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[(wo)20(me)18.4(n)-450.3(l)0(a)19.6(c)0(k)19.7(i)0(n)15(g)-450.4(ad)19.7(eq)19.7(ua)19.7(te)-441.2(sc)19.9(re)19.7(en)13.9(in)20.7(g)-450.3(f)0(r)20.9(o)0(m)-441.2(c)0(o)19.7(m)0(m)18.4(u)0(n)20.8(i)0(t)20.6(y)0(-)20.9(b)0(a)13.9(s)0(e)19.9(d)]TJ
0 -1.1116 TD
[(no)20.8(nc)19.7(li)20.6(ni)15(ca)18.5(l)-202.8(s)0(e)14.1(t)0(t)20.6(i)0(n)20.7(g)0(s)21(.)]TJ
7.3823 0 0 6.5614 138.7842 345.9401 Tm
-.0162 Tc
(32)Tj
9.843 0 0 9.843 148.1385 341.5747 Tm
0 Tc
[(Ho)20(we)18.8(ve)19.7(r,)-194.6(gi)20.7(ve)13.9(n)-202.7(o)0(u)20.8(r)-208.4(ex)19.7(pe)19.7(ri)15(en)19.7(ce)-200.3(in)-192.4(us)15.3(in)20.7(g)]TJ
-8.749 -1.1116 TD
[(th)20.7(is)-347.7(ap)19.7(pr)20.9(oa)19.7(ch)-348.9(in)-342.1(co)19.7(mm)18.4(un)20.8(it)20.6(y-)15.1(ba)19.7(se)19.9(d)-352.4(s)0(a)14.1(m)15(pl)15(es)-343(an)19.7(d)-358.2(p)0(r)20.9(o)0(v)20.8(e)0(n)-343.2(s)0(u)15.3(c)0(-)]TJ
T*
[(ce)18.5(ss)-289.8(in)-290.3(ot)20.7(he)19.7(r)-300.6(c)0(l)19.5(i)0(n)20.7(i)0(c)19.6(a)0(l)-291.5(s)0(e)19.9(t)0(t)14.8(i)0(n)20.7(g)0(s)-290(i)0(n)-284.6(o)0(t)15(h)0(e)19.7(r)-294.8(co)13.9(un)20.8(tr)20.7(ie)19.6(s,)-286.6(we)-292.2(hy)20.8(po)15.1(th)20.7(e-)]TJ
0 -1.1174 TD
[(si)20.9(ze)18.5(d)-415.8(t)0(h)20.7(a)0(t)-406.7(H)0(P)20.1(V)-416.7(se)19.9(lf)20.7(-s)21.1(am)18.5(pl)15(in)20.7(g)-410(m)0(a)18.4(y)-415.8(be)-406.5(a)-411.2(v)0(i)20.7(a)0(b)13.9(l)0(e)-400.9(s)0(t)15.1(r)0(a)19.7(t)0(e)19.6(g)0(y)-405.4(f)0(o)20.9(r)]TJ
0 -1.1116 TD
[(ce)18.5(rv)20.9(ic)19.5(al)-262.7(ca)18.5(nc)19.7(er)-256.8(sc)14.1(re)19.7(en)19.7(in)20.7(g)-266(i)0(n)-261.5(c)0(l)19.5(i)0(n)20.7(i)0(c)19.6(a)0(l)-256.9(s)0(e)14.1(t)0(t)20.6(i)0(n)20.7(g)0(s)21(.)-268.4(In)-255.6(th)15(is)-255.6(st)20.9(ud)20.8(y)-271.8(w)0(e)]TJ
T*
[(as)19.9(se)19.9(ss)-307.1(th)20.7(e)-313.3(f)0(e)19.7(a)0(s)14.1(i)0(b)20.7(i)0(l)20.6(i)0(t)20.6(y)-312.1(an)19.7(d)-312.1(a)0(c)18.5(c)0(e)12.8(p)0(t)20.7(a)0(b)19.7(i)0(l)20.6(i)0(t)20.6(y)-312.1(of)-307.4(HP)20.1(V)-313(s)0(e)19.9(l)0(f)20.7(-)0(s)15.3(a)0(m)24.2(p)0(l)14.9(i)0(n)20.7(g)]TJ
0 -1.1174 TD
[(am)18.5(on)20.8(g)-271.8(p)0(a)19.7(t)0(i)20.6(e)0(n)19.7(t)0(s)-261.3(a)0(n)19.7(d)-271.8(cl)19.5(in)20.7(ic)-262.7(st)20.9(af)19.7(f)-271.8(i)0(n)-261.5(t)0(w)19.8(o)-271.8(su)21(ch)-256.8(se)14.1(tt)20.6(in)20.7(gs)21(.)]TJ
/F4 1 Tf
8.9663 0 0 8.9663 62.022 250.9228 Tm
[(Materials)-332.7(and)-338.2(Methods)]TJ
/F10 1 Tf
0 -1.8336 TD
(Setting)Tj
/F6 1 Tf
9.843 0 0 9.843 72 218.0409 Tm
[(Th)19.6(e)-221.1(s)0(t)20.9(u)0(d)20.8(y)-220(wa)18.8(s)-225.5(c)0(o)19.7(n)0(d)20.8(u)0(c)19.7(t)0(e)19.6(d)-220(at)-210.8(tw)19.8(o)-220(s)0(a)14.1(f)0(e)19.7(t)0(y)20.7(-)0(n)20.9(e)0(t)-210.8(c)0(l)19.5(i)0(n)15(i)0(c)19.6(s)0(.)-205.9(O)0(n)14.2(e)-221.1(wa)18.8(s)]TJ
-1.0137 -1.1116 TD
-.0198 Tc
[(a)-402.2(h)-19.8(os)-19.8(pi)-19.8(ta)-19.8(l-)-19.8(ba)-19.8(se)-19.8(d)-397.5(t)-19.8(ea)-19.8(ch)-19.8(in)-19.8(g)-396.4(o)-19.8(ut)-19.8(pa)-19.8(ti)-19.8(en)-19.8(t)-396.5(c)-19.8(li)-19.8(ni)-19.8(c,)-403.4(w)-19.8(h).2(i)-19.8(c)-.2(h)-401(i)-19.8(s)-396.3(p)-19.8(ar)-19.8(t)-396.5(o)-19.8(f)]TJ
0 -1.1174 TD
0 Tc
[(Mi)19.8(am)18.5(i-)20.7(Da)18.8(de)-187.7(Co)19.8(un)15.1(ty)20.7(s)-186.3(pu)20.8(bl)20.7(ic)-187.8(ho)20.8(sp)15.3(it)20.6(al)-187.8(sy)21(st)20.9(em)-188.9(\()-116.3(J)0(a)19.9(c)0(k)19.7(s)0(o)15.3(n)-196.9(He)18.8(al)19.5(th)]TJ
0 -1.1116 TD
[(Sy)21(st)15.1(em)24.2(s)-382.1(am)18.5(bu)20.8(la)19.6(to)20.7(ry)-376.5(ca)18.5(re)-383.5(ce)18.5(nt)20.7(er)-377.7([A)20(CC)18.8(]\))20.9(.)-389.3(O)0(v)20(e)0(r)-377.7(8)0(0)20.8(%)-388.1(of)-382.3(th)20.7(e)]TJ
T*
[(pa)19.7(ti)20.6(en)19.7(ts)-198(in)-198.2(th)20.7(e)-209.6(A)0(C)18.9(C)-209.5(ar)19.7(e)-209.6(u)0(n)20.8(i)0(n)20.7(s)0(u)21(r)0(e)19.7(d)-208.4(an)19.7(d)-208.4(m)0(o)19.6(s)0(t)-198(r)0(e)19.7(c)0(e)18.5(i)0(v)20.7(e)-209.6(ca)18.5(re)-199.2(ba)19.7(se)19.9(d)]TJ
T*
[(on)-186.5(a)-203.8(s)0(l)20.9(i)0(d)20.7(i)0(n)20.7(g)-196.9(fe)14(e)-198.1(s)0(c)19.9(a)0(l)19.5(e)0(.)-190(T)0(h)19.6(e)-198.1(ot)20.7(he)13.9(r)-196.9(w)0(a)18.8(s)-196.7(a)-203.8(c)0(o)19.7(m)0(m)24.1(u)0(n)15.1(i)0(t)20.6(y)0(-)20.9(b)0(a)19.7(s)0(e)19.9(d)-196.9(cl)13.8(in)20.7(ic)]TJ
0 -1.1174 TD
[(in)-284.6(Mi)19.8(am)18.5(i)15(s)-294.6(L)0(i)19.5(t)0(t)20.6(l)0(e)-285.7(H)0(a)18.8(i)0(t)14.8(i)-295(ne)19.7(ig)20.7(hb)20.8(or)20.9(ho)15.1(od)20.8(.)-297.2(T)0(h)19.6(i)0(s)-284.4(c)0(l)19.5(i)0(n)20.7(i)0(c)19.6(,)-297.2(th)20.7(e)-296(C)0(e)12.9(n)0(t)20.7(e)0(r)]TJ
0 -1.1116 TD
[(fo)20.9(r)-248.7(H)0(a)18.8(i)0(t)20.6(i)0(a)19.6(n)-248.8(St)20.9(ud)20.8(ie)19.5(s)-248.6(\()0(C)19.8(H)0(S)20.1(\))0(,)-234.9(i)0(s)-238.3(a)-244.2(no)15.1(np)20.8(ro)20.9(t)-238.3(fa)19.7(ci)19.5(li)20.6(ty)-238.5(su)21(pp)20.8(or)20.9(te)19.6(d)-248.8(b)0(y)]TJ
T*
[(va)19.7(ri)20.7(ou)15.1(s)-294.6(f)0(e)19.7(d)0(e)19.7(r)0(a)19.7(l)0(,)-292.6(s)0(t)20.9(a)0(t)19.5(e)0(,)-287.9(a)0(n)19.7(d)-294.8(fo)15.1(un)20.8(da)19.7(ti)20.6(on)-290.2(so)21(ur)20.9(ce)18.5(s.)-286.6(Th)19.6(e)-301.8(c)0(l)19.5(i)0(n)20.7(i)0(c)-285.7(p)0(r)15.1(i)0(-)]TJ
0 -1.1174 TD
[(ma)18.4(ri)20.7(ly)-255.8(ca)18.5(te)19.6(rs)-249.6(to)-255.8(Ha)18.8(it)20.6(ia)19.5(ns)21(.)-262.6(N)0(e)18.8(a)0(r)19.7(l)0(y)-255.8(a)0(l)19.5(l)-260.4(of)-249.8(th)15(e)-261.4(p)0(a)19.7(t)0(i)20.6(e)0(n)19.7(t)0(s)-255.6(a)0(t)-251.2(t)0(h)20.7(i)0(s)-255.6(s)0(i)20.9(t)0(e)]TJ
0 -1.1116 TD
[(ar)19.7(e)-273(u)0(n)20.8(i)0(n)20.7(s)0(u)21(r)0(e)14(d)0(.)]TJ
/F10 1 Tf
8.9663 0 0 8.9663 62.022 84.0189 Tm
(Participants)Tj
/F6 1 Tf
9.843 0 0 9.843 72 67.5779 Tm
[(Female)-443.3(patients)-449.1(were)-445.3(eligible)-443.6(if)-440(they)-449.2(were)-445.3(aged)-438.7(3065)]TJ
-1.0137 -1.1116 TD
[(years,)-258.7(had)-263.6(not)-256.9(had)-257.9(a)-261.4(Pap)-257.7(smear)-262.3(in)-255.8(the)-258(prior)-259(3)-260.3(years,)-258.7(were)-261(not)]TJ
25.504 67.9184 TD
[(pregnant,)-383.3(were)-376.2(not)-372.1(actively)-381.3(menstruating,)-377.5(and)-378.8(had)-373.1(not)-377.8(had)]TJ
0 -1.1174 TD
[(their)-283.4(uterus)-284.1(removed.)]TJ
/F10 1 Tf
8.9663 0 0 8.9663 313.0582 692.277 Tm
(Recruitment)Tj
/F6 1 Tf
9.843 0 0 9.843 323.0361 675.8361 Tm
[(In)-382.3(this)-384.6(feasibility)-389.2(and)-378.8(acceptability)-389.4(pilot)-386(study,)-383.2(our)-383.4(goal)]TJ
-1.0137 -1.1116 TD
[(was)-339.2(to)-336.4(obtain)-336.3(data)-335.2(on)-336.3(a)-336.3(minimum)-340(of)-330.5(100)-337.4(women)-337.1(who)-338.2(may)]TJ
0 -1.1174 TD
[(choose)-469.5(HPV)-465.7(self-sampling.)-476.3(Based)-463.7(on)-468.7(our)-464(experience,)-469.6(we)]TJ
0 -1.1116 TD
[(estim)-8(ated)-225.7(that)-224.7(about)-225.7(50%)-229(of)-226.8(women)-227.6(would)-225.4(choose)-227.6(HPV)-229.5(self-)]TJ
T*
[(sampl)-7.8(ing.)-254.5(Thus,)-250.8(to)-255.8(recruit)-257.9(at)-256.9(least)-255.6(100)-256.7(women)-256.4(who)-257.6(preferred)]TJ
0 -1.1174 TD
[(HPV)-315.9(self-sampling,)-309.2(our)-308.5(target)-314.4(was)-310.4(to)-307.6(identify)-315.6(200)-308.6(study)-304.9(el-)]TJ
0 -1.1116 TD
[(igible)-422.9(women.)-421.2(Participant)-10.2(s)-415.6(were)-422.3(recruited)-428.3(by)-416.9(convenience)]TJ
T*
[(sampl)-7.8(ing)-383.6(from)-385.7(the)-390.5(waiting)-390.3(room)-385.7(of)-388.1(the)-384.7(above)-388(two)-390.2(clinics.)]TJ
0 -1.1174 TD
[(Recru)-8.8(itment)-452.9(took)-453.8(place)-458.4(between)-455.7(May)-454.6(2013)-453.7(and)-453.7(February)]TJ
0 -1.1116 TD
[(2014.)-503.2(Two)-500.7(community)-503.4(health)-498.8(workers)-504.8(\(CHWs\))-505.9(recruited)]TJ
T*
[(participant)-10.3(s.)-349.9(The)-357(CHW)-358.8(assigned)-356.5(to)-353.7(the)-355.9(ACC)-351.8(was)-356.5(Hispanic)]TJ
T*
[(and)-355.8(the)-350.2(other)-352.3(at)-349.1(CHS)-350.6(was)-356.5(Haitian.)-354.6(At)-348.8(ACC)-351.8(our)-354.6(CHW)-347.3(was)]TJ
0 -1.1174 TD
[(instructed)-399.4(to)-394(only)-396.2(recruit)-396.1(Latina)-402.1(patients)-397.2(and)-396.1(at)-395.2(CHS)-396.7(only)]TJ
0 -1.1116 TD
[(Haitian)-287.8(patients.)-285.5(At)-285.4(both)-281(sites)-283(the)-286.8(CHW)-283.9(approached)-286.3(women)]TJ
T*
[(waiting)-367.2(to)-359.4(be)-360.5(seen)-363.6(by)-365.1(their)-358.2(healthcare)-368.4(provider.)-364.8(The)-362.8(CHW)]TJ
0 -1.1174 TD
[(introd)-6.8(uced)-294.7(herself)-297.9(and)-292.4(gave)-294.7(a)-296(brief)-294.7(description)-296.8(of)-295.9(the)-292.6(study.)]TJ
0 -1.1116 TD
[(For)-279.6(potentially)-280(interested)-279.6(participants)-281.9(CHWs)-279.1(administered)-277.3(a)]TJ
T*
[(ve)-344.1(question)-338.3(screening)-341.6(survey)-341.6(to)-336.4(assess)-342.2(eligibility.)-345.9(If)-336.2(eligi-)]TJ
0 -1.1174 TD
[(bility)-358.5(criteria)-364(were)-358.9(met)-357.2(and)-355.8(women)-360.1(were)-358.9(interested)-360.2(in)-359.4(par-)]TJ
0 -1.1116 TD
[(ticipating,)-288.1(informed)-282(consent)-280.7(was)-281.6(obtained.)]TJ
/F10 1 Tf
8.9663 0 0 8.9663 313.0582 445.7196 Tm
[(Study)-338.6(procedures)]TJ
/F6 1 Tf
9.843 0 0 9.843 323.0361 429.2786 Tm
[(After)-341.7(informed)-339.6(consent,)-341.7(a)-342.1(brief)-340.8(demographic)-345.2(survey)-335.9(was)]TJ
-1.0137 -1.1174 TD
[(administered.)-303.8(Participant)-10.2(s)-294.6(then)-299.4(received)-301.5(a)-301.8(short)-299.2(information)]TJ
0 -1.1116 TD
[(session)-377(on)-370.8(cervical)-376.6(cancer)-379.9(screening)-376.2(using)-374.1(a)-370.9(ipchart.)-377.5(The)]TJ
T*
[(ipchart)-333.8(described)-330.1(normal)-331.6(female)-334(anatomy,)-325.9(provided)-332.6(infor-)]TJ
0 -1.1174 TD
