7. Project summary/abstract
PROJECT: Mixed-Methods approach to evaluate a mHealth intervention to increase adherence to triage of
HPV+ women who have performed self-collection
Cervical cancer is a serious public health problem reflecting social and gender inequalities in health. It is the
third cause of cancer death among women in the world, with more than 85% of cases occurring in developing
countries. Currently, the development of new technologies based on HPV DNA detection allows HPV self-
collection, increasing screening coverage. In a self-collection based strategy, triage becomes a key step in the
prevention process, as it is the first method to identify HPV+ women who will need diagnostic and treatment
procedures. However, high adherence to triage is difficult to obtain, which is not surprising given that
adherence to follow-up and treatment is a generalized problem in cervical cancer programs.
Specific aims of the study are: 1. To evaluate the effectiveness of an innovative multi-component mHealth
intervention to increase adherence to triage among women with HPV+ self-collected tests compared to usual
care. 2. To evaluate the implementation strategy and identify barriers and facilitators to implementation of the
multi-component mHealth intervention.
The research study design will follow the structure of an effectiveness-implementation hybrid type I trial, and
will use mix-method approach. A cluster randomized trial including 200 CHWs (clusters) and 4000 women will
be used to evaluate the effectiveness of the multi-component mHealth intervention to increase adherence to
cytology triage at 120 days after positive HPV testing. The mHealth intervention will include SMS messages
sent to HPV+ women to inform them when results are available, and subsequent SMS messages as
reminders. In addition, for those HPV+ women who did not had a triage cytology result within 60 days of the
HPV test result, CHWs will receive an e-mail and SMS message so they can contact these women during
home visits for specific counseling and support. For the implementation evaluation, the Consolidated
Framework for Implementation Research (CFIR) will be used to guide qualitative data collection and analysis
of factors that influence implementation. RE-AIM will be used to assess the Reach, Effectiveness, Adoption,
Implementation and Maintenance of the Intervention.
Results of this project will provide evidence on the effectiveness of the multi-component mHealth intervention
to increase triage of HPV+ women, but it could be adapted to increase compliance of diagnoses/ treatment of
cervical cancer and other health problems. Findings from the implementation evaluation will be highly
applicable to programs that use or are planning to incorporate HPV self-collection in different settings and
countries. In addition, the use of CFIR and RE-AIM in this innovative study will serve as a model of work,
constituting an important advance in the use of Implementation Science in the Region.
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