Two HOBI faculty members received pilot awards from the CTSI Precision Health Initiative this year. Khairul A. Siddiqi, Ph.D., and Rahma S. Mkuu, Ph.D., will leverage big data in the OneFlorida+ Data Trust to identify at-risk women in Florida who could benefit from proven health interventions to protect their health and improve public health.
Dr. Siddiqi will conduct a pilot study aimed at improving statewide implementation of a medical intervention for preventing human immunodeficiency virus (HIV). He’ll also explore ways to address gender disparities in current prescribing practices that tend to exclude women. Dr. Mkuu will explore the feasibility of using a home test kit to increase cervical cancer screening rates among black women in Florida.
Preventing HIV
Siddiqi, whose research at HOBI focuses on HIV prevention, will leverage electronic health records in the OneFlorida+ Data Trust to identify women in Florida who are at risk of contracting HIV, with the goal of improving the statewide implementation of a medical intervention known as PrEP (pre-exposure prophylaxis) that can help prevent new HIV infections. The CTSI pilot award will help his team to achieve this long-term goal by producing preliminary data about current PrEP practices and the need for technical support in identifying potential PrEP candidates.
HIV attacks the body’s immune system. If left untreated, HIV can lead to AIDS. Treatment is available, but there is no cure for HIV; those who contract the virus are infected for life.
Although two relatively new medications have been proven to be highly effective in preventing new infections in people at high risk, use of these medications is low in the United States, and lowest among women in the South.
In Florida, which has the nation’s highest incidence of new HIV infections, identifying at-risk people—especially women—who may benefit from PrEP is one of the key barriers to effective statewide implementation of this intervention.
In future studies, Siddiqi and his team will develop and improve HIV risk prediction algorithms to better identify women in Florida at risk of HIV. The researchers also will conduct focus groups with clinicians in Florida to better understand current PrEP practices, especially the gender disparity in PrEP prescribing, and to ask clinicians for their perspectives on an automated clinical decision support tool that may help them identify PrEP candidates.
“This risk prediction model can be a great precision public health tool to help clinicians initiate a discussion about PrEP with at-risk patients during their health-care visits,” Siddiqi said.
Increasing Cervical Cancer Screenings
Mkuu and her team will use electronic health records in the OneFlorida+ Data Trust to map cervical cancer screening patterns across the state and identify under-screened populations in Florida. She will also conduct interviews with black women to identify barriers and facilitators to using home test kits for cervical cancer screening. Black women have the highest rate of cervical cancer deaths compared to other racial groups. Interview results will guide the development of an intervention for a larger study focused on using a home test kit to increase cervical cancer screening rates among under-screened black women.
Cervical cancer, once among the most common causes of cancer death for American women, is more easily treated when caught in its earliest stages. Overall deaths from cervical cancer have declined significantly during the past few decades as a result of increased screening with the Pap test. However, black women continue to be diagnosed with cervical cancer at later stages and experience higher mortality rates compared to white women.
Many of these disparities are due largely to delays in cervical cancer screenings, according to Mkuu, whose research at HOBI focuses on disentangling determinants of health outcomes and identifying evidenced-based interventions and policies that can improve the health of underserved populations.
Until recently, the Pap test was the only cervical cancer screening tool available to women. The test is conducted at a clinic visit by a doctor or nurse, who uses a swab to collect a sample of cervical cells during a pelvic exam. The cell sample is then sent to a laboratory, where trained technicians examine the cells for early signs of cancer.
For some women, many barriers have stood in the way of getting a Pap test.
“Not all women have access to a health care provider,” said Mkuu, “Women who don’t have health insurance may not be able to pay the doctor or the laboratory for the test.”
Even for women with access to care, having to deal with other chronic health conditions at clinic visits, such as diabetes, often complicates matters for patients and providers. For example, interviews with clinicians previously conducted by other members of Mkuu’s research team found that helping the patient control a chronic condition often took priority during clinic visits, leaving little time for routine screenings.
The American Cancer Society (ACS) updated its cervical cancer screening guidelines in 2020. The ACS now recommend that women ages 25 to 65 at average risk of cervical cancer get a primary human papillomavirus (HPV) test every five years to screen for cervical cancer. According to the ACS, almost all cervical cancers are caused by HPV, and the primary HPV test can tell the difference between high-risk types of HPV that are more likely to cause pre-cancers and cancers of the cervix and types of HPV associated with a lower risk of cervical cancer.
Primary HPV tests are available for use by providers in the clinic and for home use, although the home test kits are not yet widely available. Good news: Laboratory studies have found that HPV test results using cell samples collected by patients at home are comparable to results using HPV cell samples collected by providers at a clinic. More good news: In other research, black women have indicated that they preferred using the home tests for cervical cancer screening over a clinic visit.
Mkuu said the results of this pilot project will help identify under-screened populations, develop a recruitment strategy for hard-to reach populations, and identify barriers and facilitators to participation in HPV self-collected screening that will help facilitate recruitment for a larger cervical cancer intervention study in the future.
“A substantial reduction in overall cervical cancer mortality in the U.S. is possible with successful screening interventions that are adapted and targeted to black women,” Mkuu said. “We’ll be especially focusing on women who are the most vulnerable to delayed cervical cancer screenings due to poverty, race and other chronic health conditions, such as Type 2 diabetes.”