[(mation)-412.4(about)-410(cervical)-416.9(cancer)-414.4(progression)-410.4(and)-407.6(risk)-413.2(factors.)]TJ
0 -1.1116 TD
[(Women)-309.7(then)-311(received)-307.3(information)-308.6(about)-312.1(the)-304.1(traditional)-314.6(Pap)]TJ
T*
[(smear)-371.7(as)-371.8(a)-370.9(means)-371.7(to)-365.2(screen)-372.7(for)-371.9(cervical)-370.8(cancer)-374.1(and)-367.3(an)-372(ex-)]TJ
0 -1.1174 TD
[(plana)-8(tion)-356(of)-353.5(HPV)-356.2(self-sampling)-357.6(as)-360.3(an)-354.7(alternative)-362.8(means)-354.5(of)]TJ
0 -1.1116 TD
[(screening.)-241.4(Patients)-235.8(were)-232.2(given)-237.2(a)-232.6(description)-239.2(of)-232.6(the)-235(procedure)]TJ
T*
[(for)-412.2(performing)-405.1(HPV)-408.1(self-sampling,)-412.9(and)-407.6(the)-407.8(follow-up)-408.4(and)]TJ
T*
[(navigation)-244.1(that)-242(would)-236.9(be)-239.5(provided)-240.5(for)-239.4(women)-239.2(in)-238.5(whom)-242.7(HPV)]TJ
0 -1.1174 TD
[(is)-457.1(detected.)-460.7(The)-454.9(participants)-454.7(were)-456.8(then)-455(given)-456.1(one)-453.7(of)-457.2(two)]TJ
0 -1.1116 TD
[(options.)-201.3(They)-196.8(could)-196.9(choose)-198.8(HPV)-200.7(self-sampling,)-199.8(which)-197.7(would)]TJ
T*
[(be)-320.1(done)-322.4(on)-319(site)-316.7(before)-319.9(the)-321.4(provider)-321.1(visit.)-320.2(Participants)-322.1(could)]TJ
0 -1.1174 TD
[(also)-253.2(discuss)-250.3(HPV)-246.8(self-sampling)-254(with)-247.4(their)-248.8(provider)-251.9(and)-246.4(have)]TJ
0 -1.1116 TD
[(the)-252.3(procedure)-255.3(done)-247.5(after)-249.8(they)-253.4(discussed)-247.9(the)-252.3(two)-252(options)-249.7(with)]TJ
T*
[(their)-254.6(provider.)-249.6(The)-253.3(other)-248.7(option)-248.8(for)-250.9(women)-250.7(who)-246.1(opted)-254.5(not)-245.3(to)]TJ
0 -1.1174 TD
[(have)-254.4(HPV)-252.6(sampling)-253.2(was)-252.8(to)-255.8(discuss)-250.3(with)-253.2(their)-254.6(provider)-251.9(about)]TJ
0 -1.1116 TD
[(their)-404.3(need)-404.2(for)-400.7(cervical)-405.4(cancer)-408.6(screening)-405(through)-399.5(the)-402(tradi-)]TJ
T*
[(tional)-284.6(Pap)-280.8(smear.)]TJ
1.0137 -1.1174 TD
[(If)-203.7(HPV)-206.5(self-sampling)-207.9(was)-206.7(selected)-209.4(a)-203.8(sampler)-207(was)-206.7(provided)]TJ
-1.0137 -1.1116 TD
[(to)-353.7(the)-350.2(participant.)-353.6(We)-351.2(used)-351(the)-355.9(Preventive)-354.4(Oncology)-350.8(Inter-)]TJ
T*
[(national/Nationa)-12.4(l)-243.1(Institute)-247.5(of)-244.1(Health)-252(\(POI/NIH\))-248.5(self-sampler)]TJ
T*
[(manufactur)-10(ed)-458.4(by)-463(Purita)-7.8(n)-461.9(Medical)-467.4(Products.)]TJ
7.3823 0 0 6.5614 493.3416 181.5874 Tm
(33)Tj
9.843 0 0 9.843 505.3038 177.222 Tm
[(The)-460.7(patient)]TJ
-19.5312 -1.1174 TD
[(performed)-456.9(the)-448.1(test)-454.9(in)-451.6(the)-448.1(clinic)-452.8(bathroom)-454.8(with)-449(the)-453.8(CHW)]TJ
0 -1.1116 TD
[(waiting)-257.8(outside)-250.8(to)-250(answer)-257.2(any)-252.1(questions.)-250.5(The)-253.3(vial)-253.5(having)-255.6(the)]TJ
T*
[(sampl)-7.8(e)-417(was)-419.8(then)-420.4(given)-421.5(to)-417(the)-419.3(CHW)-422.2(who)-418.9(submitted)-421.4(it)-417.2(for)]TJ
0 -1.1174 TD
[(processing)-278(through)-272.8(Quest)-278.2(diagnostics.)-271.3(Initially,)-274.3(the)-275.3(test)-276.3(used)]TJ
0 -1.1116 TD
[(was)-224(the)-223.5(Cervista)]TJ
/F9 1 Tf
6.5718 0 TD
()Tj
/F6 1 Tf
1.1059 0 TD
[(HPV)-223.8(HR)-217.2(Invader)-228.8(Assay)-220.3(but)-222.3(later)-221.2(changed)]TJ
-7.6777 -1.1116 TD
[(by)-365.1(the)-367.5(laboratory)-364.9(to)-359.4(the)-367.5(Aptima)]TJ
/F9 1 Tf
7.3823 0 0 6.5614 442.9416 115.8235 Tm
()Tj
/F6 1 Tf
9.843 0 0 9.843 452.3526 111.4582 Tm
[(HPV)-362(Assay.)]TJ
7.3823 0 0 6.5614 501.9589 115.8235 Tm
(34)Tj
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[(both)-373.2(signal-based)-379.4(assays)-371.2(that)-374.4(are)-368.5(widely)-377.5(used)-368.2(as)-377.6(screening)]TJ
0 -1.1116 TD
[(tests.)-505.3(However,)-510.5(both)-499.9(have)-507.8(slightly)-504.5(lower)-503(sensitivity)-508.9(than)]TJ
T*
[(polymerase)-286.4(chain)-284.4(reaction-based)-286.2(tests.)]TJ
7.3823 0 0 6.5614 465.9589 82.9417 Tm
(23)Tj
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[(Guidelines)-475.2(for)-469.8(the)-465.4(follow-up)-471.8(of)-468.7(women)-469.5(with)-472.1(high)-465.3(risk)]TJ
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[(HPV)-269.8(detected)-272.9(on)-267.1(self-collected)-274.9(cervical)-272.9(samples)-270.2(continue)-270.6(to)]TJ
/F4 1 Tf
8.9663 0 0 8.9663 62.022 749.6502 Tm
(2)Tj
45.1077 0 TD
[(ILANGOVAN)-334.3(ET)-338.7(AL.)]TJ
ET
endstream
endobj
55 0 obj
<>stream
/GS1 gs
BT
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9.843 0 0 9.843 59.7543 725.1588 Tm
0 0 0 rg
0 Tc
0 Tw
(evolve.)Tj
7.3823 0 0 6.5614 88.611 729.5242 Tm
(35)Tj
9.843 0 0 9.843 98.3055 725.1588 Tm
[(Current)-240.4(guidelines)-243.9(support)-238(that)-242(if)-232.7(genotypic)-242.9(testing)]TJ
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[(is)-301.6(performed,)-299(women)-302.5(having)-295.9(HPV)-298.6(16)-295.9(or)-301.7(18)-295.9(detected)-301.7(should)]TJ
0 -1.1116 TD
[(be)-222.2(directed)-219.9(to)-221.2(colposcopy.)]TJ
7.3823 0 0 6.5614 162.4818 707.5841 Tm
(36)Tj
9.843 0 0 9.843 172.0629 703.2188 Tm
[(Otherwise,)-224.8(repeat)-217.5(co-testing)-226.6(at)-216.6(1)]TJ
-11.41 -1.1116 TD
[(year)-317.7(is)-318.9(recommended.)-316.4(Since)-318.8(genotyping)-317.7(was)-316.2(not)-320.2(performed)]TJ
T*
[(and)-482.5(after)-480.2(obtaining)-478(input)-478.1(from)-477.9(various)-481.1(clinicians)-481.4(at)-481.5(each)]TJ
0 -1.1174 TD
[(practice,)-310.9(we)-303.7(decided)-305.1(that)-305.3(all)-304.2(women)-308.3(in)-301.8(this)-304(study)-304.9(who)-303.7(were)]TJ
0 -1.1116 TD
[(found)-212.8(to)-209.7(have)-208.3(high)-211.9(risk)-211.7(HPV)-206.5(would)-213.9(be)-210.7(navigated)-209.5(to)-209.7(providers)]TJ
T*
[(at)-193.6(each)-186.4(clinic)-193.6(to)-186.6(have)-185.3(a)-192.3(Pap)-188.6(smear)-187.4(with)-189.8(additional)-192.4(testing)-187.6(to)-186.6(be)]TJ
0 -1.1174 TD
[(done)-282(at)-280(the)-286.8(discretion)-284.2(of)-278.6(each)-284.4(clinician.)]TJ
1.0137 -1.1116 TD
[(Participants)-448.8(selecting)-451.3(HPV)-448.4(self-sampling)-449.8(were)-451.1(also)-443.2(ad-)]TJ
-1.0137 -1.1116 TD
[(ministered)-354.6(a)-353.6(12-item)-355.9(survey)-353.1(assessing)-351.4(attitudes)-358.1(toward)-348.6(and)]TJ
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[(acceptability)-233.9(of)-226.8(HPV)-229.5(self-sampling)-230.9(and)-229.1(the)-223.5(Pap)-228.9(smear.)-231.1(Items)]TJ
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[(were)-370.4(based)-370.5(on)-370.8(a)-370.9(prior)-368.4(survey)-370.4(of)-365(HPV)-367.7(self-sampler)-374.8(accept-)]TJ
T*
[(ability,)-202.9(which)-197.7(was)-201(translated)-204.7(and)-194.5(back)-202.6(translated)-199(into)-200.5(Spanish)]TJ
T*
[(and)-453.7(Haitian)-460.6(Creole)-453.6(\(Supplementary)-457.9(Table)-452.7(S1\).)]TJ
7.3823 0 0 6.5614 253.474 576.1132 Tm
(37)Tj
9.843 0 0 9.843 265.3228 571.7479 Tm
(Detailed)Tj
-20.8847 -1.1174 TD
[(contact)-397.4(information)-400.7(was)-396.8(also)-391.4(collected)-400.9(so)-393.7(that)-397.5(participants)]TJ
0 -1.1116 TD
[(could)-283.3(be)-279.8(notied)-279.7(of)-278.6(the)-281.1(test)-282.1(result.)-281.9(If)-278.6(HPV)-281.3(was)-281.6(detected,)-282.1(the)]TJ
T*
[(participant)-206.2(was)-206.7(offered)-200(navigation)-209.6(to)-198.2(Pap)-205.9(smear)-198.9(by)-203.8(the)-200.4(CHW.)]TJ
0 -1.1174 TD
[(Notes)-209.1(concerning)-204.7(the)-206.2(test)-201.5(and)-206.1(its)-199.2(result)-209.4(were)-203.4(also)-201.3(noted)-208.4(on)-198(the)]TJ
0 -1.1116 TD
[(patients)-288.9(medical)-283.4(record)-279.6(by)-278.7(a)-284.5(study)-281.9(team)-278.8(clinician.)]TJ
1.0137 -1.1116 TD
[(If)-278.6(HPV)-275.6(self-sampling)-282.8(was)-281.6(not)-274.1(chosen,)-282.9(the)-275.3(participant)-281(was)]TJ
-1.0137 -1.1174 TD
[(encouraged)-263.3(to)-255.8(discuss)-261.8(the)-258(need)-254.4(for)-256.7(cervical)-261.4(cancer)-258.9(screening)]TJ
0 -1.1116 TD
[(with)-431.7(her)-424.9(provider)-430.5(during)-427.2(the)-430.8(visit.)-423.8(Detailed)-434(contact)-431.9(infor-)]TJ
T*
[(mation)-372.1(was)-368(also)-368.4(obtained)-368.5(from)-368.4(these)-370.6(women.)-369.3(Five)-368.4(months)]TJ
0 -1.1174 TD
[(after)-399.6(the)-402(visits,)-395.9(the)-396.3(medical)-404.4(records)-401.4(were)-399.2(examined)-399.6(to)-394(de-)]TJ
0 -1.1116 TD
[(termine)-420.4(whether)-414.2(they)-414.6(had)-413.4(a)-417(Pap)-413.2(smear)-412(performed)-416.6(at)-418.2(their)]TJ
T*
[(clinical)-289.3(site.)]TJ
1.0137 -1.1116 TD
[(All)-275.1(participants)-270.4(\(180\))-276.2(received)-272.7(a)-273($20)-268.2(grocery)-274.9(gift)-269.6(card)-271.6(for)]TJ
-1.0137 -1.1174 TD
[(their)-283.4(time)-283.5(in)-278.8(participating)-283.4(in)-284.6(this)-280.9(study.)]TJ
/F2 1 Tf
8.9663 0 0 8.9663 69.7323 396.3968 Tm
[(Provider)-530.4(survey.)]TJ
/F6 1 Tf
9.843 0 0 9.843 145.5307 396.3968 Tm
[(At)-440.9(st)20.9(ar)14(t)-444.7(o)0(f)-439.9(t)0(h)20.7(e)-451.5(st)20.9(ud)20.8(y,)-442.3(cl)19.5(in)20.7(ic)-441.2(st)20.9(af)19.7(f)-450.3(a)0(n)19.7(d)]TJ
-8.7144 -1.1174 TD
[(pr)15.1(ov)20.8(id)20.7(er)19.7(s)-513.5(w)0(e)18.8(r)0(e)-504.4(i)0(n)15(f)0(o)20.9(r)0(m)19.6(e)0(d)-504.5(o)0(f)-503.3(t)0(h)20.7(e)-514.9(st)15.1(ud)20.8(y)-513.7(t)0(h)20.7(r)0(o)20.9(u)0(g)20.8(h)-513.7(on)15.1(e-)19.7(to)20.7(-o)20.9(ne)]TJ
25.5097 34.5179 TD
