Browsing by Author "Baker, Ellen"

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    American Society of Clinical Oncology (ASCO) Cervical Cancer Prevention Program: A Hands-On Training Course in Nepal
    (ASCO, 2021) Phoolcharoen, Natacha; Kremzier, Megan; Eaton, Vanessa; Sarchet, Vanessa; Acharya, Sandhya Chapagain; Shrestha, Eliza; Carns, Jennifer; Baker, Ellen; Varon, Melissa Lopez; Karmacharya, Saujanya; Aryal, Binod; Richards-Kortum, Rebecca; Salcedo, Mila Pontremoli; Schmeler, Kathleen M.; Pariyar, Jitendra; Bioengineering
    Cervical cancer is the leading cause of death among women in Nepal. The American Society of Clinical Oncology (ASCO) and The University of Texas MD Anderson Cancer Center collaborated with international and local experts to hold a cervical cancer prevention course in Nepal in November 2019. The course included didactic lectures and a hands-on workshop. The didactic lectures included the epidemiology of cervical cancer globally and locally, cervical cancer screening guidelines, human papillomavirus vaccination, colposcopy and visual inspection with acetic acid (VIA), cervical dysplasia, and cervical cancer treatment. The hands-on workshop consisted of four stations: (1) VIA; (2) colposcopy, cervical biopsy, and endocervical curettage; (3) thermal ablation; and (4) loop electrosurgical excision procedure (LEEP). A train-the-trainer model short course was held by the international faculty to assist six local faculty to become familiar with the instruments, procedures, and models used in the hands-on training stations. Forty-two people (84% gynecologist, 8% radiation oncologist, and 8% other) attended the course. Following the course, the international faculty visited the regional hospitals for additional educational activities. Increased knowledge in cervical cancer screening guidelines and ability in performing VIA, colposcopy and cervical biopsy, thermal ablation, and LEEP were reported by 89%, 84%, 84%, 87%, and 84% of participants, respectively, from the postcourse on-site evaluations. From the 6-month follow-up survey, all respondents reported that they had made practice changes based on what they learned in the course and had implemented or tried to implement the cervical cancer screening guidelines presented at the course. In conclusion, the course evaluations suggested an improvement in participants' ability to perform cervical cancer screening and diagnostic procedures and reported the changes in practices after training.
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    Building local capacity for cervical cancer prevention in low resource settings: Changing strategy during the COVID-19 pandemic
    (ISGH, 2021) Salcedo, Mila P.; Varon, Melissa L.; Phoolcharoen, Natacha; Osman, Nafissa; David, Ernestina; Rangeiro, Ricardina; Changule, Dercia; Andrade, Viviane; Neves, Andrea; Doughtie, Kathleen M.; Carns, Jennifer; Lorenzoni, Cesaltina; Baker, Ellen; Schmeler, Kathleen M.
    In low- and middle-income countries (LMIC), where the great majority of cervical cancer cases occur, there is a shortage of health care providers trained to diagnose and treat pre-invasive cervical disease. The cervical cancer regional incidence and mortality rates are highest in sub-Saharan Africa and South-Eastern Asia [1]. In many resource-constrained regions, the shortage of trained providers limits the scale-up of quality cervical cancer screening, diagnosis and treatment services. In Mozambique, cervical cancer is the primary cause of cancer and cancer-related deaths among women [2,3]. Since 2016 we have provided in-person support and training to gynecologists and nurses in Mozambique. Cervical cancer prevention training, included teaching skills of colposcopy, cervical biopsy and loop electrosurgical excision procedure (LEEP) [4] Completion of hands-on training was followed by patient care with the trainers in local clinics. Participation in monthly Project ECHO (Extension of Community Healthcare Outcomes) telementoring sessions was encouraged to reinforce and amplify knowledge and skills. Since March 2020 travel has been restricted due to coronavirus disease (COVID-19). We have therefore adapted the way we deliver this training and provide support to colleagues in Mozambique so that capacity building efforts continue.
