The De Casa en Casa (De Casa) program was created to specifically address barriers to cervical cancer screening among uninsured, underinsured, those in rural and border counties, and racial/ethnic minorities. The program will continue to serve El Paso County and 60 counties in West and South Texas. De Casa addresses the individual through health education, no-cost clinical services, and navigation, along with the community level, by providing capacity-building to partner community-based organizations and healthcare facilities. The target service area includes counties in Texas Public Health Regions 1, 2, 8, and 9/10, including the Paso del Norte, South Plains, Permian Basin, and Border...

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The De Casa en Casa (De Casa) program was created to specifically address barriers to cervical cancer screening among uninsured, underinsured, those in rural and border counties, and racial/ethnic minorities. The program will continue to serve El Paso County and 60 counties in West and South Texas. De Casa addresses the individual through health education, no-cost clinical services, and navigation, along with the community level, by providing capacity-building to partner community-based organizations and healthcare facilities. The target service area includes counties in Texas Public Health Regions 1, 2, 8, and 9/10, including the Paso del Norte, South Plains, Permian Basin, and Border regions. Over 40 counties in the service, area are predominantly Hispanic, have high poverty rates (ranging from 15-25%), have about a quarter of the population with no health insurance, have low educational attainment, and many residents speak Spanish at home. Thirty-four of the 61 counties in the target service area are federally designated medically underserved and rural areas. The cervical cancer incidence and mortality rates in El Paso County are higher than the US Latino and US populations. Women in our area are more likely to develop and die from cervical cancer because of being underscreened. Our service area's average cervical cancer screening rate is 56-68%. None of the counties in our service area have average screening rates exceeding the state (75.4%) or the US (77.9%). Barriers to screening in our service area include the social determinants of health-related to poor healthcare access and quality. Impediments we have witnessed in our collaborating clinics include a lack of resources, understaffing, which has only worsened since the pandemic, lack of access to specialty care, and competing priorities. These barriers are addressed through our multi-component, multi-level, culturally tailored, and bilingual intervention, which delivers outreach, education, no-cost clinical services, and navigation. Overall Project Strategy: Our De Casa program will reduce the burden of cervical cancer in our service area by providing health education and navigation to women 21-65 years old who are overdue for Pap screening regardless of insurance status while also providing free screening and diagnostic services to uninsured women. The De Casa 4 program builds upon the original program by allowing us to create more capacity for understaffed and under-resourced healthcare facilities throughout West and South Texas. This capacity will be achieved by developing our toolkit and training providers and clinical staff to sustain health education and navigation components. The program will increase its clinical services by close to 50% and increase the rescreening rate by 25%. We will place equal focus on insured individuals or individuals with Pap screening coverage through BCCS/Healthy Texas Women who are overdue for screening to provide education and navigation through the completion of their Pap and any necessary diagnostic services. The Texas DSHS-approved curriculum will be translated into Spanish and made available statewide to allow for more trained CHWs throughout Texas. Furthermore, we will develop a toolkit based on materials posted through the NCI's Evidence-Based Cancer Control Program. Our toolkit will include presentations, educational videos, and social media post templates, along with providing training to community partners to implement education and navigation components to ensure the program's sustainability. Specific Goals: Goal 1. Maintain equitable access to screening services for uninsured women throughout West and South Texas. Goal 2. Expand navigation services for insured women in rural and medically underserved target counties. We plan to provide 4,000 Pap screenings. In addition, we will provide education and navigation to 33,375 women and 4,260 clinical services. Goal 3. All patients with abnormal screening results will be navigated to and receive diagnostic testing. All patients diagnosed with cancer that requires treatment will be navigated into treatment. Significance and Impact: The De Casa en Casa program has significantly impacted cervical cancer screening rates in our service area, covering 24% of Texas. We will continue to enhance these services by providing outreach, education, and navigation to individuals with health insurance coverage who are not up-to-date with Pap screening guidelines. In addition, the program is aligned with the goals of CPRIT and the Texas Cancer Plan to reduce the burden of cancer through evidence-based programs that target communities with health disparities throughout Texas.

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