[(se)19.9(ss)21.2(io)20.7(ns)15.3(,)-291.4(g)0(r)20.9(o)0(u)20.8(p)-294.8(me)18.4(et)19.5(in)20.7(gs)21(,)-291.4(a)0(n)19.7(d)0(/)14.9(o)0(r)-278.6(e)0(m)18.5(a)0(i)19.5(l)0(s)20.9(.)-297.2(Qu)20(es)19.9(ti)20.6(on)20.8(s)-294.6(r)0(e)19.7(g)0(a)19.7(r)0(d)20.9(i)0(n)20.7(g)]TJ
0 -1.1174 TD
[(th)20.7(e)-296(s)0(t)20.9(u)0(d)20.8(y)-294.8(an)19.7(d)-294.8(H)0(P)14.4(V)-295.7(se)19.9(lf)20.7(-s)21.1(am)18.4(pl)20.7(in)15(g)-294.8(w)0(e)18.8(r)0(e)-285.6(a)0(l)19.5(s)0(o)-284.2(a)0(n)19.7(s)0(w)20.2(e)0(r)19.7(e)0(d)13.9(.)-291.4(Cl)19.7(in)20.7(ic)]TJ
0 -1.1116 TD
[(st)20.9(af)19.7(f)-208.4(w)0(e)18.8(r)0(e)-199.2(a)0(l)19.6(s)0(o)-197.8(i)0(n)20.7(f)0(o)20.9(r)0(m)19.6(e)0(d)-199.2(t)0(h)20.7(a)0(t)-199.3(a)0(t)-199.3(s)0(t)20.9(u)0(d)20.8(y)-208.4(co)19.7(nc)19.7(lu)20.7(si)20.9(on)20.8(,)-210.8(w)0(e)-194.3(w)0(o)14.2(u)0(l)20.7(d)-202.7(be)]TJ
T*
[(co)19.7(nt)20.7(ac)18.5(ti)20.6(ng)-238.3(th)20.7(em)-235(to)-232.7(re)19.7(sp)21(on)15.1(d)-243(t)0(o)-232.7(a)-244.2(ni)20.7(ne)19.7(-i)15(te)19.5(m)-244.2(a)0(n)19.7(o)0(n)20.8(y)0(m)19.6(o)0(u)20.8(s)-242.8(su)15.3(rv)20.9(ey)19.7(.)]TJ
T*
[(Th)19.6(e)-209.6(s)0(u)15.3(r)0(v)20.9(e)0(y)-204.9(i)0(n)20.7(c)0(l)19.5(u)0(d)20.8(e)0(d)-204.9(q)0(u)20.8(e)0(s)19.9(t)0(i)20.6(o)0(n)20.8(s)-214(on)-203.8(de)19.7(mo)19.6(gr)20.9(ap)19.7(hi)20.7(cs)14.1(,)-210.8(a)0(c)18.5(c)0(e)18.5(p)0(t)20.7(a)0(b)19.7(i)0(l)20.6(i)0(t)20.6(y)]TJ
0 -1.1174 TD
[(of)-393.8(HP)20.1(V)-399.4(s)0(e)14.1(l)0(f)20.7(-)0(s)21.1(a)0(m)18.4(p)0(l)20.7(i)0(n)20.7(g)0(,)-396.2(a)0(n)19.7(d)-404.3(wi)19.8(ll)20.6(in)20.7(gn)20.8(es)19.9(s)-404.1(t)0(o)-394(i)0(n)20.7(c)0(o)19.7(r)0(p)20.9(o)0(r)15.1(a)0(t)19.5(e)-399.7(HP)20.1(V)]TJ
0 -1.1116 TD
[(se)19.9(lf)20.7(-s)21.1(am)18.5(pl)14.9(in)20.7(g)-208.4(i)0(n)15(t)0(o)-198.2(c)0(l)19.5(i)0(n)15(i)0(c)19.5(a)0(l)-199.3(p)0(r)15.1(a)0(c)18.5(t)0(i)20.6(c)0(e)-200.4(\()0(S)15.3(u)0(p)20.8(p)0(l)20.7(e)0(m)18.4(e)0(n)19.7(t)0(a)19.5(r)0(y)-203.8(T)0(a)18.5(b)0(l)20.7(e)-215.4(S2)21(\).)]TJ
T*
[(It)20.7(em)18.5(s)-219.8(w)0(e)18.8(r)0(e)-216.4(o)0(b)20.8(t)0(a)19.5(i)0(n)20.7(e)0(d)-210.7(f)0(r)15.1(o)0(m)-210.8(a)-221.1(pr)20.9(io)15(r)-219.9(p)0(r)20.9(o)0(v)20.8(i)0(d)20.7(e)0(r)-216.4(s)0(u)21(r)0(v)20.9(e)0(y)-210.7(o)0(f)-215.3(s)0(c)19.9(r)0(e)19.7(e)0(n)19.7(i)0(n)20.7(g)]TJ
0 -1.1174 TD
[(te)19.6(st)-255.6(ac)18.5(ce)18.5(pt)20.7(ab)19.7(il)20.6(it)20.6(y.)]TJ
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-.0162 Tc
(38)Tj
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0 Tc
[(Em)18.4(ai)19.6(ls)-255.6(we)18.8(re)-256.8(se)19.9(nt)-250(tw)14.1(ic)19.5(e)-261.4(t)0(o)-255.8(a)0(l)19.6(l)-260.4(pr)20.9(ov)15.1(id)20.7(er)19.7(s)-260.1(a)0(t)]TJ
-7.885 -1.1116 TD
[(ea)18.5(ch)-325.9(si)20.9(te)-326(in)20.7(vi)20.7(ti)14.8(ng)-324.7(th)20.7(em)-327.1(to)-324.9(pa)19.7(rt)20.7(ic)19.5(ip)20.7(at)19.5(e)-336.3(i)0(n)-324.9(t)0(h)20.7(e)-336.3(su)15.3(rv)20.9(ey)19.7(.)-331.7(W)0(e)-328.2(a)0(l)19.5(s)0(o)]TJ
T*
[(vi)20.7(si)20.9(te)19.5(d)-260.3(e)0(a)18.5(c)0(h)-251(c)0(l)19.5(i)0(n)20.7(i)0(c)-245.4(s)0(i)15.1(t)0(e)-245.4(a)0(n)19.7(d)-260.3(ga)19.7(ve)-251(th)20.7(e)-255.7(p)0(r)20.9(o)0(v)15.1(i)0(d)20.7(e)0(r)19.7(s)-260.1(pa)19.7(pe)19.7(r)-254.5(c)0(o)13.9(p)0(i)20.7(e)0(s)-245.1(o)0(f)]TJ
0 -1.1174 TD
[(th)20.7(e)-273(a)0(n)19.7(o)0(n)20.8(y)0(m)19.6(o)0(u)20.8(s)-271.6(su)21(rv)20.9(ey)19.7(,)-268.4(w)0(h)14.2(i)0(c)19.6(h)-266(th)15(ey)-256.8(co)19.7(ul)14.9(d)-266(r)0(e)19.7(t)0(u)20.7(r)0(n)-261.3(t)0(o)-261.5(u)0(s)21(.)]TJ
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8.9663 0 0 8.9663 320.8251 582.6896 Tm
[(Data)-337.7(collection.)]TJ
/F6 1 Tf
9.843 0 0 9.843 391.3511 582.6896 Tm
[(Study)-293.5(data)-289.1(were)-289.8(collected)-291.4(and)-292.4(managed)]TJ
-8.1788 -1.1116 TD
[(using)-281.9(REDCap)-282.6(electronic)-286.7(data)-283.3(capture)-282(tools.)]TJ
7.3823 0 0 6.5614 487.8424 576.1132 Tm
(39)Tj
/F10 1 Tf
8.9663 0 0 8.9663 310.8472 549.8077 Tm
(Analysis)Tj
/F6 1 Tf
9.843 0 0 9.843 320.8251 533.3668 Tm
[(Frequencies)-287.2(and)-280.9(percentages)-294.3(for)-279.7(the)-286.8(entire)-285.6(sample)-286.6(and)-286.7(by)]TJ
-1.0137 -1.1116 TD
[(groups)-294.4(\(ACC,)-298.7(CHS\))-299.9(were)-301.3(calculated)-299.4(to)-301.8(describe)-300.2(the)-298.3(partici-)]TJ
0 -1.1174 TD
[(pants)-370.5(and)-367.3(providers)-369.1(characteristics)-374.9(and)-367.3(their)-369.8(responses)-374.5(to)]TJ
0 -1.1116 TD
[(acceptability)-199.3(items.)-195.7(Differences)-196(in)-198.2(proportions)-190.7(were)-197.6(tested)-199.1(by)]TJ
T*
[(chi-square)-233.2(\(or)-227.9(Fishers)-234.1(exact)-233.8(test,)-227.9(if)-226.9(applicable)-10.3(\).)-229.1(A)]TJ
/F11 1 Tf
20.2166 0 TD
(p)Tj
/F6 1 Tf
.5011 0 TD
[(-value)-233.7(of)]TJ
/F9 1 Tf
-20.7177 -1.1174 TD
(<)Tj
/F6 1 Tf
.5529 0 TD
[(0.05)-191(was)-195.2(considered)-198.7(statistically)-196.9(signicant.)-195.4(SAS)-199.7(v9.3)-191(\(SAS)]TJ
-.5529 -1.1116 TD
[(Institute,)-245.2(Inc.,)-247.4(Cary,)-246.2(NC\))-247.1(was)-247.1(used)-247.3(for)-245.1(all)-246.6(statistical)-252.1(analysis.)]TJ
1.0137 -1.1116 TD
[(The)-454.9(study)-454.7(protocol)-453.7(was)-454.4(approved)-460.4(by)-451.5(the)-453.8(University)-462.5(of)]TJ
-1.0137 -1.1116 TD
[(Miami)-389.2(Institutional)-396.2(Review)-391.1(Board)-393.6(and)-390.4(the)-390.5(Jackson)-389.8(Health)]TJ
0 -1.1174 TD
[(System)-279.5(Clinical)-283.4(Research)-290.7(Review)-281.7(Committee.)]TJ
/F4 1 Tf
8.9663 0 0 8.9663 310.8472 412.8377 Tm
(Results)Tj
/F6 1 Tf
9.843 0 0 9.843 320.8251 396.3968 Tm
[(We)-339.7(assessed)-345.6(1,964)-341.9(women)-348.6(for)-343.1(study)-339.5(eligibility)-348.2(\(1,545)-343(at)]TJ
-1.0137 -1.1174 TD
[(ACC)-219.3(and)-223.3(416)-222.2(at)-222.4(CHS\).)-222.7(Of)-221.9(these,)-218.6(301)-222.2(\(15%\))-219.6(were)-226.4(not)-222.3(eligible)]TJ
0 -1.1116 TD
[(due)-298.2(to)-296.1(age.)-297(Among)-295.6(the)-298.3(remaining)-301.7(1,663)-295.8(women,)-294.4(24%)-298.1(\(406\))]TJ
T*
[(had)-194.5(not)-199.3(had)-200.3(a)-198.1(Pap)-194.4(in)-198.2(the)-200.4(last)-195.7(3)-196.9(years)-203.4(and)-194.5(thus)-200.2(potentially)-199.4(study)]TJ
0 -1.1174 TD
[(eligible)-460.9([18%)-460.4(\(282/1,545\))-458(at)-458.5(ACC)-461.3(and)-459.5(30%)-459.4(\(124/416\))-459.2(at)]TJ
0 -1.1116 TD
[(CHS].)-222.7(Of)-227.7(these,)-224.3(407)-227.9(were)-226.4(excluded)-225.5(because)-225.3(they)-230.3(either)-222.3(had)-229.1(a)]TJ
T*
[(hysterectomy)-421.2(\(286\),)-423.6(were)-422.3(pregnant)-420.2(\(107\),)-423.6(or)-416.9(menstruating)]TJ
T*
[(\(14\).)-249.7(Of)-256.5(the)-252.3(200)-251(study)-253.1(eligible)-253.6(women,)-254.1(10%)-252(\(20\))-252(declined)-260.2(to)]TJ
0 -1.1174 TD
[(participate)-276.4(in)-273(the)-269.5(study.)-273.8(Thus,)-273.8(our)-274(nal)-270.5(sample)-275(included)-276.3(180)]TJ
0 -1.1116 TD
[(study)-322.2(eligible)-322.7(women.)-317.5(Of)-325.6(these,)-322.2(134)-320.1(were)-324.4(Latinas)-322.3(recruited)]TJ
T*
[(from)-236(the)-235(ACC,)-240.1(43%)-234.7(\(58\))-240.5(were)-238(Cuban,)-235.8(12%)-234.8(\(16\))-240.5(Nicaraguan,)]TJ
0 -1.1174 TD
[(11%)-298.1(\(15\))-298.1(Honduran,)-296.5(and)-298.2(10%)-298.1(\(13\))-298.1(Colombian)-301.6(with)-299.3(the)-298.3(rest)]TJ
0 -1.1116 TD
[(coming)-216.5(from)-212.9(10)-215.3(distinct)-217.7(Latin)-215.5(American)-221.9(ethnicities.)-221.1(At)-210.6(CHS,)]TJ
T*
[(we)-418.9(recruited)-422.5(46)-416.9(Haitian)-426(women.)-421.2(The)-420.4(mean)-416.9(age)-420.3(of)-422.6(all)-419.4(the)]TJ
0 -1.1174 TD
[(women)-285.2(in)-284.5(the)-286.8(sample)-286.6(was)-287.4(52)-284.4(\(SD)-280.4(8\),)-287.8(96%)-286.6(\(173/180\))-280.7(lacked)]TJ
0 -1.1116 TD
[(health)-458.4(insurance,)-466(and)-453.7(only)-459.5(12%)-459.4(\(22/180\))-458.1(reported)-460.5(annual)]TJ
T*
[(household)-373.9(incomes)-368.3(of)-370.8(over)-374.2($15,000.)-370.6(Among)-370.5(Haitians)-375.1(only)]TJ
0 -1.1174 TD
[(11%)-384.5(\(5/46\))-386.8(were)-393.5(U.S.)-384.2(citizens)-392.6(and)-384.6(26%)-390.3(\(12/46\))-387.9(had)-384.6(com-)]TJ
0 -1.1116 TD
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T*
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T*
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[(99%)-326.9(\(120/121\))-326.8(of)-330.5(participants)-333.8(selecting)-330.4(HPV)-327.4(self-sampling)]TJ
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T*
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/F11 1 Tf
20.5737 0 TD
(p)Tj
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(0.03\).)Tj
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(p)Tj
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ET
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f
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f
177.052 329.216 34.469 .28348 re
f
221.556 329.216 77.499 .28348 re
f
59.754 291.628 239.301 .22678 re
f
BT
/F8 1 Tf
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(Table)Tj
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3.0002 0 TD
(1.)Tj
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[(Screening)-333.5(Test)-333.2(Results)]TJ
/F11 1 Tf
4.2153 -1.8427 TD
[(All)-5359.9(Site)]TJ
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(180)Tj
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(\(100%\))Tj
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4.2671 1.0135 TD
(N)Tj
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/F11 1 Tf
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(134)Tj
