An innovative community-based project to document the prevalence of HPV infection and cervical dysplasia in Little Haiti, Miami, Florida

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Cervical cancer has decreased substantially in the United States due to widespread adoption of the Pap smear. Despite this success, a significant proportion of women remain at risk for developing invasive cervical carcinoma. Such women are disproportionately older, low-income, and racial/ethnic minorities. In South Florida, cervical cancer is thought to be a particular problem for the Haitian community. However, the actual burden of disease remains unknown. The practice of categorizing Haitians as Black for research and surveillance purposes, despite obvious cultural and linguistic differences between Haitians and other Black population sub-groups, precludes accurate estimation of disease incidence, morbidity, and mortality. Using culturally-appropriate methodology, our community-based research initiative will document: (1) the prevalence of routine Pap smear screening (defined by the National Cancer Institute as once every three years for sexually active women with no prior history of cervical abnormalities); (2) the prevalence and risk factors of Human Papillomavirus (HPV) infection; and, (3) the prevalence of cervical dysplasia in Little Haiti, the predominately Haitian area in Miami, Florida. Community Health Workers (CHWs), indigenous to Little Haiti and trained to conduct research, canvass door-to-door in randomly selected area block groups to identify women who meet study eligibility criteria (e.g., Haitian descent, 18 years of age or older, no history of cervical cancer and/or surgical hysterectomy). Women who consent to participate answer a short questionnaire, which assesses, among other things, known risk factors for HPV infection, and then are instructed on how to use the Fournier self-sampling device to screen for cervical dysplasia and HPV. The Fournier self-sampler has similar efficacy to the Pap smear for detecting cervical abnormalities. However, this device is self-administered, and enables women to be screened for cervical lesions and HPV within the privacy of their own home. This approach circumvents access to care issues and socio-cultural concerns about modesty that are prevalent within the South Florida Haitian community. Preliminary findings indicate that Haitian women undergo Pap smear screening at less frequent intervals than recommended by national guidelines. Of the 200 women surveyed thus far, approximately one-third reported never having had a Pap smear in their lifetime. Among women who reported prior Pap smear use, the majority was screened less frequently than once every three years. In addition to such findings, the prevalence of HPV and associated risk factors is higher among Haitian women than other racial/ethnic minorities and immigrant population sub-groups in the Miami metropolitan area. The prevalence of cervical dysplasia is similarly excessive. Study findings may directly inform the scope and direction of large-scale, public health interventions to reduce the incidence of cervical cancer among vulnerable population sub-groups such as Haitians, who are largely understudied despite contributing to excess disease incidence, morbidity and mortality.