An Overview of the Project ECHO—Cervical Cancer Prevention in Mozambique

Abstract

PURPOSE Cervical cancer is the most common cancer among women in Mozambique, a Portuguese-speaking country in sub-Saharan Africa. There is a shortage of health care providers to diagnose and treat preinvasive cervical disease. Therefore, training and mentoring to perform colposcopy, cervical biopsy, ablation and loop electrosurgical excision procedure (LEEP) is imperative. The purpose of this study is to describe our program to date. METHODS Our team of physicians, nurses and other health professionals from the United States (US) and Brazil provides in-person training for clinicians in Mozambique supplemented with Project ECHO® (Extension for Community Healthcare Outcomes), a telementoring program to provide virtual support and reinforce and amplify knowledge and skills to build capacity. In-person trainings are held 2-4 times per year. ECHO videoconferences are held monthly with Mozambican clinicians presenting de-identified patient cases for discussion with specialists from the US and Brazil and their peers. Training, lectures and discussions are held in Portuguese. In 2023 we launched a survey to assess the impact of Project ECHO to the participants. The survey covered the applicability of the content discussed in their practice and the content learned during case presentations. Data from the survey were stored in REDcap. RESULTS Since February 2019, we have held nine in-person and 16 virtual trainings supplemented with 59 ECHO telementoring sessions, with an average of 53 participants per session. Forty-eight cases were presented and discussed. Respondents included 182 participants. Of the 139 who answered their profession, the majority were nurses (83, 59.8%), followed by doctors (33, 23.7%) and others (23, 16.5%). When asked about applicability of the content discussed in ECHO, the majority agreed/strongly agreed that the content was applicable to their practice (78/79, 98.7%) and that they learned something new during the case presentations (114/116, 98.3%). Lastly, 93.2% (68/73) of responders said that they would make changes to their practice as a result of the Project ECHO participation. CONCLUSION Well-trained clinicians for the management of women with abnormal screening tests is critical for improving cervical cancer prevention. The ECHO project model facilitates and extends mentoring and training of healthcare professionals and keeps providers engaged in learning.