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(\(74%\))Tj
/F6 1 Tf
4.3938 1.0135 TD
(N)Tj
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(46)Tj
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(\(26%\))Tj
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[(Traditional)-337.6(screening)-2770.8(59)-336(\(33\))-1069.3(53)-330.2(\(40\))-1576(6)-329.2(\(13\))]TJ
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[(Test)-340.3(performed)]TJ
1.002 -1.0077 TD
[(HPV)-332.7(self-sampler)-3638.7(121)-337(\(67\))-1069.3(81)-330.2(\(60\))-1075.1(40)-330.2(\(87\))]TJ
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[(Pap)-332.2(smear)-7189.2(46)-336(\(26\))-1069.3(43)-330.2(\(32\))-1576(3)-329.2(\(6.5\))]TJ
T*
[(No)-336.8(Pap)-332.2(smear)-336.5(5-months)]TJ
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(post-recruitment)Tj
10.423 1.0077 TD
[(13)-336(\(7\))-1569.3(10)-330.2(\(8\))-2076(3)-329.2(\(6.5\))]TJ
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[(HPV)-338.4(self-sampler)-339(results)]TJ
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[(Detected)-7845.4(12)-336(\(10\))-1570.3(3)-329.2(\(4\))-2076(9)-329.2(\(22.5\))]TJ
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[(Indeterminate)-6336.4(3)-335(\(2\))-2070.3(3)-329.2(\(4\))]TJ
-1.002 -1.3187 TD
[(Pap)-338(smear)-336.5(results)]TJ
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[(Normal)-8353.4(36)-336(\(78\))-1069.3(35)-330.2(\(81\))-1576(1)-329.2(\(33\))]TJ
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[(ASCUS)-8708.4(7)-335(\(15\))-1570.3(6)-329.2(\(14\))-1576(1)-329.2(\(33\))]TJ
T*
[(LGSIL)-9083.4(1)-335(\(2\))-2070.3(1)-329.2(\(2\))-3199(0)]TJ
T*
[(Missing)-336(results)-5749.4(2)-335(\(4\))-2070.3(1)-329.2(\(2\))-2076(1)-329.2(\(33\))]TJ
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T*
[(l)-10.5(i)0(a)-10.5(l)-340.9(ne)-11.8(op)-10.6(la)-10.5(si)-7.7(a.)]TJ
/F4 1 Tf
8.9663 0 0 8.9663 59.7543 749.7069 Tm
[(ACCEPTABILITY)-341.6(OF)-337.5(HPV)-333.7(SELF-SAMPLING)-334.4(CLINICS)-29167.7(3)]TJ
ET
endstream
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[(choosi)-7.7(ng)-249.9(HPV)-258.3(self-sampling)-259.7(agree)-9(d)-254.5(that)-253.5(the)-258(test)-259.1(was)-258.6(easy)-254.2(to)]TJ
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[(perform)-217.4(and)-211.8(felt)-207.4(they)-213(did)-210.8(it)-209.8(correctly)-215.2(\(Table)-211.8(2\).)-213(In)-209.5(addition,)-209.6(at)]TJ
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[(sampl)-7.8(er)-228(again)-226.8(and)-229.1(would)-231.1(recommend)-228.9(it)-232.8(to)-227(family)-228.1(and)-229.1(friends)]TJ
T*
[(\(Tabl)-8(e)-284.5(2\).)-287.8(Less)-294.4(than)-287.9(20%)-292.3(\(96/121\))-285.4(reported)-293.4(any)-286.7(pain)-293.7(or)-290.2(dis-)]TJ
0 -1.1174 TD
[(comfort)-309.7(when)-300.2(obtaining)-305.2(the)-304.1(sample)-303.8(\(Table)-304(2\).)-305.1(Among)-301.4(Lati-)]TJ
0 -1.1116 TD
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T*
[(prior)-333.9(discomfort)-330.2(during)-335(the)-327.1(Pap)-332.6(smear)-331.4(and)-332.8(89%)-326.9(\(72\))-332.6(stated)]TJ
T*
[(they)-368.6(would)-369.4(choose)-365.8(HPV)-367.7(self-sampling)-369.2(over)-368.4(the)-367.5(Pap)-367.2(smear)]TJ
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[(\(Tabl)-8(e)-261.4(2\).)-264.8(Among)-261(Haitians)-265.6(almost)-268.3(half)-264.9(of)-261.4(women)-268(responded)]TJ
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[(neutral)-321.3(when)-311.7(asked)-318.7(preferences)-317.1(for)-314.3(HPV)-315.9(self-sampling)-323.1(ver-)]TJ
T*
[(sus)-198.7(Pap)-200.1(smear)-198.9(or)-198(about)-196.9(pain)-201.5(during)-196.8(prior)-195.6(Pap)-200.1(smear)-198.9(\(Table)-200.3(2\).)]TJ
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[(Howev)-8.4(er,)-294.7(the)-298.3(CHW)-301.2(conducting)-301.6(the)-298.3(survey)-301.3(noted)-300.5(the)-298.3(reason)]TJ
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[(being)-386.9(that)-391.7(most)-385.7(of)-382.3(these)-387.9(respondents)-388.5(had)-390.4(never)-387.9(had)-384.6(a)-388.2(Pap)]TJ
T*
[(smear)-291.1(and)-292.4(thus)-286.6(could)-289(not)-285.7(compare)-294.6(Pap)-286.5(versus)-289.6(self-sampling)]TJ
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[(\(data)-284.4(on)-278.7(this)-280.9(variable)-289(were)-284(not)-279.9(collected\).)]TJ
1.0137 -1.1116 TD
[(Of)-377.4(the)-379(121)-377.7(women)-383.2(who)-372.8(chose)-382(HPV)-379.3(self-sampling,)-384.1(98%)]TJ
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[(\(118\))-207(had)-206.1(an)-205(adequate)-209.4(sample)-205.9(for)-210.6(processing)-208.9(\(the)-201.5(three)-209.5(others)]TJ
T*
[(were)-272.5(referred)-277.1(and)-269.4(completed)-274.1(Pap)-269.2(smear)-273.8(tests\).)-270.2(Among)-272.6(those)]TJ
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[(having)-267.1(adequate)-261.3(sampling,)-262.4(high)-263.7(risk)-257.7(strains)-262.1(were)-266.8(detected)-261.4(in)]TJ
0 -1.1116 TD
[(10%)-378.7(\(12/121\))-377.5(of)-370.8(women,)-380.8(with)-374.2(Haitian)-379.9(women)-377.4(being)-375.4(more)]TJ
T*
[(likely)-204(than)-195.8(Latinas)-201.4(to)-198.2(have)-202.6(high)-194.6(risk)-200.1(HPV)-200.7(detected)-203.8([22.5%)-194.3(\(9/)]TJ
0 -1.1174 TD
[(40\))-250.9(vs.)-253.1(4%)-250.9(\(3/81\),)]TJ
/F11 1 Tf
7.5049 0 TD
(p)Tj
/F9 1 Tf
.6624 0 TD
(<)Tj
/F6 1 Tf
.72 0 TD
[(0.01].)-253.1(At)-250.9(the)-252.3(ACC,)-251.6(the)-246.5(CHW)-255.1(was)-252.8(able)]TJ
-8.8872 -1.1116 TD
[(to)-238.5(navigate)-237.2(all)-235.1(three)-238.3(women)-233.4(who)-234.6(had)-234.9(high)-234.9(risk)-234.7(HPV)-241(detected)]TJ
T*
[(at)-337.6(a)-336.3(subsequent)-335.6(Pap)-332.6(smear)-337.1(\(one)-333.8(also)-333.8(had)-332.8(a)-336.3(colposcopy\).)-334.6(At)]TJ
0 -1.1174 TD
[(CHS,)-348.3(the)-338.7(CHW)-347.3(was)-339.2(able)-346.7(to)-342.1(contact)-345.5(all)-344.5(nine)-339.8(participants)-345.3(to)]TJ
0 -1.1116 TD
[(inform)-272.8(them)-266.1(of)-267.1(their)-266.1(result)-272.8(and)-263.6(stress)-272.2(to)-267.3(them,)-263.8(the)-269.5(need)-265.9(for)-268.2(a)]TJ
T*
[(Pap)-200.1(smear,)-196.6(and)-200.3(close)-197.8(follow-up)-195.3(with)-195.6(a)-198.1(clinician.)-201.7(She)-194.4(was)-201(then)]TJ
0 -1.1174 TD
[(able)-300.6(to)-296.1(navigate)-300.6(six)-297(of)-295.9(these)-301.5(to)-296.1(a)-296(subsequent)-301.1(Pap)-298(smear,)-294.5(but)]TJ
0 -1.1116 TD
[(two)-321.1(missed)-314(multiple)-322.7(appointments)-316.5(for)-320(a)-313.3(Pap)-321.1(smear)-314.1(and)-321.2(one)]TJ
T*
[(was)-287.4(unreachable)-283(for)-279.7(additional)-284.6(follow-up.)]TJ
1.0137 -1.1116 TD
[(There)-285.5(were)-278.3(59)-278.7(participants)-281.9(\(33%\))-283(who)-280.6(did)-274.1(not)-279.9(choose)-285.2(the)]TJ
-1.0137 -1.1174 TD
[(HPV)-241(self-sampling)-248.2(option)-237.3(\(Table)-246.4(1\).)-236(Our)-240.3(CHWs)-244.5(encouraged)]TJ
0 -1.1116 TD
[(all)-338.8(of)-336.2(these)-336.1(women)-337.1(to)-336.4(discuss)-336.7(having)-336.2(a)-336.3(Pap)-338.4(smear)-337.1(with)-339.6(the)]TJ
T*
[(provid)-6.7(er.)-202.6(We)-213(reviewed)-209.1(the)-211.9(medical)-208.5(records)-211.4(of)-203.8(these)-209.4(women)-210.4(5)]TJ
0 -1.1174 TD
[(months)-480.1(after)-480.2(study)-477.7(enrollment)-481.5(\(follow-up)-484.3(visit)-478(data)-479.2(were)]TJ
0 -1.1116 TD
[(available)-216.5(for)-210.6(57)-209.5(of)-209.5(the)-211.9(59)-203.8(women\).)-214.9(Of)-210.4(these,)-212.8(22%)-206(\(13/59\))-215.1(had)]TJ
T*
[(not)-205(had)-200.3(a)-198.1(Pap)-205.9(smear)-198.9(\(Table)-206.1(1\).)-201.4(Of)-198.9(the)-200.4(46)-203.8(women)-198.8(having)-203.7(a)-203.8(Pap)]TJ
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[(smear)-8.8(,)-349(17%)-355.7(\(8\))-354.6(needed)-355.7(follow-up)-356.6(including)-357(7)-352.4(women)-360.1(with)]TJ
0 -1.1116 TD
[(atypical)-248.8(cells)-244(of)-244.1(undetermined)-242.8(signicance)-247.1(and)-246.4(one)-240.6(with)-247.4(low)]TJ
T*
[(grade)-284.3(squamous)-281.5(intraepithelial)-287(neoplasia)-284.2(\(Table)-286.7(1\).)]TJ
/F10 1 Tf
8.9663 0 0 8.9663 313.0582 83.9622 Tm
[(Provider)-340.7(survey)]TJ
/F6 1 Tf
9.843 0 0 9.843 323.0361 67.5212 Tm
[(A)-428.2(total)-427.5(of)-422.6(178)-429.5(clinic)-424(staff)-427(including)-431.9(medical)-427.4(assistants,)]TJ
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[(nurses,)-218.1(nurse)-219.6(practitioners,)-223.1(and)-211.8(physic)-7.7(ians)-212.9(were)-220.7(sent)-218.6(surveys.)]TJ
ET
62.022 719.49 239.017 .22668 re
f
132.945 700.611 49.663 .22681 re
f
193.379 700.611 107.66 .22681 re
f
62.022 662.967 239.017 .28351 re
f
BT
/F8 1 Tf
9.845 0 0 9.845 64.9134 725.1588 Tm
(Table)Tj
/F6 1 Tf
3.0002 0 TD
(2.)Tj
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1.2496 0 TD
[(Participant)-335.5(Acceptability)-337.3(Survey)-334.8(Results)]TJ
/F11 1 Tf
4.5953 -1.8427 TD
[(All)-7738.2(Site)]TJ
5.4994 -1.8197 TD
[(ACC)-4100.5(CHS)]TJ
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(N)Tj
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(=)Tj
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(121)Tj
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(\(100%\))Tj
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6.081 1.0135 TD
(N)Tj
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(81)Tj
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(\(67%\))Tj
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5.9601 1.0135 TD
