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BackgroundCervical cancer is the primary cause of cancer death for women in Nicaragua, despite being highly preventable through vaccination against high-risk genotypes of the Human Papillomavirus (hrHPV), screening for hrHPV, and early detection of lesions. Despite technological advances designed to increase access to screening in low resource settings, barriers to increasing population-level screening coverage persist. On the Caribbean Coast of Nicaragua, only 59% of women have received one lifetime screen, compared to 78.6% of eligible women living on the Pacific and in the Interior. In concordance with the WHO’s call for best practices to eliminate cervical cancer, we explored the feasibility and acceptability of self-collection of samples for hrHPV testing on the Caribbean Coast of Nicaragua through a multi-year, bi-national, community-based mixed methods study.MethodsBetween 2016 and 2019, focus groups (n=25), key informant interviews (n=12) [phase I] and an environmental scan [phase II] were conducted on the Caribbean Coast of Nicaragua in partnership and collaboration with long-term research partners at the University of Virginia and community-based organizations. In spring 2020, underscreened women on the Caribbean Coast of Nicaragua were recruited and screened for hrHPV, with the choice of clinician collection or self-collection of samples.ResultsOver the course of the study, providers and potential patients expressed significant acceptability of self-collection of samples as a strategy to reduce barriers currently contributing to the low rates of screening (phases I and II). Ultimately 99.16% (n=1,767) of women chose to self-collect samples, demonstrating a high level of acceptability of self-collection in this pilot sample (phase III). Similarly, focus groups, key informant interviews, and the environmental scan (phases I and II) of resources indicated critical considerations for feasibility of implementation of both HPV primary screening and subsequently, self-collection of samples. Through phase III, we piloted hrHPV screening (n=1,782), with a 19.25% hrHPV positivity rate.ConclusionSelf-collection of samples for hrHPV testing demonstrated high acceptability and feasibility. Through concerted effort at the local, regional, and national levels, this project supported capacity building in reporting, monitoring, and surveilling cervical cancer screening across the continuum of cervical cancer control. more...

Background: Cervical cancer, a preventable cancer of disparities, is the primary cause of cancer death for women in Nicaragua. Clinics and personnel in rural and remote Nicaragua may not be accessible to perform recommended screening or follow-up services. Objective: To assess acceptability and feasibility of integrating innovations for high-quality screening and treatment follow-up (tele-colposcopy) into existing pathways on Nicaragua's Caribbean Coast within the context of the National Cervical Cancer Control Program. Methods: Provider focus groups, key informant interviews, and environmental scans were conducted for 13 clinics on the Caribbean Coast of Nicaragua. Topics discussed included a smartphone-based mobile colposcope (MobileODT hardware and mobile platform), mobile connectivity capacity, clinic resources, provider acceptability, and current diagnostic and clinical protocols. We tested device connectivity through image upload availability and real-time video connection and simulated clinical encounters utilizing MobileODT and a low-cost cervical simulator. We developed a database of colposcopic images to establish feasibility of integrating this database and clinical characteristics into the cervical cancer registry. Results: Provider acceptability of integrating tele-colposcopy into existing cancer control efforts was high. Image upload connectivity varied by location (mean?=?1?h 9?min). Most clinics had running water (84.6%) and consistent electricity (92.3%), but some did not have access to landline telephones (53.8%). Conclusions: As faster connectivity becomes available in remote settings, Mobile Health tools such as tele-colposcopy will be increasingly feasible to provide access to high-quality cervical cancer follow-up. World Health Organization guidance on integrating technology into existing programs will remain important to ensure programmatic efficacy, local relevance, and sustainability. more...

Background: A common practice in global nursing education is short-term missions where US-based students spend a brief time in a host country with hands-on experiences with patients, but maintain a US-centric perspective. Subsequently, an exchange becomes extractive, where one group benefits. Capacity-building models are needed in global health nursing education. In 2007, Bluefields Indian and Caribbean University (BICU), Nicaragua, and the University of Virginia (UVA), USA, began a collaborative partnership. In 2018, nursing faculties in these institutions developed simulations for nursing students at both sites, focused on disaster response in the context of climate change. Bluefields, located on the Caribbean Coast of Nicaragua, is vulnerable to extreme weather events and, increasingly, communities across Virginia are also experiencing such weather events. Here, we describe the joint programme and report student responses to the pilot simulations. Methods: In 2019, three pilot simulations were conducted with groups of BICU and UVA students in Bluefields; subsequently, simulation-based training events centred on disaster preparedness responses to climate change were integrated into curricula at both institutions. In July, 2019, faculty partnered to run the simulation with 46 UVA graduate (pre-licensure) second year students, and 36 undergraduate students at BICU. Only faculty travelled between both institutions in 2019, although student groups in both locations participated in the same simulated disaster scenarios to promote preparedness. All participants completed a pre-event and post-event survey about the simulation experience and their preparedness for a disaster scenario and also participated in group debriefing. Findings: Students at UVA reported increased confidence related to their ability to: respond in the event of a disaster (96%); their ability to describe three important considerations for disaster response in low-resource settings (97%); and their ability to describe considerations or activities for public health nurses to support disaster preparedness before a disaster (97%). Similarly, increased confidence was reported students at BICU in these categories of 97%, 99%, and 98%, respectively. Interpretation: Students and faculty at both institutions were open to, and interested in, the focus area of disaster preparedness, and the process of learning about extreme weather events related to climate change. A focus on the simulation on the acute disaster response and the subsequent debriefing on proactive pre-disaster prevention was important for learning. This work exemplifies a process for developing best practice models in global nursing education, underpinned by nursing education research in global health and capacity building. Funding: The Jefferson Trust, an initiative of the Alumni Association of the University of Virginia. more...

Most articles on nursing student study abroad experiences are one-sided case studies focusing on students and faculty from developed countries who travel to less developed countries. This article presents the perspectives of students from theUnited States, Chile, Mexico, and Taiwan, both sides of the international exchange experience. Students described the real-world, hands-on experience of immersion in a different health system and professional culture as transformational and having a significant impact on their nursing career goals. In an era of increasing globalization, cross-cultural experiences have great potential for nursing students on both sides of the exchange. more...