If there’s a single truth that associate professor of nursing Emma Mitchell knows from 10 years of fighting cervical cancer, it’s this: Tailored approaches work.
They work in rural areas like Southwest Virginia, where cervical cancer mortality is two to three times higher than elsewhere in the state. They work in global settings, where stigma and access inhibit preventative care and curative treatment. And, cemented by long-forged relationships, they work during pandemics.
Over the last decade, Mitchell’s connection to Nicaragua – home to the Central American and Caribbean region’s highest cervical cancer mortality rates – has forged alliances with a fantastic array of colleagues. She’s well-known in the region, to Nicaragua’s Ministry of Health authorities, at the two universities on the Caribbean coast, and a familiar face and name to the dozens of clinicians who staff clinics.
It’s in Bluefields where Mitchell and partner Dr. Rebecca Dillingham, an infectious diseases expert, professor of medicine and director of UVA’s Center for Global Health Equity, put cervical cancer in their crosshairs – developing nuanced systems to screen, follow up and treat patients who’d developed cervical cancer, which is caused by high-risk genotypes of the human papilloma virus, or HPV.
Self-collection HPV tests, for instance – done quickly in the privacy of one’s home – resonated in Bluefields, a region where just one-third of women have ever had a Pap test, but where almost everyone has a cell phone and internet access. With community partners, Mitchell and Dillingham developed the smartphone app Azulado – “blueish” in Spanish, a reference to the region’s diverse 60,000 Mestizo, Black, Caribbean and Indigenous people – that is culturally, linguistically and technologically tailored to women up and down the Caribbean coast.
It also works.
When the pandemic struck, Mitchell’s project infrastructure was largely in place: A local lab to process and diagnose self-collection samples, a method to feed data into Nicaragua’s National Cancer Surveillance System, a protocol for following up with HPV-positive women, and training for rural gynecologists to remove cervical cancer lesions using a smartphone-based colposcope, a low-cost cervical simulator and a mobile thermo-ablation machine.
So, in spring 2020, when nearly 2,000 HPV self-collection kits were received during the first phase of Mitchell’s pilot study, more than 350 HPV-positive women were quickly notified, connected with resources and urged to take the next steps for treatment. In a moment when the pandemic might have derailed cervical cancer detection and treatment, the vast majority of women with cancerous lesions were treated.
(Video by Christine Elizabeth Kueter, School of Nursing, and Max Kueter)
The new smartphone app – which debuted in spring 2021 – is the critical final piece of Mitchell’s tailored approach. It provides a roadmap and ethos for other resource-limited countries battling cervical cancer looking for best practices, important as the World Health Organization aims to eradicate cervical cancer in the next century.
But while cool tech often gets props, Dillingham insists the study’s success is built on the partnerships and mutual respect Mitchell has built over time.
“We’re modeling the kind of collaboration that’s essential for true change to occur,” Dillingham said. “These aren’t processes that occur overnight; they’re not processes that occur when someone from UVA flies to a place and says, ‘This is how you do it.’ You figure out how to do it by taking the time to understand what’s happening, know what partners want to happen next, and how that can be achieved.”
Mitchell and her development team continue to refine and tailor the app, and, pending funding, plan to expand screening, treatment and deployment to communities surrounding Bluefields.