(N)Tj
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(=)Tj
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(40)Tj
-1.549 -1.0135 TD
(\(33%\))Tj
/F6 1 Tf
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[(I)-335(chose)-335.4(the)-332.6(HPV)-338.4(self-sampler)-333.3(because)-339.7(it)-336.3(allows)-330.6(more)]TJ
.9905 -1.0135 TD
[(privacy)-337.7(than)-333.5(the)-332.6(Pap)-338(smear)]TJ
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[(Agree)-4528.6(113)-331.2(\(93\))-2641.4(77)-336(\(95\))-2635.6(36)-336(\(90\))]TJ
T*
[(Neutral)-4968.6(6)-329.2(\(5\))-3642.4(4)-335(\(5\))-3636.6(2)-335(\(5\))]TJ
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[(Disagree)-4417.5(2)-329.2(\(2\))-4391(0)-4389(2)-335(\(5\))]TJ
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[(perform)-337.5(than)-333.5(the)-332.6(Pap)-338(smear)]TJ
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[(Agree)-4528.6(107)-331.2(\(88\))-2641.4(75)-336(\(93\))-2635.6(32)-336(\(80\))]TJ
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[(Neutral)-4467.6(14)-330.2(\(12\))-3142.4(6)-335(\(7\))-3636.6(8)-335(\(20\))]TJ
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[(I)-335(chose)-335.4(the)-332.6(HPV)-338.4(self-sampler)-333.3(because)-339.7(I)-335(have)-334.5(had)]TJ
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[(discomfort)-334.9(with)-339.1(the)-332.6(Pap)-332.2(smear)]TJ
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[(Agree)-5029.6(67)-330.2(\(55\))-2641.4(55)-336(\(68\))-2635.6(12)-336(\(30\))]TJ
T*
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[(Disagree)-3916.6(28)-330.2(\(23\))-2641.4(16)-336(\(20\))-2635.6(12)-336(\(30\))]TJ
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[(I)-335(chose)-335.4(the)-332.6(HPV)-338.4(self-sampler)-333.3(because)-339.7(it)-336.3(is)-330.2(faster)]TJ
.9905 -1.0135 TD
[(than)-333.5(the)-338.3(Pap)-332.2(smear)]TJ
.0115 -1.0077 TD
[(Agree)-4528.6(106)-331.2(\(88\))-2641.4(77)-336(\(95\))-2635.6(29)-336(\(73\))]TJ
0 -1.0135 TD
[(Neutral)-4467.6(13)-330.2(\(10\))-3142.4(3)-335(\(4\))-3135.6(10)-336(\(25\))]TJ
T*
[(Disagree)-4417.5(2)-329.2(\(2\))-3642.4(1)-335(\(1\))-3636.6(1)-335(\(2\))]TJ
-1.002 -1.313 TD
[(I)-335(chose)-335.4(the)-332.6(HPV)-338.4(self-sampler)-333.3(because)-339.7(my)-331.4(provider)]TJ
.9905 -1.0135 TD
[(did)-337.1(not)-331.4(offer)-334.4(cervical)-341.2(cancer)-333.1(screening)]TJ
.0115 -1.0135 TD
[(Agree)-5029.6(28)-330.2(\(23\))-2641.4(14)-336(\(17\))-2635.6(14)-336(\(35\))]TJ
0 -1.0077 TD
[(Neutral)-4467.6(21)-330.2(\(17\))-2641.4(17)-336(\(21\))-3136.6(4)-335(\(10\))]TJ
0 -1.0135 TD
[(Disagree)-3916.6(72)-330.2(\(60\))-2641.4(50)-336(\(62\))-2635.6(22)-336(\(55\))]TJ
-1.002 -1.3187 TD
[(I)-335(found)-333.2(the)-332.6(self-sampler)-339(easy)-334.4(to)-336.2(use)]TJ
1.002 -1.0077 TD
[(Agree)-4528.6(118)-331.2(\(97\))-2641.4(80)-336(\(99\))-2635.6(38)-336(\(95\))]TJ
0 -1.0135 TD
[(Neutral)-4968.6(1)-329.2(\(1\))-3642.4(1)-335(\(1\))]TJ
T*
[(Disagree)-4417.5(1)-329.2(\(1\))-4391(0)-4389(1)-335(\(2.5\))]TJ
T*
[(Missing)-4758.6(1)-329.2(\(1\))-4391(0)-4389(1)-335(\(2.5\))]TJ
-1.002 -1.313 TD
[(I)-335(feel)-334.7(I)-335(performed)-334.9(the)-332.6(self-sampler)-339(test)-333.5(correctly)]TJ
1.002 -1.0135 TD
[(Agree)-4528.6(116)-331.2(\(96\))-2641.4(78)-336(\(96\))-2635.6(38)-336(\(95\))]TJ
0 -1.0077 TD
[(Neutral)-4968.6(4)-329.2(\(3\))-3642.4(3)-335(\(4\))-3636.6(1)-335(\(2.5\))]TJ
0 -1.0135 TD
[(Missing)-4758.6(1)-329.2(\(1\))-4391(0)-4389(1)-335(\(2.5\))]TJ
-1.002 -1.3187 TD
[(I)-335(would)-334.2(use)-332.2(the)-338.3(self-sampler)-333.3(again)]TJ
1.002 -1.0077 TD
[(Agree)-4528.6(118)-331.2(\(97\))-2641.4(80)-336(\(99\))-2635.6(38)-336(\(95\))]TJ
0 -1.0135 TD
[(Neutral)-4968.6(2)-329.2(\(2\))-3642.4(1)-335(\(1\))-3636.6(1)-335(\(2.5\))]TJ
T*
[(Missing)-4758.6(1)-329.2(\(1\))-4391(0)-4389(1)-335(\(2.5\))]TJ
-1.002 -1.3129 TD
[(I)-335(would)-334.2(recommend)-337.2(using)-333.2(the)-332.6(self-sampler)-339(to)]TJ
.9905 -1.0135 TD
[(my)-337.1(female)-333.3(family)-336.9(members)-333.9(and)-338.1(friends)]TJ
.0115 -1.0135 TD
[(Agree)-4528.6(117)-331.2(\(97\))-2641.4(79)-336(\(98\))-2635.6(38)-336(\(95\))]TJ
0 -1.0077 TD
[(Neutral)-4968.6(3)-329.2(\(2\))-3642.4(2)-335(\(2\))-3636.6(1)-335(\(2.5\))]TJ
0 -1.0135 TD
[(Missing)-4758.6(1)-329.2(\(1\))-9280(1)-335(\(2.5\))]TJ
-1.002 -1.3187 TD
[(I)-335(felt)-333.7(comfortable)-338.4(using)-333.2(the)-332.6(test)-339.3(in)-330.4(the)-332.6(clinic)]TJ
1.002 -1.0077 TD
[(Agree)-4528.6(111)-331.2(\(92\))-2641.4(80)-336(\(99\))-2635.6(31)-336(\(77.5\))]TJ
0 -1.0135 TD
[(Neutral)-4968.6(1)-329.2(\(1\))-3642.4(1)-335(\(1\))]TJ
T*
[(Disagree)-4417.5(8)-329.2(\(6\))-4391(0)-4389(8)-335(\(20\))]TJ
T*
[(Missing)-4758.6(1)-329.2(\(1\))-9280(1)-335(\(2.5\))]TJ
-1.002 -1.3129 TD
[(I)-335(experienced)-339.4(pain)-333.5(and/or)-335.5(discomfort)-334.9(using)]TJ
.9905 -1.0135 TD
[(the)-338.3(self-sampler)]TJ
.0115 -1.0077 TD
[(Agree)-5029.6(16)-330.2(\(13\))-2641.4(13)-336(\(16\))-3136.6(3)-335(\(7.5\))]TJ
0 -1.0135 TD
[(Neutral)-4968.6(8)-329.2(\(7\))-3642.4(6)-335(\(7\))-3636.6(2)-335(\(5\))]TJ
T*
[(Disagree)-3916.6(96)-330.2(\(79\))-2641.4(62)-336(\(77\))-2635.6(34)-336(\(85\))]TJ
T*
[(Missing)-4758.6(1)-329.2(\(1\))-4391(0)-4389(1)-335(\(2.5\))]TJ
18.6519 -1.4627 TD
(\()Tj
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(continued)Tj
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ET
313.058 603.666 239.017 .22675 re
f
313.058 719.036 239.017 .22681 re
f
383.981 699.931 49.72 .22681 re
f
444.416 699.931 107.66 .22681 re
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313.058 662.286 239.017 .28345 re
f
BT
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(Table)Tj
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[(2.)-499.6(\()]TJ
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(Continued)Tj
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4.9005 0 TD
(\))Tj
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[(All)-7744(Site)]TJ
5.5052 -1.8197 TD
[(ACC)-4100.5(CHS)]TJ
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(N)Tj
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(=)Tj
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(\(100%\))Tj
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6.0868 1.0135 TD
(N)Tj
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(=)Tj
/F11 1 Tf
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(81)Tj
-1.549 -1.0135 TD
(\(67%\))Tj
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5.9601 1.0135 TD
(N)Tj
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(=)Tj
/F11 1 Tf
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(40)Tj
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(\(33%\))Tj
/F6 1 Tf
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[(I)-335(prefer)-336.5(the)-332.6(self-sampler)-339(method)-336.7(over)-333.4(the)-332.6(Pap)-338(smear)]TJ
1.002 -1.0077 TD
[(Agree)-5029.6(93)-336(\(77\))-2641.4(72)-330.2(\(89\))-2641.4(21)-330.2(\(53\))]TJ
0 -1.0135 TD
[(Neutral)-4467.6(25)-336(\(20\))-3136.6(8)-335(\(10\))-2641.4(17)-330.2(\(42\))]TJ
T*
[(Disagree)-4417.5(2)-335(\(2\))-3636.6(1)-335(\(1\))-3636.6(1)-335(\(2.5\))]TJ
0 -1.0077 TD
[(Missing)-4758.5(1)-335(\(1\))-4391(0)-4383.3(1)-335(\(2.5\))]TJ
8.7511 0 0 8.7511 321.0519 591.8738 Tm
[(Possible)-737.4(responses)-737.1(to)-734.9(each)-737.4(question)-732.7(were)-737.1()54.4(agree,)-734.8(neutral,)]TJ
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[(disagree.)55.4()-444.4(I)0(f)-441.8(there)-447.3(were)-439(no)-444.7(responses)-439.1(to)-443.4(any)-444.7(of)-443.2(one)-438.2(category)-445(in)]TJ
0 -1.0301 TD
[(each)-335.7(item)-334.9(that)-337.3(particular)-328.6(category)-334.9(was)-335.2(not)-332.1(listed.)]TJ
/F4 1 Tf
8.9663 0 0 8.9663 62.022 749.6502 Tm
(4)Tj
45.1077 0 TD
[(ILANGOVAN)-334.3(ET)-338.7(AL.)]TJ
ET
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9.843 0 0 9.843 59.7543 237.6566 Tm
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0 -1.1116 TD
[(physicians)-255.1(and)-246.4(all)-252.4(responders)-254.8(completed)-251(the)-246.5(survey)-249.5(fully.)-251.1(Of)]TJ
T*
[(the)-275.3(respondents,)-276.8(66%)-269.3(noted)-277.5(it)-267.4(was)-275.8(difcult)-275.1(to)-273(perform)-274.9(a)-267.2(Pap)]TJ
T*
[(smear)-515.7(because)-507.5(of)-509(time)-508.1(constraints)-515.5(and)-505.6(80%)-511.2(agreed)-511.2(they)]TJ
0 -1.1174 TD
[(would)-225.4(be)-228(willing)-222.2(to)-227(incorporate)-228.9(HPV)-223.7(self-sampling)-230.9(into)-223.5(their)]TJ
0 -1.1116 TD
[(clinical)-289.3(practice)-284.4(\(Table)-280.9(3\).)]TJ
/F4 1 Tf
8.9663 0 0 8.9663 59.7543 160.9511 Tm
(Discussion)Tj
/F6 1 Tf
9.843 0 0 9.843 69.7323 144.5102 Tm
[(We)-380(fo)20.9(un)20.8(d)-387(t)0(h)20.7(a)0(t)-377.9(a)0(m)18.5(o)0(n)20.8(g)-387(Ha)18.8(it)20.6(ia)19.6(n)-387(a)0(n)19.7(d)-387(La)18.5(ti)20.6(na)-377.7(wo)20(me)24.2(n)-392.8(a)0(t)-377.9(t)0(w)19.8(o)]TJ
-1.0137 -1.1116 TD
[(sa)19.9(fe)19.7(ty)20.7(-n)20.9(e)15(t)-248.9(cl)19.5(in)26.5(ic)19.6(s,)-234.7(HP)20.1(V)-243.9(s)0(e)19.9(l)0(f)20.7(-)0(s)21.1(a)0(m)18.5(p)0(l)26.5(i)0(n)20.7(g)-248.8(w)15.3(a)0(s)-239.3(a)-244.2(fe)19.7(as)19.9(ib)20.7(le)-233.9(ap)19.7(pr)20.9(o)16.2(a)0(c)18.5(h)]TJ
T*