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    Cervical cancer prevention program in Nepal: a ‘training of trainers’ approach
    (International Society of Global Health, 2023) Batman, Samantha; Piya, Madan; Chapagain, Sandhya; Lama, Poonam; Maharjan, Pabitra; Aryal, Binod; Neupane, Maya; Pariyar, Shashwat; Phoolcharoen, Natacha; Eaton, Vanessa; Sarchet, Vanessa; Kremzier, Megan; Carns, Jenny; Richards-Kortum, Rebecca; Baker, Ellen; Varon, Melissa Lopez; Salcedo, Mila Pontremoli; Milan, Jessica; Schmeler, Kathleen; Pariyar, Jitendra; Bioengineering
    Background: Cervical cancer remains the leading cause of cancer-related death among Nepalese women. To this effect, Cancer Care Nepal established an international collaboration to implement a 'training of trainers' (TOT) program to expand the reach of cervical cancer prevention techniques. Methods: The Nepal cervical cancer prevention program began with an in-person TOT session in Kathmandu in November 2019. Due to the COVID-19 pandemic, two additional TOT courses were held in October and November 2021 with virtual support, didactic lectures from international faculty, and a hands-on component by Nepalese faculty. The Nepalese providers underwent training in these courses and then held further training in five collaborating centers across Nepal. Participants completed pre- and post-course knowledge assessments. The trainings were supplemented by the creation of a new Project ECHO® (Extension for Community Healthcare Outcomes) telementoring hub at Cancer Care Nepal. A capstone refresher course was held in November 2022. Results: 42 participants attended the initial TOT course in 2019. The two follow-up TOT courses held in October/November 2021 were two days long and included providers from five participating regions in Nepal. The courses included virtual didactic sessions followed by hands-on stations led by the Nepalese faculty who had participated in the 2019 TOT course. The stations included: visual inspection with acetic acid (VIA), colposcopy, thermal ablation, and loop electrosurgical excision procedure (LEEP). There were 41 participants in the October/November TOT courses. The trainers who received the TOT education then conducted local courses of similar content in each of the five regions for 152 local providers. Participants had improved mean knowledge scores after the training (0.70, 95% CI=0.67-0.72) in comparison to prior to training (0.50, 95% CI=0.47-0.53), p\<0.001. The program concluded with a capstone course in November 2022 attended by 26 participants. To date, 11 Project ECHO sessions have been held, with an average of 20 participants per session. Conclusions: Nepal's cervical cancer prevention program has increased the number of providers trained in cervical cancer prevention techniques. By increasing provider capacity, individuals will have increased access to cervical cancer screening and treatment of pre-invasive disease, hopefully decreasing the burden of cervical cancer in Nepal.
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    Hands-On Training Courses for Cervical Cancer Screening, Diagnosis, and Treatment Procedures in Low- and Middle-Income Countries
    (American Society of Clinical Oncology, 2022) Phoolcharoen, Natacha; Varon, Melissa Lopez; Baker, Ellen; Parra, Sonia; Carns, Jennifer; Cherry, Katelin; Smith, Chelsey; Sonka, Theresa; Doughtie, Kathleen; Lorenzoni, Cesaltina; Richards-Kortum, Rebecca; Schmeler, Kathleen; Salcedo, Mila Pontremoli; Bioengineering
    In 2018, there were approximately 570,000 new cases of cervical cancer worldwide. More than 85% of cases occurred in low- and middle-income countries (LMICs), primarily because of poor access to screening and a limited number of medical providers trained to diagnose and treat cervical precancerous lesions. Our objective was to provide locally arranged, hands-on training courses for medical providers in LMICs to learn to perform cervical cancer screening, diagnosis, and treatment procedures. The courses included didactic lectures and hands-on training stations using low-cost simulation models developed by bioengineers and students at Rice University in Houston, TX, United States, and the Malawi Polytechnic in Blantyre, Malawi. The hands-on training stations included visual inspection with acetic acid (VIA), colposcopy, cervical biopsy, endocervical curettage, loop electrosurgical excision procedure (LEEP), and thermal ablation. Provider pre- and postcourse confidence levels in performing the procedures were evaluated. From February 2017 to January 2020, we arranged 15 hands-on training courses in seven cities across six countries (El Salvador, Mozambique, Trinidad and Tobago, Lesotho, Malawi, and Nepal). Overall, there were 506 participants. The average number of participants per course was 38 (range 19-92). The participants included doctors, nurses, and midwives. The course duration varied from 1 to 3 days. Increased confidence in performing VIA, colposcopy and cervical biopsy, ablation, and LEEP was reported by 69%, 71%, 61%, and 76% of participants, respectively. Our findings suggest that locally arranged, hands-on cervical cancer prevention training courses in LMICs can improve provider confidence in performing cervical cancer screening, diagnosis, and treatment procedures. These courses are part of a larger strategy to build local capacity for delivering and improving cervical cancer prevention services in LMICs.
