Team profile by Brian Crouch, Marlee Krieger, Kayla Hendrickson, Perla Medrano, Gareth Kelleher, Amy Guan, Laya Sathyan, Anika Mandavilli, Neha Shaw and Sofia Chodri

Globally, more and more women are being diagnosed with and dying from cervical cancer every year. Unfortunately, the situation is only projected to get worse. The World Health Organization (WHO) predicts that the number of global cancer deaths will double by 2040 if we maintain the status quo. Surgery remains the cornerstone treatment for cancer; however, a staggering 5 billion people lack access to basic surgical care. Additionally, while new therapeutic strategies are rapidly emerging in high-income countries (HICs), the growing cost of care amplifies existing disparities in access to healthcare. 

We have previously demonstrated the safety and efficacy of a point-of-care ethanol ethyl cellulose (PEEC) therapy, which can be used as an alternative to surgery in some clinical situations. The goal of this project was to perform a needs assessment to understand the shortcomings of traditional cervical cancer therapies in low- and middle-income countries (LMICs) like Peru and how our novel ablative strategy could have meaningful clinical impact there. 

To work towards that goal, we had two subteams with distinct goals. Team 1 set out to assess the different types of healthcare systems in LMICs to understand how PEEC could best be integrated. Team 2 aimed to identify and plan a path to regulatory approval for PEEC (e.g., U.S. Food and Drug Administration [FDA], Peruvian FDA, local institutional review boards). Each team consisted of a master of global health student, who served as the team lead, and three undergraduate students across Pratt School of Engineering and Trinity College of Arts and Sciences. 

The focus of the first semester was to establish the different stakeholders who would impact translation of a new cervical cancer therapy in Peru. Towards this end, students met with three different experts to investigate the Peruvian healthcare system landscape. First, students met with Dr. Adela Hernandez, a gynecologist in Lima, Peru who is involved in project HOPE, which seeks to increase access to human papillomavirus screening for cervical cancer prevention. Dr. Hernandez provided valuable background on cervical cancer care in Peru and how it differs from high income countries like the US. 

Next, students met with Dr. Ernesto Ortiz from the Duke Global Health Institute. Dr. Ortiz has extensive experience working within the Peruvian healthcare system and provided students with a broader understanding of how healthcare is delivered and paid for in Peru. Finally, students met with Dr. Dayne Hamrick from the Sanford School of Public Policy. Dr. Hamrick helped the students understand the global value chain and the process from developing a product to having impact. 

After learning more about the Peruvian healthcare landscape, cervical cancer in Peru, and how to take a product from idea to impact, the students developed a stakeholder matrix. The matrix identified the type of stakeholder, their level of impact on adoption of the product and their level of influence on the product itself. The final bins of stakeholders identified were healthcare providers, administrators, researchers, policy groups, advocacy groups, funders and patients. At the same time, the students developed a one-page flyer summarizing the project that would be used in Peru to introduce potential interviewees to the project and drafted questions to be part of the interview guide. 

One of the biggest challenges our team faced occurred between the fall and spring semesters when a new presidential election in Peru led to unforeseen turmoil within the region. As a result, the team was not able to travel to Lima as planned in March and is planning to travel to Lima to complete the interviews at the end of the summer. As a result, we had to pivot our focus for the spring semester. The students utilized the extra time to develop an in-depth and culturally appropriate interview guide and prepared an IRB submission for Duke’s Campus IRB. The team presented the results of their work from the fall semester and plans for the interviews at the Fortin Foundation Bass Connections Showcase in April of 2023. 

Novel Therapies for Cervical Cancer in Peru

Poster by Sofia Chodri, Amy Guan, Kayla Hendrickson, Gareth Kelleher, Anika Mandavilli, Perla Medrano, Laya Sathyan, Neha Shaw, Marlee Krieger and Brian Crouch