors for shorter interpregnancy intervals included young maternal age, lower educational attainment, public insurance, and prior preterm birth. Similar findings were noted for interpregnancy intervals of 6-18 months.CONCLUSIONS: There were significantly higher rates of short interpregnancy intervals among Pacific Islanders and Asian subgroups. More work should focus on rates of adverse maternal and neonatal outcomes associated with short interpregnancy intervals in these populations. A better understanding of whether short intervals are the result of intended or unintended pregnancies will be critical in informing effective interventions.INTRODUCTION: Cervical cancer is the second most common malignancy among women in developing countries with a 53% mortality rate. Human papillomavirus (HPV) is the principal cause of cervical cancer. We have tested an innovative approach to cervical cancer screening, using community health workers and self-samplers for detecting high-risk HPV.METHODS: Community health workers visited homes and recruited 493 women, ages 18-50 years, from two rural villages in Haiti. Participants were instructed about cervical cancer and the self-sampler before privately performing the test in their homes. Community health workers then surveyed women about their experiences. After specimen processing, community health workers returned to women's homes to provide test results and navigation to follow-up care. At the end of the 3-year study, semistructured interviews were conducted with community health workers to identify strengths and weaknesses of the program.RESULTS: Nearly all women (98.1%) were comfortable using the self-sampler with 99.8% stating they would recommend the method. Qualitative survey responses and community health worker feedback were also overwhelmingly positive. Of the women screened, 11.6% were positive for high-risk HP...