COVID-19 as a catalyst for reimagining cervical cancer prevention.

Cervical cancer has killed millions of women over the past decade. In 2019 the World Health Organization launched the Cervical Cancer Elimination Strategy, which included ambitious targets for vaccination, screening, and treatment. The COVID-19 pandemic disrupted progress on the strategy, but lessons learned during the pandemic - especially in vaccination, self-administered testing, and coordinated mobilization on a global scale - may help with efforts to achieve its targets. However, we must also learn from the failure of the COVID-19 response to include adequate representation of global voices. Efforts to eliminate cervical cancer will only succeed if those countries most affected are involved from the very start of planning. In this article we summarize innovations and highlight missed opportunities in the COVID response, and make recommendations to leverage the COVID experience to accelerate the elimination of cervical cancer globally.

Disparities in Telemedicine Use among Pediatric Patients with Type 1 and Type 2 Diabetes

Despite the increase in telehealth services in diabetes care during the COVID-pandemic, studies have found disparities in telemedicine (TM) use among patients. Our Diabetes Clinic currently cares for 1400 patients with type 1 diabetes (T1D) with 46% being publicly insured and for 375 patients with type 2 diabetes (T2D) , 88% being publicly insured. We have previously shown a significantly lower number of completed TM encounters between March and July 2020 by publicly insured patients when compared with privately insured and a threefold increase in no-shows and same day TM visit cancelations by the publicly insured group. Between January and March 2021 we surveyed families who had never attended a TM visit to better understand barriers to TM use. Of the 7patients who received care during this period, 162 (22.8%) had never attended a TM visit. Of the 39 surveyed patients, 84.6% had T1D and 15.4% had T2D. There were 46.2% who self-identified as Non-Hispanic White, 35.9% as Hispanic, 5.1% as Asian, 2.6% as Non-Hispanic Black, and 10.3% as Other. Additionally, 48.7% had public insurance, 23.1% had no EMR access and 15.4% did not speak English as their primary language. Out of patients with T1D, 63.6% used a CGM and 33.3% used an insulin pump. Reported reasons not to attend a TM visit included: preference for in-person care (43.6%) , not being offered a TM visit (17.9%) , technology issues (12.8%) , scheduling conflicts or forgetting about the appointment (17.9%) and 20.5% preferred not to provide a reason. In conclusion, more than half of our surveyed patients with diabetes who never attended a TM visit were from racial and ethnic minority groups. The COVID-pandemic has highlighted disparities related to access to and use of technology to improve diabetes care. Our results show the importance of ensuring all families are aware of TM options and receive support with TM technology. Further research into TM perception and adoption barriers should be conducted to prevent disparities in care and to close health equity gaps.

Human Papillomavirus Self-Sampling for Primary Cervical Cancer Screening in Under-Screened Women in Hong Kong during the COVID-19 Pandemic.

The aim of this study was to assess the effectiveness of HPV self-sampling for cervical cancer screening and the best means of service delivery, with a specific focus on under-screened women, particularly during the COVID-19 pandemic. Using three arms of service delivery (social media, school outreach and underserved outreach), we recruited under-screened women aged 30-65 years from two population groups: the general public and specific underserved communities, from whom self-sampled specimens and optional clinician-sampled cervical specimens were obtained for HPV testing. A total of 521 self-sampling kits were distributed, of which 321 were returned, giving an overall uptake rate of 61.6%. The response rate was higher in the face-to-face underserved outreach (65.5%) compared to social media (22.8%) and school outreach (18.2%). The concordance for HPV detection between self-sampled and clinician-sampled specimens was 90.2% [95% confidence interval (CI) 85.1-93.8%; Cohen's kappa 0.59 (95% CI 0.42-0.75)]. Overall, 89.2% of women were willing to have self-sampling again. In conclusion, HPV self-sampling is an effective method for cervical cancer screening and can be considered as an option, particularly in women who are reluctant or unable to attend regular screening. Various service deliveries could be considered to increase participation in cervical cancer screening.

Global COVID-19 pandemic demands joint interventions for the suppression of future waves.

Emerging evidence suggests a resurgence of COVID-19 in the coming years. It is thus critical to optimize emergency response planning from a broad, integrated perspective. We developed a mathematical model incorporating climate-driven variation in community transmissions and movement-modulated spatial diffusions of COVID-19 into various intervention scenarios. We find that an intensive 8-wk intervention targeting the reduction of local transmissibility and international travel is efficient and effective. Practically, we suggest a tiered implementation of this strategy where interventions are first implemented at locations in what we call the Global Intervention Hub, followed by timely interventions in secondary high-risk locations. We argue that thinking globally, categorizing locations in a hub-and-spoke intervention network, and acting locally, applying interventions at high-risk areas, is a functional strategy to avert the tremendous burden that would otherwise be placed on public health and society.