Pacific Against Cervical Cancer (PACe)

The Pacific Against Cervical Cancer (PACe) Program’s overall goal is to decrease the morbidity and mortality of cervical cancer in the U.S. Affiliated Pacific Islands (USAPI).  The primary objective is to increase the capacity of health care workers to prevent and control cervical cancer via enhanced evidence-based public health screening practices in Guam and Yap State,  Federated States of Micronesia (FSM).  PACe project is an evaluation project that focuses on clinician and self-collection primary HPV DNA testing targeting un/under-screened women aged 30-64.  The program is guided by the principles of community-based participatory engagement, implementation science, and capacity building.

There are 3 main strategies to achieve the primary objective:

1. Develop and implement a governance, organizational, and administrative structure that is responsive to the evolving health and health care environment at the respective project sites, the funding source requirements, and the engagement requirements of a multi-jurisdiction / multi-institutional / multi-agency partnership
2. Enhance the capacity to deliver jurisdiction specific, sustainable, and evidence-based interventions to enhance cervical cancer prevention and control through integrated cervical cancer screening programs
   1. Develop and utilize participatory community-based engagement processes and an implementation science framework for project development at all sites
   2. Harmonize the jurisdiction specific cervical cancer screening and treatment data to enhance, evaluate, and deliver effective cervical cancer screening and treatment programs
   3. Identify, define, and develop applicable evidence-based cervical cancer screening, protocols, and treatment technologies for project development at all sites
   4. Utilize statistical and medical modeling science to forecast the jurisdiction specific impact, present and future, of cervical cancer screening and prevention strategies as they relate to intervention costs, morbidity / mortality outcomes, and human resource needs
3. Using the experience, lessons learned, and outcomes of the PACe project in Yap, FSM and Guam as foundation, cervical cancer prevention and screening strategies will be shared throughout the other USAPI jurisdictions

Partnerships:

This project is funded through the Pacific Island Health Officers Association and supported by the Centers for Disease Control and Prevention funding. The project is a collaboration with the:

• Cancer Council NSW (cost-effectiveness/modeling lead)
• Centers for Disease Control and Prevention
• Guam Alternative Lifestyle Association
• Guam Community Advisory Board
• Guam Department of Public Health and Social Services
• Dr. Rick Lu (medical lead)
• Pacific Island Health Officers Association
• University of Alabama at Birmingham (community engagement and education lead)
• University of Hawai’i John A. Burns School of Medicine Department of Family Medicine and Community Health
• Megan Wysong (data evaluator)
• Yap State Community Advisory Board
• Yap State Department of Health Services

PACe Outcomes:

PACe has been working with partners from the U.S., Australia, Singapore, and the Pacific to plan and coordinate training and technical assistance needs in Guam and Yap, FSM, along with purchasing supplies and equipment for this cervical cancer screening project.  A crucial part of the project is capacity building of the health care providers and community health workers to increase cervical cancer screening rates, enhance screening management capacity, and build a robust cervical cancer elimination strategy. 

• Training and technical assistance were provided by Obstetrics and Gynecology experts from the U.S., including a member from the American Society for Colposcopy and Cervical Pathology, to build the capacity of the hospital and clinic staff in Guam and Yap to provide colposcopy management/evaluation in the context of cervical cancer screening. The goal was to enhance capacity and competence in recognizing cervical abnormalities and the clinical management of cervical lesions through formal training and mentoring of the identified healthcare providers. 
• The University of Alabama at Birmingham (UAB) provided technical assistance on behavior change/education strategies to the community outreach workers/health assistants in the islands.

 From very low cervical screening rates, Yap State in FSM reached 75% of its screening goal in 2 years.  There were 1,200 underserved women aged 30-50 who were screened via HPV self-collection tests and provider-collection tests.

• Over 62% of the screened women indicated that they had never received any cervical screening during their lifetime
• 168 women tested HPV positive, and 95% of the women requiring treatment received appropriate treatment

If Yap continues its cervical control activities, it will be the first island in the world to achieve the World Health Organization's Global Elimination of Cervical Cancer targets by 2030.