[(to)-238.5(ce)18.5(rv)26.6(ic)19.6(al)-239.6(ca)24.3(nc)19.7(er)-239.5(sc)19.9(re)25.5(en)19.7(in)20.7(g,)-234.9(ha)19.7(vi)20.7(n)16.2(g)-248.8(hi)20.7(gh)-238.3(a)15(c)0(c)18.5(e)0(p)19.7(t)0(a)19.6(b)16.2(il)20.6(it)20.6(y)-248.8(a)0(m)24.2(o)0(n)20.8(g)]TJ
0 -1.1174 TD
[(pa)19.7(ti)20.6(en)19.7(ts)-336.2(an)19.7(d)-352.4(p)16.2(ro)20.9(vi)20.7(de)19.7(rs)21.1(.)-349(W)0(h)18.6(e)15(n)-352.4(o)0(f)20.9(f)0(e)19.7(r)0(e)25.5(d)-352.4(a)-347.8(c)0(h)19.7(o)0(i)20.7(c)0(e)-338.6(o)0(f)-342(H)0(P)20.1(V)-347.5(se)19.9(lf)20.7(-)]TJ
0 -1.1116 TD
[(sa)19.9(mp)19.6(li)20.6(ng)-215.3(or)-215.3(tr)20.7(a)15(d)0(i)20.7(t)0(i)20.6(o)0(n)20.8(a)0(l)-216.6(s)0(c)19.9(r)0(e)25.5(e)0(n)19.7(i)0(n)20.7(g)-225.7(wi)19.8(th)-215.4(a)-226.9(P)0(a)19.8(p)-225.7(sm)19.8(e)15(a)0(r)19.7(,)-228.1(tw)19.8(o-)26.6(th)20.7(ir)20.7(ds)]TJ
T*
[(of)-353.5(pa)19.7(rt)20.7(ic)25.3(ip)20.7(an)19.7(ts)-353.5(se)19.9(l)16.1(e)0(c)18.5(t)0(e)19.6(d)-364(HP)20.1(V)-359.1(s)0(e)19.9(l)0(f)20.7(-)0(s)21.1(a)0(m)24.2(p)0(l)20.7(i)0(n)20.7(g)0(.)-350.1(O)0(u)20(r)-363.9(n)21(di)20.7(n)16.2(g)0(s)-353.3(o)0(n)]TJ
T*
[(pa)19.7(ti)20.6(en)19.7(t)-559.9(a)0(c)18.5(c)0(e)24.3(p)0(t)20.7(a)0(b)19.7(i)0(l)20.6(i)0(t)20.6(y)-559.8(of)-549.3(HP)20.1(V)-566.4(s)0(e)25.6(l)0(f)20.7(-)0(s)21.1(a)0(m)18.5(p)0(l)20.7(i)16.1(ng)-555.1(ar)19.7(e)-560.9(c)0(o)19.7(n)0(s)21(i)16.1(st)20.9(en)19.7(t)]TJ
0 -1.1174 TD
[(wi)19.8(th)-342.1(da)19.7(t)16.1(a)-353.6(am)18.5(on)20.8(g)-346.7(o)0(t)20.7(h)0(e)19.7(r)-352.4(vu)20.8(l)16.1(n)0(e)19.7(r)0(a)19.7(b)0(l)20.7(e)-353.6(g)16.2(r)0(o)20.9(u)0(p)20.8(s)-352.2(an)19.7(d)-346.7(s)0(i)20.9(m)0(i)19.5(l)0(a)19.6(r)-352.4(t)16.1(o)-352.4(ou)20.8(r)]TJ
0 -1.1116 TD
[(pr)20.9(io)20.7(r)-369.7()16.3(nd)20.8(in)20.7(gs)-359.1(a)15(m)0(o)19.6(n)0(g)-353.5(a)-370.9(co)19.7(m)15(m)0(u)19.6(n)0(i)20.7(t)0(y)20.7(-)16.2(ba)19.7(se)19.9(d)-369.7(s)0(a)25.6(m)0(p)19.6(l)0(e)-354.8(o)0(f)-359.3(H)0(a)24.6(i)0(t)20.6(i)0(a)19.5(n)]TJ
25.5097 67.8954 TD
[(wo)20(m)15(e)0(n)19.7(.)]TJ
7.3823 0 0 6.5614 341.6314 729.5242 Tm
[(37)24.7(,4)28.1(0)16.2()0(4)24.7(4)]TJ
9.843 0 0 9.843 372.6424 725.1588 Tm
[(We)-397.3(al)19.5(so)-393.7(fo)20.9(un)20.8(d)-404.3(t)0(h)20.7(a)0(t)-400.9(H)0(a)24.6(i)0(t)20.6(i)0(a)19.6(n)-404.3(wo)20(me)18.4(n)-404.3(a)0(t)-400.9(C)0(H)24.7(S)]TJ
-6.2781 -1.1174 TD
[(we)24.6(re)-216.4(mo)19.6(re)-210.7(li)20.6(ke)19.7(ly)-209.7(to)-215.4(ch)19.7(oo)20.8(se)-210.5(HP)20.1(V)-226.6(s)0(e)19.9(l)0(f)26.5(-)0(s)21.1(a)0(m)18.4(p)0(l)20.7(i)0(n)20.7(g)-220(th)20.7(an)-216.5(L)15(a)0(t)19.6(i)0(n)20.7(a)0(s)-216.3(a)15(t)]TJ
0 -1.1116 TD
[(AC)24.7(C.)-385.7(Ou)20(r)-398.5(p)0(r)20.9(i)0(o)26.5(r)-398.5(wo)20(rk)-382.3(ha)19.7(s)-398.3(s)0(h)21(o)16.2(wn)-389(th)20.7(at)-383.6(Ha)18.8(it)20.6(ia)25.3(n)-398.5(w)0(o)20(m)15(en)-389.3(ha)19.7(v)16.2(e)]TJ
T*
[(m)15(u)0(c)19.7(h)-444.6(le)19.5(ss)-428(fa)19.7(mi)19.5(l)16.1(i)0(a)19.5(r)0(i)20.7(t)0(y)-434.3(a)15(nd)-434.2(ex)19.7(p)16.2(e)0(r)19.7(i)0(e)19.6(n)0(c)19.7(e)-440(wi)19.8(th)-428.5(Pa)19.8(p)-444.6(s)0(m)19.8(e)15(ar)-435.3(th)20.7(a)15(n)]TJ
T*
[(La)24.2(ti)20.6(na)19.7(s.)]TJ
7.3823 0 0 6.5614 341.518 685.7006 Tm
[(42)24.7()16.2(4)0(4)]TJ
9.843 0 0 9.843 361.7574 681.3352 Tm
[(Ho)20(we)18.8(v)16.2(e)0(r)19.7(,)-222.3(n)21(a)15(n)0(c)19.7(i)0(a)19.6(l)-220.1(co)19.7(ns)21(i)16.1(d)0(e)19.7(r)0(a)19.7(t)0(i)20.6(o)0(n)20.8(s)-219.8(m)15(a)0(y)-210.7(h)0(a)19.7(v)0(e)-210.7(a)0(l)25.3(s)0(o)]TJ
-5.1722 -1.1174 TD
[(pl)20.7(a)15(y)0(e)19.7(d)-208.4(a)-209.6(r)0(o)20.9(l)0(e)-199.3(i)0(n)-198.2(w)0(h)25.7(y)-208.4(mo)19.6(re)-199.2(Ha)18.8(it)20.6(i)16.1(a)0(n)-199.2(w)0(o)20(m)0(e)18.4(n)-208.4(c)15(h)0(o)20.8(s)0(e)-199(H)0(P)20.1(V)0(;)-199(a)0(t)-199.3(C)0(H)24.7(S)]TJ
0 -1.1116 TD
[(wo)20(m)15(e)0(n)-348.9(h)0(a)19.7(v)0(e)-348.9(t)0(o)-342.1(p)0(a)19.7(y)-358.2(se)19.9(pa)19.7(ra)19.7(t)16.1(e)0(l)19.5(y)-358.2(fo)20.9(r)-358.2(a)-359.4(Pa)19.8(p)-358.2(s)0(m)25.6(e)0(a)18.5(r)-358.2(\(b)20.9(as)19.9(ed)-348.9(on)-342(a)]TJ
T*
[(sl)20.9(id)26.5(in)20.7(g)-306.4(f)0(e)19.7(e)-301.8(sc)19.9(al)19.5(e\))-297.1(w)15.3(h)0(i)20.7(l)0(e)-297.2(a)0(t)-291.5(A)0(C)18.9(C)-307.4(th)20.7(e)-301.8(s)0(e)19.9(r)0(v)20.9(i)0(c)19.5(e)-301.8(is)-295.9(in)20.7(cl)25.3(ud)20.8(ed)-297.1(wh)20(e)15(n)]TJ
0 -1.1174 TD
[(do)20.8(n)16.2(e)-284.5(as)-273.9(pa)19.7(rt)-273(of)-272.9(th)20.7(e)-284.5(v)0(i)20.7(s)0(i)20.9(t)16.1(.)-285.7(W)0(e)-276.3(a)0(l)25.3(s)0(o)-272.7(f)0(o)20.9(u)0(n)20.8(d)-283.3(th)20.7(at)-274.2(HP)20.1(V)-284.2(p)16.2(re)19.7(va)19.7(le)19.5(nc)25.4(e)]TJ
0 -1.1116 TD
[(am)24.2(on)20.8(g)-340.9(t)0(h)20.7(e)-342.1(pa)19.7(rt)20.7(ic)19.6(ip)26.5(an)19.7(ts)-330.4(va)19.7(ri)20.7(ed)-331.7(by)-330.5(et)19.5(hn)20.8(i)16.1(c)0(i)19.5(t)0(y)-330.6(w)0(i)19.8(t)0(h)-330.6(H)0(a)18.8(i)0(t)20.6(i)0(a)19.6(n)-340.9(pa)25.4(r-)]TJ
T*
[(ti)20.6(c)15(i)0(p)20.7(a)0(n)19.7(t)0(s)-543.5(d)0(e)19.7(m)0(o)19.6(n)16.2(st)20.9(ra)19.7(ti)20.6(ng)-543.6(a)-555.2(h)0(i)20.7(g)0(h)20.8(e)0(r)-544.7(p)0(r)20.9(e)15(va)19.7(le)19.6(nc)19.7(e)-555.2(t)0(h)20.7(a)0(n)-544.8(L)15(at)19.5(in)20.7(as)19.9(,)]TJ
0 -1.1174 TD
[(wh)20(o)16.2(s)0(e)-170.2(p)16.2(re)19.7(va)19.7(le)19.6(nc)19.7(e)-175(w)0(a)24.6(s)-179.5(no)20.8(t)16.1(a)0(b)19.7(l)0(y)-163.6(l)0(o)20.7(w)0(e)18.8(r)-173.9(th)20.7(an)-164.6(pr)20.9(ev)19.7(i)16.1(o)0(u)20.8(s)0(l)20.9(y)-173.9(me)18.5(as)19.9(ur)20.9(e)15(d)]TJ
0 -1.1116 TD
[(in)-250(a)-267.2(n)0(a)19.7(t)0(i)20.6(o)16.2(na)19.7(l)-266.2(s)0(a)19.9(m)15(pl)20.7(e.)]TJ
7.3823 0 0 6.5614 391.4645 597.9967 Tm
-.0162 Tc
(45)Tj
9.843 0 0 9.843 401.329 593.6313 Tm
0 Tc
[(Th)19.6(e)-261.4(h)0(i)20.7(g)0(h)20.8(e)0(r)-251(p)0(r)20.9(e)0(v)19.7(a)0(l)19.5(e)0(n)19.7(c)15(e)-267.2(o)0(f)-255.6(H)0(P)25.9(V)-266.9(am)18.5(on)20.8(g)]TJ
-9.1925 -1.1116 TD
[(Ha)24.6(it)20.6(ia)19.6(ns)-261.2(is)-255.6(co)19.7(ns)21(is)20.9(te)25.3(nt)-261.5(wi)19.8(th)-255.8(ou)20.8(r)-271.8(p)0(r)20.9(i)16.1(or)-261.4(wo)20(rk)20.9(,)-268.4(b)0(u)26.6(t)-271.9(th)20.7(e)-267.2(r)0(e)19.7(a)0(s)19.9(o)0(n)20.8(s)-271.6(f)16.2(o)0(r)]TJ
T*
[(th)20.7(i)16.1(s)-271.6(di)20.7(ff)20.9(er)19.7(e)15(n)0(c)19.7(e)-273(re)25.5(ma)18.4(in)-255.8(un)20.8(cl)19.5(ea)18.5(r.)]TJ
7.3823 0 0 6.5614 429.4487 576.1132 Tm
-.0162 Tc
[(44)-16.2(,)11.9(4)-16.2(6)]TJ
9.843 0 0 9.843 320.8251 560.7495 Tm
.0121 Tc
[(Alt)5.1(h)-.5(o)5.2(ugh)-190.6(s)5.4(c)-1.7(reen)5.2(in)5.2(g)-196.3(f)5.3(or)-190.6(cerv)5.2(ic)]TJ
12.0896 0 TD
.013 Tc
[(al)-189.8(ca)5(nc)5(er)-189.7(us)6.3(in)6.1(g)-195.4(H)5.3(PV)-190.6(t)6(e)-.8(st)6(in)6.1(g)]TJ
-13.1033 -1.1116 TD
[(i)6.1(s)-523.5(g)6.2(a)-.7(i)6.1(n).5(in)6.2(g)-523.6(i)6.1(nc)5.1(re)5.1(ase)5.1(d)-517.9(ac)5.1(cep)6.2(ta)]TJ
12.3085 0 TD
.011 Tc
[(nce,)-522.3(t)4(h)-1.6(e)-521.2(U)-2.5(n)4.1(ited)-520(S)-1.5(tates)-525.6(P)4.3(re-)]TJ
-12.3085 -1.1116 TD
.013 Tc
[(v)6.1(e)-.8(n)6.1(tiv)6.1(e)-363.6(S).5(e)5(r).4(v)6.1(i).3(ce)5(s)-362.3(T)-.8(a)5(s).6(k)-362.5(F)6.3(orc)5(e)-363.6(h)6.1(as)-362.3(st)6(il)6(l)-362.6(not)-356.9(end)6.1(o).4(r)6.2(s).6(ed)-356.7(it)-362.6(a)5(s)-362.3(a)]TJ
0 -1.1174 TD
.0133 Tc
[(p)6.4(r).7(im)5.2(ar)6.5(y)-304.6(s)6.6(cr)6.5(een)6.4(in)6.4(g)-304.6(t)6.3(est)-299(f).7(o)6.4(r)-304.5(c)5.3(e)-.5(r)6.5(v).7(ic)5.3(al)-298.9(ca)5.3(nc)5.3(er.)-301.1(G)5.6(iv)6.4(en)-298.8(a)-305.7(l)6.3(ac)5.3(k)-304.6(o)6.4(f)]TJ
0 -1.1116 TD
.0072 Tc
[(sp)-5.4(e)-6.6(c)-.8(i)-5.5().5(c)-202.4(g)-5.4(ui)-5.5(de)-6.6(li)-5.5(n)-5.4(e)-.8(s)-201.1(a)-6.6(nd)-201.2(li)-5.5(mi)-5.5(t)-5.5(e)-.8(d)-201.2(p).3(r)-5.4(i)-5.5(or)-201.2(p)-5.4(r).4(o)-5.4(v).3(i)-5.5(d)-5.4(er)-201.2(aw)-6.3(a)-6.6(r).4(e)-6.6(n).3(e)-6.6(s)-5.2(s)-195.3(a)-6.6(nd)]TJ
T*
.0122 Tc
[(k)5.3(nowledg)5.3(e)-347.2(a)-1.6(b)5.3(o)-.4(u)5.3(t)-346.1(HP)5.5(V)-346.9(s)-.2(elf-)5.4(samp)5.3(lin)5.3(g)-346(a)-1.6(s)-340(a)-1.6(n)-346(a)4.2(lt)5.2(ern)5.3(a)-1.6(t)5.2(i)-.5(ve)-341.4(ap)5.3(-)]TJ
0 -1.1174 TD
.0131 Tc
[(p)6.2(roa)5.1(ch)-310.5(to)-310.5(ce)5.1(rvi)6.1(ca)5.1(l)-316.4(c)5.1(an)6.2(cer)-310.5(sc)5.1(re)5.1(eni)6.1(n).5(g)6.2(,)-312.9(we)-317.5(h)6.2(a)-.7(d)-310.5(e)-.7(x)6.2(p).5(e)5.1(c)-.7(te)5.1(d)-316.3(p)6.2(ro)6.2(-)]TJ
0 -1.1116 TD
.0118 Tc
[(v)4.9(i)-.9(der)-375.2(a)3.8(tti)4.8(tu)4.9(des)-375(t)-.9(o)-375.2(b)4.9(e)-376.4(m)3.7(or)5(e)-376.4(h)-.8(eterog)4.9(en)4.9(eo)4.9(us.)-371.8(I)-.8(n)4.9(s)-.6(t)4.8(e)-2(ad,)-371.8(a)-2(mon)4.9(g)]TJ
T*
.0123 Tc
[(cli)5.3(n)-.3(ic)-381.6(st)5.3(af)5.5(f)-386.2(w)4.6(e)-387.4(f)5.5(ou)5.4(nd)-380.5(th)5.4(at)-380.6(th)5.4(e)-387.4(m)4.2(aj)5.3(or)5.5(ity)-380.5(agreed)-380.5(\(7)5.4(9%\))-386.2(t)5.3(hat)]TJ
0 -1.1174 TD
.0071 Tc
[(th)-5.5(ey)-431.7(w)-6.4(o)-5.5(ul)-5.6(d)-431.7(b).2(e)-432.9(w)-6.4(il)-5.6(l)-5.6(i).1(n)-5.5(g)-431.7(to)-431.7(i)-5.6(n)-5.5(co)-5.5(rp)-5.5(o)-5.5(r).3(a)-6.7(t).1(e)-432.9(H)-6.4(PV)-432.6(s)-5.3(e)-6.7(lf)-5.5(-s)-5.3(a)-6.7(m)-1(p)-5.5(l).1(i)-5.6(n).2(g)]TJ
0 -1.1116 TD
.0132 Tc
[(i)6.2(n).6(to)-281.6(t)6.2(h).6(e)5.2(i).5(r)-281.6(c)-.6(l)6.2(i).5(n)6.3(i).5(ca)5.2(l)-281.8(p).6(r)6.4(act)6.2(ic)5.2(e.)-278.2(Thi)6.2(s)-281.4(nd)6.3(i).5(n)6.3(g)-281.6(was)-281.4(s)6.5(im)5.1(ila)5.2(r)-281.6(a)-.6(m)5.1(o).6(n)6.3(g)]TJ
T*
.0121 Tc
[(p)5.2(hys)5.4(icians)-236.5(an)5.2(d)-236.7(n)-.5(o)5.2(n)-.5(p)5.2(hys)5.4(ician)5.2(s)]TJ
12.1472 0 TD
.0115 Tc
[(.)-233.8(D)-2(i)4.5(f)-1.1(cul)4.5(ties)-237.1(i)-1.2(n)-237.3(p)4.6(ro)4.6(vid)4.6(i)-1.2(n)4.6(g)-237.3(Pap)]TJ
-12.1472 -1.1116 TD
.0121 Tc
