Background: Although cervical cancer is preventable, females living with HIV (FLWH) are 3-8 times more at risk compared to females who are HIV negative. Detecting cervical changes at its earliest stages when treatment is most effective is essential to reducing these cancer health disparities among FLWH. Although FLWH are more at risk for developing cervical cancer, many do not adhere to screening guidelines or recommended follow-up care for abnormal results. Therefore, there remains a critical need for increasing community access and reducing structural barriers to cervical cancer screening (including follow-up care for abnormal results) among FLWH. Objective: To describe system integration of existing ASO services and cervical cancer screening evidence-based intervention (EBI) strategies. Methods: We mapped the subsystems of a multi-level systems approach to integrating existing ASO services with cervical cancer EBI strategies to reduce disparities among FLWH. Individual, interpersonal, and organizational variables for our model were obtained from the PI’s (LTW) formative research and a literature review of cervical cancer EBIs. We used the Plectica, a visual mapping software, to build our preliminary model. Our final model will be validated by systems science exerts, healthcare professionals who provide gynecological care to FLWH, and members of the target population (i.e., ASO leaders and employees, FLWH). Results: Our preliminary model denotes the interplay between EBI strategies at the individual, interpersonal and organizational. Successful implementation will increase cervical cancer screening (including follow-up care for abnormal results), which will reduce these cancer health disparities among FLWH. The systems model that we have designed to achieve our program goal is comprised of two balancing loops and one reinforcing loop. Cervical cancer screening represents the stock, whereas adherence and mortality represent the model’s flows. The integration of two ASO subsystems (i.e., STD testing and patient navigation) with EBI strategies provided two strategically located leverage points (STD + HPV self- collected testing) and (patient navigation + follow-up care for abnormal results) for increasing community access to cervical cancer screening for FLWH at the organizational level. Peer navigation was also found to be a strategically located leverage point increasing cervical cancer screening at the interpersonal level.
Conclusions: Although EBIs exist, cervical cancer screening via Pap testing alone or Pap/HPV co-testing is suboptimal, as evidence by health disparities among FLWH. An ecological approach is needed to address the complex array of healthcare and other structural barriers that FLWH may encounter when trying to access cervical cancer screening and if need be, follow-up care for abnormal results and treatment. Therefore, a multi-level approach to increasing community access is needed, including the relational dynamics with peer networks at ASOs.
Citation Format: Lisa T. Wigfall, Aditi Tomar, Tiffany C. Washington. A systems model of integrating HPV self-sampling and evidence-based intervention strategies for increasing follow-up care for abnormal screening results with existing services at community-based HIV/AIDS service organizations [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-055.