How Research can lead to Implementation in Limited Resource Settings: The Case of El Salvador
Friday 10 June - 11:00-11:20
photo intervenant Mauricio MAZA
Chief Medical Officer for Basic Health International, San Salvador, El Salvador

Dr Mauricio Maza is the Chief Medical Officer for Basic Health International, an organization dedicated to the eradication of cervical cancer. He received his MD from the Universidad Dr Jose Matias Delgado in El Salvador, and his Master's of Public Health from Harvard University with a concentration in health Care Management and Policy. As a medical doctor, public health practitioner and researcher, Dr Maza's focus is cervical cancer prevention in low-resource settings, specifically with the use of novel technologies and treatment paradigms. He is a co-investigator in NIh-funded studies that include development of technologies for screening, triaging and treatment of pre-cancerous lesions. Dr Maza is currently leading a 3-phase demonstration project in El Salvador that will screen 30 000 women by 2016 with an HPV test developed specifically for use in low-resource areas. Dr Maza has presented programme results and implementation strategies at international conferences and meetings held in Brazil, China, Guatemala, India, Panama, Peru and the United States. He believes in the need to advocate for more clinical and implementation research, in order to support more evidence-based policies in limited-resource settings.

ABSTRACT

Mauricio Maza MD/MPH (Basic Health International, El Salvador), Karla Alfaro MD/MPH (Basic Health International, El Salvador), Julia Gage PhD/MPH (National Cancer Institute, NIH, USA), Philip Castle PhD/MPH (Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY; Global Coalition Against Cervical Cancer, Arlington, VA, USA), Jane Kim PhD (Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA), Juan Felix MD (Keck School of Medicine, University of Southern California, USA), Miriam Cremer MD/MPH (Basic Health International, USA; Department of Obstetrics and Gynecology & Women's Health Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA)

INTRODUCTION: El Salvador has one of the Latin America’s highest cervical cancer incidence and mortality rates, at 24.8/100,000 and 11.9/100,000, respectively. In an effort to improve cervical cancer screening in El Salvador, the Ministry of Health, in cooperation with Basic Health International, started the CAPE (Cervical Cancer Prevention in El Salvador), demonstration project, which integrates a low cost HPV test into the public health system of El Salvador.
OBJECTIVE: To outline the research projects which have led to decision making, for changes to the cervical cancer program in El Salvador.
METHODS: CAPE project goals were based on consensus amongst stakeholders from the Ministry of Health, the medical societies, international agencies, non-profits, and other public sector institutions that work on cervical cancer prevention. Research about cost-effectiveness, adherence to recommended screening, screening acceptability, and follow-up were conducted.
RESULTS: This project to date has provided population-based screening for over 20,000 women aged 30-59 living in the Paracentral Region of El Salvador. Studies have demonstrated good acceptability of self-sampling, strong adherence to screening based on a health promoter educational model, women who were HPV positive were more likely to follow up with a screen and treat modality than colposcopy management, and cost effectiveness was shown to be better with the use of the screen and treat. The Ministry of Health has changed its local guidelines, which now include HPV screening followed by cryotherapy. It is expected that the Ministry of Health includes HPV testing in their national program and have the test available nationwide by 2019.
CONCLUSION: Research in limited resource settings is feasible and valuable for decision maker in order to support evidence-based policies.