[(s)5.4(m)-1.7(ears)-265.3(due)-266.6(to)-271.2(t)5.1(i)-.6(me)-272.4(co)5.2(nst)5.1(r)-.5(aint)5.1(s)-271(m)4(ay)-271.2(h)5.2(a)-1.7(ve)-266.6(co)5.2(ntr)5.3(i)-.6(b)5.2(u)-.5(ted)-271.2(t)-.6(o)-265.5(t)-.6(he)]TJ
0 -1.1174 TD
[(h)5.3(i)-.5(gh)-530.3(level)-530.4(o)-.4(f)-536(s)5.5(up)5.3(por)5.4(t.)-532.6(In)-536.1(t)5.2(h)-.4(ese)-537.2(s)5.5(af)5.4(ety)5.3(-)-.4(n)5.3(e)-1.6(t)-536.2(p)5.3(ri)5.2(mary)-536.1(car)5.4(e)]TJ
0 -1.1116 TD
.0118 Tc
[(cli)4.8(n)-.8(ics,)-291.1(many)-288.8(pati)4.8(en)4.9(ts)-294.4(h)4.9(a)-2(v)4.9(e)-295.7(s)5.1(e)-2(veral)-294.7(c)3.8(hro)4.9(ni)4.8(c)-295.7(m)3.7(ed)4.9(ical)-294.7(con)4.9(d)-.8(i)4.8(-)]TJ
T*
[(t)4.9(i)-.8(on)5(s)-259.7(a)3.9(s)-259.7(w)4.2(el)4.9(l)-260(a)3.9(s)-259.7(p)5(sycho)5(s)-.5(ocial)-260(c)3.9(halleng)5(es)5.2(.)-256.5(S)-.6(in)5(ce)-255.3(do)5(ing)-254.1(a)-255.3(Pap)]TJ
0 -1.1174 TD
[(s)5.2(m)-1.9(ear)-323.2(o)5(ften)-323.3(warr)5.1(ant)4.9(s)-323.1(ad)5(di)4.9(tio)5(nal)-323.4(t)-.8(i)4.9(m)-1.9(e)-324.4(i)4.9(n)-323.3(h)-.7(avin)5(g)-323.3(t)-.8(h)5(e)-324.4(pati)4.9(en)5(t)]TJ
0 -1.1116 TD
.0117 Tc
[(p)4.8(u)-.9(t)-196.9(o)4.8(n)-196.7(a)-197.9(gown,)-193.3(n)4.8(din)4.8(g)-196.7(a)-197.9(c)-2.1(h)4.8(a)-2.1(p)4.8(e)-2.1(r)4.9(one)-192.1(\(of)4.9(ten)-196.7(a)-197.9(nu)4.8(rse)-197.9(o)4.8(r)-196.7(m)-2.1(edi)4.7(c)-2.1(al)]TJ
T*
.012 Tc
[(assi)5(stant)5(\))-.6(,)-337(e)4(qu)5.1(ip)5.1(ment)-334.8(set-)5.2(up,)-331.3(an)5.1(d)-340.4(d)5.1(oi)5(ng)-334.7(th)5.1(e)-335.8(t)-.7(est,)-331.3(it)-334.8(may)-334.7(b)-.6(e)]TJ
0 -1.1174 TD
.0125 Tc
[(d)5.6(i)-.2(f)5.8(cu)5.6(lt)-334.3(to)-334.2(i)5.5(n)-.1(corp)5.6(or)5.7(ate)-335.3(a)-335.3(P)5.8(ap)-334.2(s)5.8(m)-1.3(ear)-334.1(i)-.2(n)5.6(t)-.2(o)-334.2(a)-335.3(st)5.5(an)5.6(dard)-334.2(15)5.6(3)5.6(0)]TJ
0 -1.1116 TD
.0133 Tc
[(m)5.2(i).6(n)6.4(u).7(te)5.3(s)-436.9(v).7(i)6.3(s).9(i)6.3(t)-437.2(th)6.4(at)-437.2(m)5.2(u).7(s)6.6(t)-437.2(al)6.3(so)-437.1(a)5.3(d).7(d)6.4(r).7(es)6.6(s)-436.9(s).9(e)5.3(v).7(er)6.5(al)-437.2(o)6.4(t).6(h)6.4(e)-.5(r)-437(a)5.3(ct)6.3(iv)6.4(e)]TJ
T*
.0129 Tc
[(i)5.9(ssu)6(es.)-192.1(T)4.9(hu)6(s,)-192.1(it)-189.9(wa)4.9(s)-195.3(n).3(o)6(t)-195.7(su)6(rp)6(ris)6.2(i).2(n)6(g)-195.5(th)6(at)-189.9(an)-189.8(alt)5.9(e)-.9(r)6.1(n).3(a)4.9(tiv)6(e)-196.7(m)4.8(et)5.9(ho)6(d)]TJ
T*
.0121 Tc
[(o)5.2(f)-415.2(s)5.4(c)-1.7(r)5.3(e)-1.7(enin)5.2(g)-409.5(t)-.6(hat)-409.6(d)-.5(i)5.1(d)-409.5(not)-409.6(i)5.1(nvo)5.2(lv)5.2(e)-410.6(time)-410.6(f)-.5(r)5.3(o)-.5(m)-410.7(p)5.2(rov)5.2(id)5.2(ers)-409.3(o)5.2(r)]TJ
0 -1.1174 TD
.0115 Tc
[(s)4.8(p)-1.1(eciali)4.5(zed)-387(c)-2.3(li)4.5(ni)4.5(c)-388.2(s)-.9(taff)-387(was)-386.8(d)-1.1(eemed)-381.3(a)-2.3(s)-386.8(a)-2.3(ccept)4.5(a)-2.3(bl)4.5(e)-388.2(t)-1.2(o)-387(p)4.6(ro)4.6(-)]TJ
0 -1.1116 TD
.0112 Tc
[(v)4.3(i)-1.5(ders)-277.7(at)-278(t)4.2(h)-1.4(ese)-279(t)-1.5(wo)-283.6(s)4.5(i)-1.5(t)4.2(e)-2.6(s.)]TJ
1.0137 -1.1116 TD
.0124 Tc
[(One)-289.4(i)-.3(mpo)5.5(r)-.2(t)5.4(a)-1.4(nt)-288.3(ch)5.5(ar)5.6(acter)5.6(i)-.3(s)5.7(tic)-289.4(of)-288.2(ou)5.5(r)-293.9(i)5.4(nterv)5.5(e)-1.4(n)5.5(tio)5.5(n)-294(w)4.7(as)-288(th)5.5(e)]TJ
-1.0137 -1.1174 TD
.013 Tc
[(u)6.1(s).6(e)-248.4(o)6.1(f)-247.2(C)5.1(HWs)-247.1(d).4(e)5(d).4(i)6(c)-.8(a)5(t).3(ed)-241.5(to)-241.5(thi)6(s)-247.1(pr)6.2(oj)6(ec)5(t.)-243.9(Th)6.1(ese)-242.7(a)-.8(r)6.2(e)-248.4(l)6(a)-.8(y)-247.3(h)6.1(ea)5(lt)6(h)]TJ
0 -1.1116 TD
.0122 Tc
[(work)5.3(er)5.4(s)-236.4(s)-.2(hari)5.2(ng)-236.6(si)5.2(mi)5.2(lar)-236.5(c)-1.6(u)5.3(ltu)]TJ
11.9456 0 TD
[(ral)-236.7(a)-1.6(n)5.3(d)-236.6(lin)5.3(gu)5.3(ist)5.2(i)-.5(c)-237.7(b)5.3(ackg)5.3(rou)5.3(nd)5.3(s)]TJ
-11.9456 -1.1116 TD
.0129 Tc
[(a)4.9(s)-201.1(th)6(eir)-195.5(p).3(at)5.9(ie)4.9(nt)5.9(s.)]TJ
7.3823 0 0 6.5614 375.9873 258.2928 Tm
.0145 Tc
(4749)Tj
9.843 0 0 9.843 396.9637 253.9275 Tm
.2144 Tc
[(B)200.8(o)201.8(t)207.4(h).2(h)201.8(a)206.4(do)201.8(v)207.5(e)200.6(r2)6(y)201.8(e)206.4(a)200.6(r)201.8(so)207.5(fe)200.6(x)207.5(p)201.8(e)206.4(r)201.8(i)207.4(e)200.6(n)201.8(c)206.4(ea)206.4(s)]TJ
-8.749 -1.1174 TD
.0074 Tc
[(CH)-6.1(Ws)-223.9(i)-5.3(n)-218.3(r)-5.2(e)-6.4(se)-6.4(ar)-5.2(c)-6.4(h)-218.3(s)-5(t)-5.3(ud)-5.2(ie)-6.4(s)-223.9(a)-.6(t)-224.2(t)-5.3(he)-6.4(se)-225.2(s)-5(i).4(t)-5.3(e)-6.4(s)-218.1(a)-6.4(nd)-224.1(o)-5.2(n).5(e)-225.2(w)-6.1(as)-223.9(a)-6.4(l).4(r)-5.2(e)-.6(a)-6.4(d).5(y)]TJ
0 -1.1116 TD
.0125 Tc
[(f)5.7(a)-1.3(mili)5.5(ar)-380.2(wi)5.5(th)-380.3(HPV)-381.1(s).1(elf-)5.7(samp)5.6(lin)5.6(g)-386(f)5.7(rom)-381.5(a)-381.4(pri)5.5(or)-380.2(stu)5.6(d)-.1(y)5.6(.)-382.6(Th)5.6(e)]TJ
T*
.0072 Tc
[(ot)-5.5(h)-5.4(e)-.8(r)-379.8(w)-6.3(as)-379.6(a)-381(d)-5.4(ia)-6.6(be)-6.6(te)-6.6(s)-5.2(-).4(t)-5.5(r).4(a)-6.6(i)-5.5(ne)-6.6(d)-379.8(C)-.7(H)-6.3(W)-376.3(w)-6.3(h)-5.4(om)-381(we)-381(r)-5.4(e)-.8(t)-5.5(r)-5.4(ai)-5.6(ne)-6.6(d)-379.8(i).2(n)]TJ
0 -1.1174 TD
.0087 Tc
[(ce)-5.1(rvica)-5.1(l)-493.6(ca)-5.1(nce)-5.1(r)-493.5(and)-493.5(H)-4.8(PV)-500.1(sa)-5.1(mp)]TJ
13.5814 0 TD
.0123 Tc
[(l)5.3(i)-.4(ng)5.4(.)-492.2(C)-1.3(u)5.4(l)-.4(t)5.3(u)-.3(r)5.5(a)-1.5(l)-490(s)-.1(ensi)5.3(tiv)5.4(it)5.3(y,)]TJ
-13.5814 -1.1116 TD
[(p)5.4(a)-1.5(t)5.3(i)-.4(en)5.4(t)-743.4(c)4.3(ommu)5.4(ni)5.3(catio)5.4(n,)-739.9(and)-737.6(m)-1.5(o)5.4(tiv)5.4(at)5.3(io)5.4(nal)-737.7(i)-.4(n)5.4(t)-.4(ervi)5.3(ewin)5.4(g)]TJ
T*
[(t)5.3(e)-1.5(chni)5.3(qu)5.4(es)-316.9(ar)5.5(e)-324(a)4.3(ll)-317.2(i)5.3(m)-1.5(p)5.4(ort)5.3(an)5.4(t)-323(f)5.5(eatur)5.5(e)-1.5(s)-316.9(o)-.3(f)-317.1(o)5.4(ur)-317.1(CHW)-319.4(t)-.4(rain)5.4(in)5.4(g)]TJ
T*
.0115 Tc
[(p)4.6(rog)4.6(rams)-283.2(and)-283.3(l)-1.2(i)4.5(k)-1.1(ely)-283.3(c)-2.3(o)4.6(n)-1.1(t)4.5(r)-1.1(ib)4.6(ut)4.5(ed)-283.3(to)-283.3(t)4.5(h)-1.1(e)-284.5(h)-1.1(i)4.5(g)-1.1(h)-283.3(u)4.6(ptake.)-285.7(CHWs)]TJ
0 -1.1174 TD
.0124 Tc
[(t)5.4(ook)-265.2(t)5.4(h)-.2(e)-266.3(t)-.3(i)5.4(m)-1.4(e)-266.3(t)-.3(o)-265.2(e)4.4(xpl)5.4(ai)5.4(n)-270.9(t)5.4(he)-266.3(two)-265.2(a)-1.4(lt)5.4(er)5.6(nativ)5.5(es)-265(in)-265.2(d)5.5(e)-1.4(tail)-265.3(us)5.7(in)5.5(g)]TJ
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[(with)-379.9(paper)-387.9(copie)-8(s,)-378.7(our)-377.7(respon)-7.5(se)-383.3(rate)-381.2(among)-382.3(provid)-6.7(ers)-384.4(was)]TJ
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[(50,5)-8.6(1)]TJ
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T*
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T*
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[(abilit)-8.3(y)-196.9(among)-198(women)-198.8(having)-203.7(a)-192.3(Pap)-200.1(smear)-198.9(and)-200.3(thus)-200.2(there)-198(is)-198(no)]TJ
T*
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[(sampl)-7.8(ing)-470(versus)-468.1(Pap)-470.8(smear)-8.8(.)-464.2(Howev)-8.4(er,)-467.5(we)-470.8(found)-466.3(that)-472.4(the)]TJ
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[(major)-8(ity)-510.4(of)-509(women)-515.6(choose)-515.6(HPV)-511.7(self-sa)-9.7(mplin)-7(g)-507.9(over)-512.4(Pap)]TJ
T*
[(smear)-256.5(and)-252.1(among)-249.8(thos)-10.1(e)-244.2(choosi)-7.7(ng)-249.9(HPV)-252.6(self-s)-13.2(ampling,)-255.7(nearly)]TJ
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[(all)-286.9(would)-283(prefer)-291.1(it)-284.7(versus)-283.8(a)-284.5(Pap)-286.5(smear)-8.8(.)]TJ
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T*
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T*
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0 -1.1116 TD
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T*
.0133 Tc
[(co)6.4(me)5.3(s)-298.6(a)-.5(n)6.4(d)-298.8(not)-299(v)6.4(o).7(l)6.3(u).7(m)5.2(e)-.5(,)-301.2(t)6.3(he)-300(l)6.3(e)-.5(a)5.3(d).7(er)6.5(s)-298.6(o).7(f)-298.8(h).7(e)5.3(a)-.5(l)6.3(t).6(h)6.4(car)6.5(e)-300(o).7(r)6.5(g).7(a)5.3(n).7(iz)5.3(a-)]TJ
0 -1.1174 TD
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[(ti)4.9(on)5(s,)-187.4(p)5(a)-1.9(r)5.1(ticul)4.9(ar)5.1(ly)-185(th)5(os)5.2(e)-186.2(i)-.8(n)-185(s)-.5(afety)5(-net)-185.2(s)-.5(etti)4.9(ng)5(s,)-187.4(may)-179.3()-.6(nd)-185(HPV)]TJ
0 -1.1116 TD
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T*
.0131 Tc
[(sm)5(ea)5.1(r)-345.1(s)6.4(cr)6.3(een)6.2(in)6.2(g.)-341.7(A)5.4(d).5(d)6.2(iti)6.1(on)6.2(al)-339.5(wo)6.2(rk)-339.3(sho)6.2(u).5(l)6.1(d)-345.1(e)5.1(x).5(p)6.2(l).4(o)6.2(r).5(e)-340.5(w)-.4(h)6.2(e)-.7(th)6.2(er)]TJ
T*
.012 Tc
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0 -1.1174 TD
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0 -1.1116 TD
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T*
.0132 Tc
[(Un)6.3(it)6.2(ed)-275.9(St)6.2(at)6.2(es.)]TJ
7.3823 0 0 6.5614 118.9984 243.5527 Tm
.0145 Tc
(22)Tj
/F4 1 Tf
8.9663 0 0 8.9663 62.022 215.7732 Tm
0 Tc
(Acknowledgment)Tj
/F6 1 Tf
9.843 0 0 9.843 72 199.3323 Tm
[(This)-328.1(study)-333.7(was)-327.7(supported)-333.5(by)-330.5(a)-324.8(supplemental)-334.9(award)-331.2(from)]TJ
-1.0137 -1.1174 TD
[(the)-379(National)-375.3(Cancer)-379.7(Institute)-380(to)-370.9(the)-379(University)-376.1(of)-376.5(Miamis)]TJ
0 -1.1116 TD
[(South)-696.6(Florida)-700.1(Center)-701.2(for)-700.2(Reducing)-697.7(Cancer)-702.3(Disparities)]TJ
T*
[(\(SUCCESS,)-286.6(U54CA153705\).)]TJ
/F4 1 Tf
8.9663 0 0 8.9663 62.022 143.0362 Tm
[(Author)-338.7(Disclosure)-330.4(Statement)]TJ
/F6 1 Tf
9.843 0 0 9.843 72 126.5952 Tm
[(No)-279.5(competing)-284.4(nancial)-283.1(interests)-282.9(exist.)]TJ
/F4 1 Tf
8.9663 0 0 8.9663 62.022 103.1811 Tm
(References)Tj
/F6 1 Tf
9.2951 0 0 9.2951 66.6708 87.0803 Tm
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1.2503 -1.1223 TD
