When Ashwini Kamath Mulki began her online Master of Public Health at Keck School of Medicine of USC, she just wanted to help more people.
Before enrolling, she was already practicing as a family physician at Valley Health Partners Family Health Center, faculty with Lehigh Valley Family Medicine Residency Program in Allentown, Pennsylvania and an associate professor with USF Morsani College of Medicine. She was experiencing some burnout, however, as too many of her patients continued to require advanced care beyond clinical medicine.
Ashwini knew there had to be a better way to approach community health, but felt like she needed the specific knowledge to apply to her work. As a mother, wife, family doctor and faculty member, she also needed an online program that fit into her busy schedule. The online MPH program met her needs — and more.
“Everyone I spoke to at the USC MPH online program was super friendly, very helpful and assured me this was doable, as it has been. The curriculum also seemed unique, providing a comprehensive mix of traditional MPH courses with life skills required to do the work (e.g., human rights and leadership courses).”
After beginning her online MPH coursework, Ashwini quickly learned to appreciate the quality of the faculty, particularly the expertise, passion and availability of professor Dr. Mellissa Withers. Her teaching style, thoroughness with instructions, constructive feedback, prompt responses to student queries and passion on women’s health issues led Ashwini to request Dr. Withers’ mentorship during her global health project. Dr. Withers agreed, and Ashwini’s human papilloma virus self-sampling study began.
In her study, titled Human Papilloma Virus Self-Sampling Performance in Low- and Middle-Income Countries, Ashwini set out to examine the disparities in HPV screening between economies. HPV screening is one of the most effective ways to detect precancerous lesions in the cervix and remove them before they become cancerous. High-income countries have reduced deaths related to cervical cancer through proper screening, but low-income countries haven’t been as successful. Hoping to increase the number of successful HPV tests to prevent death from cervical cancer, Ashwini hypothesized that HPV self-sampling could improve screening rates, thus improving the survival rate.
Barriers to HPV screenings in low- and middle-income countries (LMICs) can vary by demographics and geography. These barriers can include, but are not limited to, access to care, affordability, privacy issues, spousal permission, wait times, high stigma and low awareness of the importance of getting screened.
HPV self-sampling can alleviate many of these barriers by allowing women to perform screening at home or in a private location. Additionally, without the cost of a medical facility or medical professional, HPV self-screening can also lower the cost of the initial screening. Self-screening is only recommended for the initial test, and a positive screen would still require the patient to seek medical care.
Ashwini’s research highlights that HPV self-sampling is a promising cervical cancer screening method in LMICs for several reasons. It is a valid test with high sensitivity and specificity. In fact, in over 70 percent of the studies reporting on validity, self-sampling had a sensitivity and specificity of over 90 percent.
Ashwini’s research also demonstrated a very high concordance rate between self-sampling and provider-collected sampling, ranging from 86.7 to 97.5 percent. Overall, participants reported that HPV self-sampling was easy to perform (75 to 97 percent, 18 studies), painless (60 to 90 percent, nine studies), and preferred over provider-collected sampling (57 to 100 percent, 14 studies).
Overall, Ashwini found that HPV self-sampling is a well-performing test that shows promise in terms of expanding screening efforts to prevent cervical cancer-related deaths in LMICs. Improved education and awareness of self-sampling, combined with support from community health workers, could reduce perceptions of self-sampling being inferior to provider-collected sampling.
“I am inspired by public health and feel well equipped to continue focusing on women’s health and maternal and child health locally and globally,” Ashwini said. “At a personal level, this program has helped me look deeper and reflect on my own values and biases, heightening my self-awareness around human rights, equity and equality.”