PROJECT SUMMARY / ABSTRACT Senegal ranks 15th in the world in cervical cancer incidence, and this is the number one cancer killer among women there. However, the estimated participation rate for cervical cancer screening in Senegal (where incidence peaks between the ages of 45 and 54) is very low. Ten of the 13 rural Senegal regions remain with no access to cervical cancer screening services, even though screening by visual inspection of the cervix with acetic acid is highly effective and affordable. Since 2010, I, Andrew Dykens MD, MPH, Assistant Professor of Family Medicine at the University of Illinois at Chicago (UIC), have led a partnership between the Kedougou Regional health system, the Institute of Health and Development, the University of Illinois at Chicago, and the U.S. Peace Corps to implement a visual inspection cervical cancer screening program in this far southeastern, rural region. The partnership made a screening service available to over 18,300 women region-wide by 2014. However, the utilization by eligible women, especially the high-risk older cohort, remains very low. In 2014, only 509, roughly 5% of eligible women targeted through a mass campaign that year, were screened and only 10% were 45 years or older. This career development award will provide me with critical research skills through a mentored project that will expand our current research. My research proposal aims to address preliminary data describing poor uptake and barriers to screening access in this region through a multi-level mixed methods assessment of the barriers and facilitators of initial uptake. This knowledge will guide us in developing and adapting a peer education health promotion intervention to this specific context in order to demonstrate an increased rate of initial screenings and re-screenings over time. Using mixed methods, we will 1) assess cervical cancer screening access determinants in Kedougou, Senegal by identifying barriers and facilitators of service uptake over time at the person, household, and community levels; 2) develop and deploy a wide-reaching, multi-level responsive peer education curriculum aimed at motivating eligible women to seek cervical cancer screenings in Kedougou, Senegal; and 3) evaluate the impact of the peer education intervention on initial screening uptake and re-screening rates. The support provided by this mentored career development award will allow me to achieve my goal of becoming an independent implementation researcher with expertise in evaluating the access determinants for a cervical cancer screening program in a rural region of Senegal and designing and evaluating a behavioral change intervention. I will develop the necessary experience to strengthen and scale cervical cancer prevention programs in Senegal and other low- and middle-income countries, reduce barriers to cervical cancer diagnosis, and implement evidence-based screening approaches in real world settings. To achieve this goal, I have assembled ...