[(ge)19.9(nc)19.9(y)-506.4(c)0(a)21.8(r)0(e)17.6(.)-506.3(Hy)16.4(a)14(t)0(t)19.2(s)0(v)18.9(i)12.6(l)12.6(l)0(e)14.4(,)-506.3(M)12.8(D)0(:)-501.4(N)0(a)18.3(t)12.6(i)12.6(o)0(n)18(a)14(l)-511.9(C)13.4(en)19.9(te)20.5(r)-508.7(f)0(o)21.8(r)-508.7(He)18.3(al)20.5(th)]TJ
0 -1.1284 TD
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25.7571 70.8975 TD
[(2.)-500.4(Howlader)-319.4(N,)-319(Noone)-311.5(A,)-319(Krapcho)-312.2(M,)-316.6(et)-315(al.)-315(National)-320.5(Cancer)]TJ
1.2503 -1.1223 TD
[(Institute.)-693.9(SEER)-695.1(Cancer)-691.5(Statistics)-697.3(Review,)-692.2(19752010.)]TJ
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[(Updated)-236.1(June)-235.7(14,)-238.2(2013.)-232.4(Available)-233.3(at:)-235.3(http://seer.cancer.gov/)]TJ
0 -1.1223 TD
[(csr/1975_2010/)-335.9(Accessed)-341.1(November)-336.3(29,)-329.7(2013.)]TJ
-1.2503 -1.1283 TD
[(3.)-500.4(Health)-485.5(Council)-478.5(of)-478.3(South)-478.8(Florida.)-479(Racial)-486.8(and)-480.4(ethnic)-477.8(dis-)]TJ
1.2503 -1.1223 TD
[(parities)-283.7(in)-280.3(Miami-Dade)-284(County.)-279.6(2008.)-281.2(Available)-282.1(at:)-278(https://)]TJ
0 -1.1284 TD
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0 -1.1223 TD
[(Ra)15.1(ci)14.4(al)-491.9(an)19.9(d)-500.3(E)0(t)16.7(h)0(n)18(i)0(c)-491.9(H)0(e)12.2(a)0(l)20.5(t)0(h)-493.7(D)0(i)17(s)0(p)18.9(a)0(r)17.6(i)0(t)13.1(i)12.6(es)-491.5(in)-493.7(Mi)19.3(am)14.2(i)-499.7(D)0(a)18.3(d)0(e)13.8(.)0(p)18.1(d)0(f)]TJ
0 -1.1284 TD
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[(4.)-500.4(Fl)15.7(or)21.8(i)12.6(d)0(a)-309.5(D)0(e)18.3(p)0(a)19.9(r)0(t)22.4(m)0(e)20.3(n)0(t)-310.8(o)0(f)-313.7(H)0(e)24.4(a)0(l)20.5(t)0(h)18.6(.)-323.3(De)24.4(at)20.5(hs)-316.6(f)15.8(r)0(o)15.7(m)-316.9(ce)15.7(rv)21.8(i)12.6(c)0(a)21.8(l)-322.8(ca)15.7(nc)26(er)17.6(.)]TJ
1.2503 -1.1284 TD
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-1.2503 -1.1223 TD
[(5.)-500.4(Fl)21.8(or)21.8(id)18.6(a)-327.6(C)13.4(an)19.9(c)14(e)0(r)-317.9(D)0(a)18.3(t)12.6(a)-321.5(S)0(y)21.2(s)0(t)19.5(e)0(m)20.3(.)-323.3(Ce)21.2(rv)21.8(ic)20.5(al)-315(ca)21.8(nc)19.9(er)-317.9(i)12.6(n)0(c)19.9(i)12.6(de)19.9(nc)19.9(e)-321.5(a)0(n)19.9(d)]TJ
1.2503 -1.1284 TD
[(st)19.5(at)20.5(e)-486.2(o)0(f)-472.2(d)0(i)24.7(a)0(g)19.9(n)0(o)24.1(s)0(i)19.5(s)-481.1(am)20.3(on)18(g)-482(w)0(o)22.5(m)12.5(en)-474.1(i)12.6(n)-482(Mi)19.3(am)20.3(i)12.6(-)0(D)20.2(a)0(d)19.9(e)-486.2(C)13.4(o)0(u)18(n)0(t)24.7(y)]TJ
T*
[(Mi)19.3(am)20.3(i)12.6(,)-402.6(F)15.3(l)0(o)18.6(r)0(i)22.4(d)0(a)19.9(.)-396.5(20)24.1(07)18(.)-396.5(A)0(v)22.5(a)0(i)20.5(l)12.6(ab)19.9(le)-388.2(at)20.5(:)-402.1(h)0(t)24.7(t)12.6(ps)18.9(:)12.6(/)0(/)19.2(f)0(c)23.7(d)0(s)18.9(.)0(m)24.6(e)0(d)19.9(.)0(m)18.5(i)12.6(am)20.3(i)]TJ
0 -1.1223 TD
[(.e)20(du)18(/)-524.1(A)0(c)18.3(c)0(e)21.8(s)0(s)19.8(e)0(d)-248.5(M)0(a)20.6(y)-262.4(7,)-244.2(20)18(14)24.1(.)]TJ
-1.2503 -1.1284 TD
[(6.)-500.4(Centers)-283.4(for)-285.6(Disease)-281.2(Control)-287.5(and)-279.1(Prevention)-282.3(\(CDC\).)-284.9(Cancer)]TJ
1.2503 -1.1223 TD
[(ScreeningUnited)-609.9(States,)-601.8(2010.)-604.5(MMWR)-599.9(Morb)-606(Mortal)]TJ
0 -1.1284 TD
[(Wkly)-339.8(Rep)-332.7(2012;61:43.)]TJ
-1.2503 -1.1223 TD
[(7.)-500.4(Carrasquillo)-303.6(O,)-300.7(Pati)-299.3(S.)-295.9(The)-299.3(role)-299.3(of)-295.4(health)-300.9(insurance)-301.5(on)-299.1(pap)]TJ
1.2503 -1.1284 TD
[(smear)-345.6(and)-346.2(mammography)-346.5(utilization)-348.1(by)-341.8(immigrants)-346.1(living)]TJ
0 -1.1223 TD
[(in)-335.2(the)-333.4(United)-334.9(States.)-339.6(Prev)-333.3(Med)-333.3(2004;39:943950.)]TJ
-1.2503 -1.1284 TD
[(8.)-500.4(Kobetz)-339.6(E,)-337.6(Menard)-340.2(J,)-334.8(Barton)-341(B,)-334.4(Pierre)-339.5(L,)-337.6(Diem)-334.7(J,)-334.8(Auguste)]TJ
1.2503 -1.1223 TD
[(PD.)-236.6(Patne)-243.2(en)-236.3(aksyon:)-235.5(Addressing)-239(cancer)-239.6(disparities)-246.1(in)-231.5(Little)]TJ
0 -1.1284 TD
[(Ha)18.3(it)19.2(i)-255.7(t)0(h)18.6(r)0(o)21.8(u)0(g)24.1(h)-262.4(re)23.7(se)20.8(ar)17.6(ch)-248.5(a)14(n)0(d)-250.4(s)12.9(oc)19.9(ia)20.5(l)-261.8(a)14(ct)20.5(io)18.6(n.)-244.2(Am)-251.5(J)-255.4(P)0(u)21.2(b)0(l)18.6(i)12.6(c)-260.5(H)0(e)18.3(a)14(lt)19.2(h)]TJ
0 -1.1223 TD
[(20)18(09)24.1(;9)18.6(9:)24.7(11)18(63)24.1(1)18(16)24.1(5.)]TJ
-1.7505 -1.1284 TD
[(8a.)-504.7(Fr)18.9(e)14(e)0(m)20.3(a)0(n)-449.7(H)0(P)19.6(,)-457.5(W)13.8(i)0(n)18.6(g)0(r)21.8(o)0(v)18(e)-455.7(BK)17.8(.)-457.5(E)0(x)22.2(c)0(e)21.8(s)0(s)-449.9(c)0(e)21.8(r)0(v)21.8(i)0(c)20.5(a)0(l)-449.2(c)0(a)15.7(n)0(c)19.9(e)14(r)-459.9(m)12.5(or)21.8(-)]TJ
1.7017 -1.1223 TD
[(t)12.6(a)0(l)20.5(i)0(t)19.2(y)0(:)-323(A)-337.2(m)12.5(a)0(r)23.7(k)0(e)19.9(r)-337.9(fo)21.8(r)-331.8(l)0(o)18.6(w)-331.1(ac)15.7(c)14(e)0(s)14.7(s)-328.6(to)-329.1(he)26(al)20.5(th)-329.1(c)14(a)0(r)17.6(e)-333.7(i)12.6(n)-335.6(po)24.1(or)-325.9(co)19.9(m)12.5(-)]TJ
0 -1.1284 TD
[(m)12.5(u)0(n)18(i)12.6(t)12.6(i)0(e)20.5(s)0(:)-602.6(A)0(n)-605.7(a)14(na)19.9(ly)18.6(s)12.9(i)0(s)19.5(.)-610(Ro)19.3(ck)19.9(vi)18.6(l)12.6(l)12.6(e)0(,)-602.1(M)0(D)17.2(:)-609.5(Na)18.3(ti)19.2(on)24.1(al)-607.7(C)13.4(a)0(n)19.9(c)0(e)21.8(r)]TJ
0 -1.1223 TD
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-1.2015 -1.1284 TD
[(9.)-500.4(Baumer)-449(J.)-438.5(Race)-444.9(and)-443.8(ethnic)-441.2(disparities)-441.3(in)-445(cervical)-446.1(cancer)]TJ
1.2503 -1.1223 TD
[(screening)-472.2(in)-463.2(a)-467.9(safety-net)-468(system.)-472(Matern)-467.7(Child)-467.9(Health)-467.2(J)]TJ
0 -1.1284 TD
(2005;9:285295.)Tj
-1.7505 -1.1223 TD
.0125 Tc
[(1)12.5(0)12.5(.)-488(Akers)-456.4(A)-1.4(Y,)-457.2(Newmann)-457.3(S)-2.7(J,)-457.2(Smi)-5.4(t).7(h)-457.3(J)1(S.)-451.1(Factors)-456.4(underl)-5.4(ying)]TJ
1.7505 -1.1284 TD
.0145 Tc
[(dispar)5.9(ities)-491(i)-3.4(n)-491.9(c)-2(e)4.1(r)-.2(vica)4.1(l)-497.4(c)4.1(ance)4.1(r)-494.2(i)-3.4(nc)4.1(idence)4.1(,)-497.9(s)3(cr)5.9(ee)4.1(ning,)-491.8(and)]TJ
0 -1.1223 TD
.0127 Tc
[(t)-5.2(r)4.1(eat)-5.2(m).8(en)-5.7(t)-383.3(i).9(n)-383.9(t).9(he)-388.1(United)-383.9(S)3.6(tates.)-383.8(Curr)-386.2(Pro)-5.7(b).4(l)-383.3(C)1.7(ancer)-386.2(2007;)]TJ
0 -1.1284 TD
.0123 Tc
[(31)-6.1(:157181.)]TJ
-1.7505 -1.1223 TD
0 Tc
[(11.)-500.5(Echeverria)-518.3(SE,)-511.4(Carrasquillo)-517.1(O.)-514.1(The)-512.8(roles)-512(of)-508.8(citizenship)]TJ
1.7505 -1.1284 TD
[(status,)-514.6(acculturation,)-512.9(and)-510.9(health)-514.4(insurance)-514.9(in)-505.9(breast)-516.4(and)]TJ
0 -1.1223 TD
[(cervical)-403.4(cancer)-398.2(screening)-399(among)-394.9(immigrant)-395.6(women.)-396.5(Med)]TJ
0 -1.1284 TD
[(Care)-339.4(2006;44:788792.)]TJ
-1.7505 -1.1223 TD
[(12.)-500.5(Lewin)-355.5(ME,)-355.3(Altman)-352.7(S.)-350.8(Americas)-353.7(Health)-351.3(Care)-357.7(Safety)-349.4(Net:)]TJ
1.7505 -1.1284 TD
[(Intact)-480.1(but)-475.6(endangered.)-484.2(Washington,)-477.7(D.C.:)-476(National)-485.2(Aca-)]TJ
0 -1.1223 TD
[(demies)-336.8(Press,)-337.8(2000.)]TJ
-1.7505 -1.1284 TD
.0115 Tc
[(1)11.5(3)11.5(.)-489(Daley)-281.4(E)3.4(,)-281.3(A)-2.4(lio)-275.3(A,)-281.3(Anstey)-281.4(EH,)-281.3(C).5(h)5.3(a)-5(n)5.3(d)-.8(ler)-277.6(R)-5.6(,)-275.2(D)-2.4(yer)-277.6(K)-2.4(,)-281.3(H)3.7(elmy)]TJ
1.7505 -1.1223 TD
.0109 Tc
[(H.)-452.7(Examini)10.9(n)-7.1(g)-452.8(b)-1.4(arri)10.9(e)-11.3(r)2.3(s)-451.9(t)-.9(o)-452.8(cervical)-452.2(ca)-5.6(nc)-5.6(er)-449(screening)-452.8(a).5(nd)]TJ
0 -1.1284 TD
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[(treatment)-664.8(i)11.8(n)-671(Fl)11.8(o)-6.2(r)-2.9(i)11.8(d)-6.2(a)-663.5(t)0(hrough)-659.3(a)-669.6(s).3(o)5.6(c)-4.7(io)5.6(-ecolo)5.6(gical)-664.8(lens.)]TJ
T*
.0121 Tc
[(J)-334.8(C)1.1(omm)12.1(u)-6.1(nity)-329.6(Health)-329.6(201)5.9(1;36)5.9(:121)5.9(131)5.9(.)]TJ
-1.7505 -1.1223 TD
0 Tc
[(14.)-500.5(Gany)-421.1(F,)-417.9(Trinh-Shevrin)-419.2(C,)-419.7(Aragones)-421.2(A.)-416.5(Cancer)-423.1(screening)]TJ
1.7505 -1.1284 TD
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ET
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T*
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14.0526 .0427 TD
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1.7505 -1.1284 TD
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()Tj
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1.7505 -1.1223 TD
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[(and)-248.6(cost-effectiveness)-256.1(of)-252.7(cervical)-250.9(cancer)-251.8(screening)-252.7(by)-244.3(high-)]TJ
T*
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1.7505 -1.1223 TD
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1.7505 -1.1284 TD
[(increase)-250.6(participation)-251.8(in)-243.7(cervical)-250.9(cancer)-245.7(screening:)-252.2(An)-245.8(RCT)]TJ
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1.7505 -1.1284 TD
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27.0135 70.8975 TD
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1.7505 -1.1223 TD
[(vaginal)-288.9(self-collection)-300.4(and)-291.3(high-risk)-290.6(human)-291.2(papillomavirus)]TJ
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[(34.)-500.5(Stillman)-383.7(MJ,)-383(Day)-384.4(SP,)-384.3(Schutzbank)-388.5(TE.)-382.3(A)-386(comparative)-391.2(re-)]TJ
1.7505 -1.1284 TD
[(view)-304.6(of)-307.6(laboratory-developed)-309.8(tests)-307(utilizing)-307.6(Invader)]TJ
/F9 1 Tf
6.9712 0 0 6.196 523.1053 666.5385 Tm
()Tj
/F6 1 Tf
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