1. Proposal by Basic Health International, Inc.

2.  NGO founded by Dr. Miriam Cremer, MD MPH at Mount Sinai School of Medicine, New York City.  Our Vision: Eradicate Cervical Cancer in Latin America and the Caribbean.  To achieve this goal we: - Train healthcare providers in low-cost, low-tech methods of cervical cancer screening and treatment - Provide Direct Patient Care - Conduct research - Help shape cervical cancer policy

4. Pap Smear Coverage (%) for Rural Women Ever (in lifetime)82.7 Past two years63.3 Percentage of women (aged 15- 49) who have heard of HPV 29.1% There is also a vast lack of knowledge about the human papillomavirus (HPV). This is due to the fact that women of rural El Salvador have a very low rate of cervical cancer screening. Encuesta Nacional,de Salud, FESAL 2008 Familiar. October 2009

5. Improve the awareness and knowledge of HPV infection and cervical cancer prevention among health promoters serving the Department of San Vicente, El Salvador.

6.  Develop a curriculum for health promoter education on cervical cancer prevention.  Conduct education trainings for the health promoters of the Department of San Vicente, El Salvador.  Work with the health promoters to develop a targeted cervical cancer prevention program for members of their communities. Ethel Peralta. BHI Program Manager, explaining forms to health promoters and nurses during a Basic Health delegation. Health promoters studying cervical cancer prevention material.

7.  125 Health Promoters working in San Vicente, El Salvador : It is our goal to provide health promoters with a comprehensive knowledge-base about HPV and cervical cancer. During the course, health Promoters will develop targeted informational campaigns for:  Sexually active women Goal: To improve knowledge about methods to prevent cervical cancer, and to improve understanding of the history of HPV and its progression to cervical cancer.  Sexually active men Goal: To encourage involvement in the process of cervical cancer screening with their partners, decrease the negative stigma associated with gynecological exams in order to ensure they are not a barrier to their partner’s cervical cancer screening and treatment.

8. WOMEN BHI MEN HEALTH PROMOTERS BHI technical advisors will conduct cervical cancer awareness trainings to the health promoters in order to arm them with tools necessary to successfully educate members of their community. WHO ARE HEALTH PROMOTERS? Health promoters are members of the rural community that keep track of their constituents health needs, and informs about disease prevention and healthcare campaigns. WHO ARE HEALTH PROMOTERS? Health promoters are members of the rural community that keep track of their constituents health needs, and informs about disease prevention and healthcare campaigns. Health promoters will develop targeted campaigns for their community, with a focus on presenting information to both men and women.

9. DAYACTIVITYMATERIALS 1 – Morning Focus: Understanding the basics of HPV infection, cervical cancer screening (Pap Smear, VIA, HPV-DNA test), and cervical cancer. In groups, participants will present different topics about cervical cancer, including epidemiology, natural history of HPV, classification, diagnosis and treatment of cervical pre-cancers and cancers. The facilitator will explain the variety of screening techniques for cervical cancer detection. Computer, projector for power point presentations and bibliographic material to present the topics 1- Afternoon Focus: Overview of educational techniques to present knowledge The facilitator will present different educational techniques that can be used to transmit knowledge, with a focus on shaping the info for a target audience. Facilitator will present a sample healthcare education campaign to health promoters Flipcharts, power point presentations and dynamic exercises that will include the participants 2- Morning Focus: Developing methods to present information to the female community. Health promoters will work in groups to develop campaigns targeted at women in their community. Health promoters will conduct mock-interactions to practice campaign. Dynamic exercises with the participants, power point presentation, flip charts, public health outreach materials. 2- Afternoon Focus: Developing methods to present information to the male community, and putting it all together. The facilitator will present different techniques to talk with men in the community about the history of cervical cancer, and women’s rights to cervical cancer screening, in an effort to ensure men feel like an Important part of their partner’s evaluation and treatment. Health promoters will work in groups to develop campaigns targeted at males in their community. Flipcharts, power point presentations, public health outreach material, dynamic exercises with the participants.

10.  Quantitative improvement in health promoter knowledge of HPV infection and cervical cancer prevention (pre-and post course tests).  Implementation of educational HPV/Cervical Cancer campaigns reaching over 73,000 rural Salvadorans.  Free web-based programmatic materials to implement health promoter education course in low-resource settings globally.  Program description and outcomes published in peer-reviewed journal.

12. Please go to http://www.youtube.com/BasicHealthhttp://www.youtube.com/BasicHealth to view a short video about Basic Health International’s work in El Salvador. Please refer to our website www.basichealth.org for morewww.basichealth.org information. The following slides provide additional background information about Basic Health International.

13.  Develop national cervical cancer guidelines with the Ministry of Health, including the integration of the single-visit approach into an existing cytology program.  Conduct annual regional Cervical Cancer Screening Symposium in San Salvador, El Salvador. (Upcoming event January 28, 2010)  Work with community organizers to develop the best practices to implement cervical cancer screening initiatives and programs. Dr. Miriam Cremer, President and Founder of BHI, talking at the 2008 cervical cancer symposium. Over 250 people from Central America attended the 2008 cervical cancer symposium.

14.  BHI holds tri-annual delegations to El Salvador during which Salvadoran Healthcare providers receive a 5-day training on visual inspection with acetic acid and cryotherapy. Women waiting in line for their exam.BHI trainer Dr. Rachel Masch training Salvadoran physician.

15. YEARMONTHLOCATIONWomen 2006 JANUARYJucuarán614 2006 AUGUSTSan Vicente358 2007 MARCHSan Vicente578 2007 MARCHArcatao153 2007 NOVEMBERArcatao112 2007 NOVEMBERCojutepeque683 2008 MAYIlobasco698 2008 JULY-AUGUSTSan Vicente - Jucuarán - Arcatao108 2008 NOVEMBERSuchitoto 527 2009 JANUARYProcess Evaluation283 2009 APRILSensutepeque 883 TOTAL 4997

16. Year Invasive Cancer CIN 1CIN 2CIN 3 200611885 2007510115 20082573 TOTAL 8332613  72 pre-cancers have been treated.  8 invasive cancers have been detected and treated. CIN CLASIFICATIONS CIN 1Mild dysplasia; abnormal cells can be found in 1/3 of the lining of the cervix CIN 2Moderate dysplasia; abnormal cells can be found in 2/3 of the lining of the cervix CIN 3Severe dysplasia; abnormal cells can be found in more than 2/3 of the lining of the cervix and up to the full thickness of the lining

17.  11 Publications  21 Abstracts  First prize for original research, Federation of Latin American Obstetrics and Gynecology (FLASOG) Conference, San Salvador, El Salvador, 1999  14 current research projects

18. THANK YOU Contacts: Dr. Miriam Cremer, President and Founder miriam.cremer@mssm.edu Dr. Mauricio Maza, Medical Director mmaza@basichealth.org Lauren Ditzian, Program Manager lditzian@basichealth.org www.basichealth.org