Assistant Professor Daisy Le.
By Kristen Mitchell
A George Washington University School of Nursing faculty member is working on research aimed at promoting HPV self-sampling test kits to increase cervical cancer screening among women living with HIV. By reducing barriers to care, Assistant Professor Daisy Le aims to better serve one of the Washington, D.C., region’s most vulnerable populations.
Le, who specializes in community-engaged cancer prevention and health disparities research, launched the MySHARE study two years ago—it stands for self-sampling, HPV awareness, results and empowerment. The project aims to assess whether self-sampling could be an effective and feasible tool to improve screening for, and detection of, cervical cancer in women in the Washington, D.C., and Baltimore metropolitan area, especially those who belong to medically underserved communities. HPV, or human papillomavirus, is a common sexually transmitted infection that can lead to cervical and other cancers.
Women over age 25 should be screened for cervical cancer every five years, however, guidelines say immunocompromised individuals at high risk for cervical cancer—including those living with HIV—may need to be screened more frequently. Limited transportation, an inability to take time off work for in-person appointments, a lack of childcare and more can all contribute to women not getting the screenings they need, Le said.
“For many of us when we miss a couple of months, or we're a little delayed in getting screened, it's generally OK, but especially for a more vulnerable population, multiple missed appointments have a larger impact,” she said.
“This was something we thought about before the COVID-19 pandemic, and this is a time that especially highlights why something like this would be needed.”
The team wrapped up the first phase of the MySHARE study last year, where they gathered information in focus groups, surveys and interviews with the HIV-positive community and health care providers. In phase two, which launched recently, the team is implementing a pilot intervention to examine the feasibility, acceptability and preliminary efficacy of mail-based HPV self-sampling. The team is also engaging in prevention-focused text messaging about HPV and cervical cancer and providing additional educational materials to study participants.
Participants will use the at-home test kits to collect cervicovaginal and anal samples, which will be processed by Le’s collaborator, Professor Jeanne Jordan from the Milken Institute School of Public Health, who leads a research lab equipped for biospecimen sampling out of Science and Engineering Hall. Jordan has spent years working closely with the HIV-positive community in D.C. and does research in self sampling for anal cancer among men.
Le collaborates on the MySHARE study with faculty from GW Nursing, Milken Institute SPH, the GW Cancer Center, the District of Columbia Center for AIDS Research, Whitman-Walker Health, the Washington Health Institute and additional local community organizations and clinics. Her team has received funding to pursue this research from the GW Cancer Center and the Clinical and Translational Science Institute at Children’s National, a partnership with GW.
Targeting Health Disparities
Le’s interest in community-based public health stems from her upbringing as the daughter of Vietnamese refugees, where she experienced firsthand the challenges that come with navigating the health care system. Cervical cancer is a major health concern for the Vietnamese American community, which disproportionately affects Vietnamese women in the United States compared to other ethnic groups. Le studied cervical cancer in the Vietnamese population as a master’s student and has since dedicated her career to cancer prevention within underserved and vulnerable populations.
Washington, D.C., has a significant population of HIV-positive residents. Treatment for HIV has radically improved quality of life for positive individuals over the past several decades. As a result, this population is dealing with chronic illness and disease throughout their longer lives in a way they previously were not.
“For this population, their priority has been HIV management. Many have spent most of their life just trying to fight that, going in for their regular exams and follow ups; some have expressed how they haven't even thought about living long enough to consider these other components of health,” Le said. “Cancer screening is important to them, they've acknowledged that, but it hasn't been something many have been able to prioritize.”
International researchers have utilized self-administered HPV testing in regions where resources are scarce, and hospitals and clinics are generally inaccessible for women. Findings showing self-collected samples and clinician-collected samples yielded equivalent success in HPV detection piqued Le’s interest.
“If they are giving us similar results, and it's one additional thing we can do to minimize a barrier for this community and any other underserved communities, why shouldn’t we try it here in the U.S.,” she asked.
Le is in the process of applying for additional funding to expand the pilot study, enabling the team to collect a larger, national sample. She hopes to someday expand the MySHARE project to offer at-home HPV testing kits at a more systematic level, making kits readily available for the community through partnerships with local health departments such as the D.C. Department of Health.
