Abstract
BackgroundUnderserved ethnic minority populations experience significant disparities in HIV, hepatitis C virus (HCV), colorectal cancer (CRC), and cervical cancer incidence and mortality. Much of the excess burden of these diseases among underserved communities is due to lack of preventive care, including screening. Barriers to disease screening include low awareness, lack of access to care and health insurance, and cultural beliefs regarding disease prevention. Our current trial aims to examine community health worker (CHW)-delivered, home-based multi-modality screening for HIV, HCV, CRC, and cervical cancer simultaneously.DesignWe are conducting a randomized pragmatic trial among 900 Haitian, Hispanic, and African-American participants from diverse underserved communities in South Florida. People between the ages of 50 and 65 who have not had appropriate HIV, HCV, CRC, and cervical cancer screening per United States Preventive Services Task Force (USPSTF) recommendations are eligible for the study. Participants are recruited by CHWs and complete a structured interview to assess multilevel determinants of disease risk. Participants are then randomized to receive HIV, HCV, CRC, and cervical cancer screening via navigation to care by a CHW (Group 1) or via CHW-delivered home-based screening (Group 2). The primary outcome is completion of screening for each of these diseases within 6 months post-enrollment.DiscussionOur trial is among the first to examine the effectiveness of a CHW-delivered, multimodality, home-based disease-screening approach. If found to be effective, this approach may represent a cost-effective strategy for disease screening within underserved and underscreened minority groups.Trial registrationClinical Trials.gov # NCT02970136, registered November 21, 2016.
Highlights
Underserved ethnic minority populations experience significant disparities in HIV, hepatitis C virus (HCV), colorectal cancer (CRC), and cervical cancer incidence and mortality
Minority, low income, and underinsured communities are at excess risk of morbidity and mortality from HIV, hepatitis C virus (HCV), colorectal cancer (CRC), and cervical cancer [1,2,3,4,5,6,7,8,9,10]
Intervention Group 1—community health worker (CHW)-delivered navigation to primary care (PC) for disease screening For participants assigned to Group 1, CHWs work closely with their Federally qualified health center (FQHC) supervisor to develop tailored navigation approaches appropriate for each person
Summary
Our project addresses the excess burden of HIV, HCV, CRC, and cervical cancer experienced by Little Haiti, Hialeah, and South Dade, three medically underserved communities within the Miami metropolitan area. Using a CBPR approach, we will determine the effectiveness of navigation to primary care for screening versus CHWdelivered, home-based, multimodality screening among 900 individuals from our target communities. Our results may not be generalizable outside of our target communities, as the current intervention approaches are heavily tailored based on community partner input. While this approach is a valid method of addressing health disparity within these specific communities, the effectiveness of multi-modality homebased testing would likely need to be re-examined if implemented outside of our target communities. If participants in the PC group overestimate their screenings, it could bias our results towards the null hypothesis.
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