A Comprehensive Program to Improve Treatment of Precancerous Cervical Lesions in the Rio Grande Valley of Texas.

OBJECTIVE: To assess the impact of a multicomponent intervention in women with cervical dysplasia who were treated with loop electrosurgical excision procedure (LEEP), as well as the time between colposcopy and treatment. DESIGN: Retrospective cohort study. INTERVENTION: Clinic participation in a multicomponent cervical cancer prevention program that included community outreach, patient in-reach, and navigation, as well as provider capacity building with in-person training and ongoing telementoring through Project ECHO. MAIN OUTCOME MEASURES: Medical records were reviewed to evaluate women with cervical dysplasia undergoing treatment with LEEP within 90 days of colposcopy, as well as time between colposcopy and treatment. Baseline data from year 1 were compared with each subsequent year of implementation. Additional variables examined included patient's age, history of abnormal screening results, and percentage of families living below poverty line based on county of residence, parity, and clinic site. We performed logistic regression and multiple linear regression analyses to assess the programmatic impact in the outcomes of interest by year of program implementation. RESULTS: A total of 290 women were included in the study. The proportion of women undergoing treatment within 90 days of colposcopy increased from 76.2% at baseline to 91.3% in year 3 and 92.9% in year 4 of program implementation. The odds of undergoing treatment within 90 days were 5.11 times higher in year 4 of program implementation than at baseline. The mean time between colposcopy and LEEP decreased from 62 days at baseline to 45 days by year 4 of program implementation. CONCLUSIONS: Implementation of our multicomponent cervical cancer prevention program increased the proportion of women undergoing LEEP within 90 days of colposcopy and decreased the time between colposcopy and LEEP. This program has the potential to support cervical cancer prevention efforts and could be implemented in other low-resource settings.

Addressing cervical cancer disparities in Texas: Expansion of a community-based prevention initiative for medically underserved populations.

Although cervical cancer is preventable, significant disparities exist in access to screening and prevention services. In medically underserved areas (MUAs) of Texas, these rates are 55% higher compared to the remainder of the US. In 2019, we expanded a multicomponent, comprehensive program to improve cervical cancer prevention in partnership with 13 clinics and mobile vans in MUAs of Texas. Our multicomponent intervention program consists of community education and patient navigation coupled with a training/mentoring program for local medical providers to perform diagnostic procedures and treatment for patients with abnormal screening results. Hands-on training courses to learn these skills are coupled with biweekly telementoring conferences using Project ECHO® (Extension for Community Healthcare Outcomes). This program was implemented in 2015 and expanded to other MUAs in Texas in 2019. From March 2019 to August 2022, 75,842 individuals were educated about cervical cancer screening and HPV vaccination. A total of 44,781 women underwent screening for cervical cancer, and 2,216 underwent colposcopy and 264 underwent LEEP. High-grade cervical dysplasia was diagnosed in 658 individuals and invasive cervical cancer in 33 individuals. We trained 22 providers to perform colposcopy and/or LEEP. In addition, 78 Project ECHO telementoring sessions were held with an average of 42 attendees per session, with 72 individual patient cases discussed. Our comprehensive community-based prevention initiative for medically underserved populations has led to a significant number of individuals undergoing cervical cancer screening in MUAs, as well as improved access to colposcopy and LEEP services.

Field evidence of biodegradation of N-Nitrosodimethylamine (NDMA) in groundwater with incidental and active recycled water recharge.

Biodegradation of N-Nitrosodimethylamine (NDMA) has been found through laboratory incubation in unsaturated and saturated soil samples under both aerobic and anaerobic conditions. However, direct field evidence of in situ biodegradation in groundwater is very limited. This research aimed to evaluate biodegradation of NDMA in a large-scale groundwater system receiving recycled water as incidental and active recharge. NDMA concentrations in 32 monitoring and production wells with different screen intervals were monitored over a period of seven years. Groundwater monitoring was used to characterize changes in the magnitude and extent of NDMA in groundwater in response to seasonal hydrogeologic conditions and, more importantly, to significant concentration variations in effluent from water reclamation plants (associated with treatment-process changes). Extensive monitoring of NDMA concentrations and flow rates at effluent discharge locations and surface-water stations was also conducted to reasonably estimate mass loading through unlined river reaches to underlying groundwater. Monitoring results indicate that significant biodegradation of NDMA occurred in groundwater, accounting for an estimated 90% mass reduction over the seven-year monitoring period. In addition, a discrete effluent-discharge and groundwater-extraction event was extensively monitored in a well-characterized, localized groundwater subsystem for 626 days. Analysis of the associated NDMA fate and transport in the subsystem indicated that an estimated 80% of the recharged mass was biodegraded. The observed field evidence of NDMA biodegradation is supported by groundwater transport modeling accounting for various dilution mechanisms and first-order decay for biodegradation, and by a previous laboratory study on soil samples collected from the study site [Bradley, P.M., Carr, S.A., Baird, R.B., Chapelle, F.H., 2005. Biodegradation of N-Nitrosodimethylamine in soil from a water reclamation facility. Bioremediat. J. 9 (2), 115-120.].