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    A low-cost, paper-based hybrid capture assay to detect high-risk HPV DNA for cervical cancer screening in low-resource settings
    (Royal Society of Chemisty, 2023) Smith, Chelsey A.; Chang, Megan M.; Kundrod, Kathryn A.; Novak, Emilie N.; Parra, Sonia G.; López, Leticia; Mavume, Celda; Lorenzoni, Cesaltina; Maza, Mauricio; Salcedo, Mila P.; Carns, Jennifer L.; Baker, Ellen; Montealegre, Jane; Scheurer, Michael; Castle, Philip E.; Schmeler, Kathleen M.; Richards-Kortum, Rebecca R.; Bioengineering
    Cervical cancer is a leading cause of cancer death for women in low-resource settings. The World Health Organization recommends that cervical cancer screening programs incorporate HPV DNA testing, but available tests are expensive, require laboratory infrastructure, and cannot be performed at the point-of-care. We developed a two-dimensional paper network (2DPN), hybrid-capture, signal amplification assay and a point-of-care sample preparation protocol to detect high-risk HPV DNA from exfoliated cervical cells within an hour. The test does not require expensive equipment and has an estimated cost of <$3 per test without the need for batching. We evaluated performance of the paper HPV DNA assay with short synthetic and genomic HPV DNA targets, HPV positive and negative cellular samples, and two sets of clinical samples. The first set of clinical samples consisted of 16 biobanked, provider-collected cervical samples from a study in El Salvador previously tested with careHPV and subsequently tested in a controlled laboratory environment. The paper HPV DNA test correctly identified eight of eight HPV-negative clinical samples and seven of eight HPV-positive clinical samples. We then performed a field evaluation of the paper HPV DNA test in a hospital laboratory in Mozambique. Cellular controls generated expected results throughout field testing with fully lyophilized sample preparation and 2DPN reagents. When evaluated with 16 residual self-collected cervicovaginal samples previously tested by the GeneXpert HPV assay (“Xpert”), the accuracy of the HPV DNA paper test in the field was reduced compared to testing in the controlled laboratory environment, with positive results obtained for all eight HPV-positive samples as well as seven of eight HPV-negative samples. Further evaluation showed reduction in performance was likely due in part to increased concentration of exfoliated cells in the self-collected clinical samples from Mozambique compared with provider-collected samples from El Salvador. Finally, a formal usability assessment was conducted with users in El Salvador and Mozambique; the assay was rated as acceptable to perform after minimal training. With additional optimization for higher cell concentrations and inclusion of an internal cellular control, the paper HPV DNA assay offers promise as a low-cost, point-of-care cervical cancer screening test in low-resource settings.
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    Sample-to-answer, extraction-free, real-time RT-LAMP test for SARS-CoV-2 in nasopharyngeal, nasal, and saliva samples: Implications and use for surveillance testing
    (Public Library of Science, 2022) Kundrod, Kathryn A.; Natoli, Mary E.; Chang, Megan M.; Smith, Chelsey A.; Paul, Sai; Ogoe, Dereq; Goh, Christopher; Santhanaraj, Akshaya; Price, Anthony; Eldin, Karen W.; Patel, Keyur P.; Baker, Ellen; Schmeler, Kathleen M.; Richards-Kortum, Rebecca; Bioengineering
    The global COVID-19 pandemic has highlighted the need for rapid, accurate and accessible nucleic acid tests to enable timely identification of infected individuals. We optimized a sample-to-answer nucleic acid test for SARS-CoV-2 that provides results in <1 hour using inexpensive and readily available reagents. The test workflow includes a simple lysis and viral inactivation protocol followed by direct isothermal amplification of viral RNA using RT-LAMP. The assay was validated using two different instruments, a portable isothermal fluorimeter and a standard thermocycler. Results of the RT-LAMP assay were compared to traditional RT-qPCR for nasopharyngeal swabs, nasal swabs, and saliva collected from a cohort of patients hospitalized due to COVID-19. For all three sample types, positive agreement with RT-LAMP performed using the isothermal fluorimeter was 100% for samples with Ct <30 and 69–91% for samples with Ct <40. Following validation, the test was successfully scaled to test the saliva of up to 400 asymptomatic individuals per day as part of the campus surveillance program at Rice University. Successful development, validation, and scaling of this sample-to-answer, extraction-free real-time RT-LAMP test for SARS-CoV-2 adds a highly adaptable tool to efforts to control the COVID-19 pandemic, and can inform test development strategies for future infectious disease threats.