New Member Spotlight: Delivette Castor, PhD, MPH

Few researcher’s careers in public health follow a straight line, and Delivette Castor, PhD, MPH is no exception. Driven by a curiosity that crosses disciplines and continents, Castor has built a career focused on a central goal: ensuring that evidence does not sit on shelves, but translates into meaningful, population-level impact. 

We spoke with the Herbert Irving Comprehensive Cancer Center (HICCC) new member about her path spanning frontline global health research, federal scientific leadership, and her research at the intersection of HIV and cervical cancer screening. 

Finding her path: From HIV epidemiology to cervical cancer control 

You started your career in infectious disease research. How did that evolve into a focus on cervical cancer? 

I began (and continue) my career in HIV prevention, care, and treatment across a range of settings. After completing my PhD in epidemiology, I pursued postdoctoral work at Rockefeller University, where I studied new HIV infections. From there, I took what felt like a major shift and spent a decade in the U.S. government within the President’s Emergency Plan for AIDS Relief (PEPFAR) working in two agencies, United States Agency for International Development (USAID) and US Department of State. 

That experience exposed me to the intersection of epidemiology and implementation science. As epidemiologists, we are in search of fundamental causes and in the process, often identify problem after problem. Implementation science helped push me to think about how to address health problems and bring effective solutions to scale and achieve population-level impact. It was also through PEPFAR/USAID microbicides program that I became more engaged in cervical cancer research. This program supported the global initiative to end both HIV and cervical cancer. As a development officer, I contributed to modeling studies on the joint prevention and elimination of HIV and cervical cancer- an entry point into seeing the synergy in these two conditions. 

In 2019 I returned to Columbia and began collaborating with HICCC member Louise Kuhn, PhD. Dr. Kuhn and collaborators at the University of Cape Town in South Africa had been conducting clinical studies off HPV-based cervical cancer screening strategies suitable for low and middle-income countries.

What makes South Africa such a critical setting for your ongoing cervical cancer prevention work? 

South Africa has one of the highest HIV burden settings in the world, and was embarking on integrating HPV-based cervical cancer screening into public primary care settings. HIV increases the risk of cervical cancer nearly six-fold, and HPV increases HIV acquisition. Therefore, the opportunity was timely to conduct epidemiologic and implementation science to support the country’s cervical cancer elimination goals in the context of HIV. I serve as multiple principal investigator of an implementation research program seeking to inform cervical cancer control alongside other HICCC colleagues, Parisa Tehranifar, Rachel Shelton and co-investigators Min Qian and Elena Elkin. Together with our colleagues at the University of Cape Town and with the Western Cape Department of Health and Wellness, we are trying to understand how to scale cervical cancer control in the Khayelitshe community and eventually the province.

This alignment ties  my interests in biology, epidemiology, implementation research, and capacity building in resource-constrained settings, all while collaborating with exceptional teams in South Africa and at Columbia. 

Applying HIV lessons to cervical cancer prevention systems 

How has your HIV control experience shaped your approach to cervical cancer prevention and control? 

Through PEPFAR, we saw the transformative benefit of a population-wide approach to effective HIV prevention, care, and treatment in changing the course of a global epidemic. 

Cervical cancer is almost entirely preventable. We have an extremely effective vaccine and highly sensitive screening tools. What we lack is systems to support implementation that make screening accessible. 

In many settings where we worked, women living with HIV benefited more from cervical cancer prevention services because the HIV care platform created access. That inversion of disparity demonstrates the power of integrated systems. But it also highlights gaps: women not living with HIV still represent the largest proportion of cervical cancer deaths because they are less likely to be screened. Addressing that requires the same principles that guided HIV progress- strong policies, evidence-based implementation, and attention to structural barriers. 

Navigating two opposite ends of science 

You spent a decade in government before returning to academia. What was it like moving between those environments? 

It was a culture shock both times. 

When I first joined the government, it felt like stepping into something big and fuzzy compared to the constrained way science is typically conducted in academia. In government, doing science also means doing diplomacy. I often told incoming scientists at USAID that you have to be flexible enough to show up as a diplomat in the morning, a scientist at midday, and a janitor afterward if that’s what’s needed. 

Returning to academia required another adjustment. Moving from massive programs and big budgets back to a single study site with more limited resources forces you to re-engage with the methodological details and the nuances of new approaches. You shift from managing issues at a distance to studying them directly. 

I now live at both ends of that continuum. I keep my eye on macro-level problems but conduct micro-scale studies that can inform how interventions are implemented more broadly. 

Progress and persistent gaps in addressing disparities 

Over your career, what progress have you seen in reducing health disparities-and what remains to be done? 

With HIV, the gains have been profound. PEPFAR represented the largest single funding commitment to a disease in history, and mortality dropped dramatically as treatment expanded. What was striking, though, was seeing similar patterns of the HIV care cascade in the U.S. as in the global settings where we worked- underscoring that disparities are not only global but also domestic. 

For cervical cancer, the situation is similar but even more urgent because the disease is preventable. Yet women continue to die from cervical cancer across low- and middle-income countries AND in the U.S. Structural barriers - limited access, cost, geography, and inconsistent screening- drive these disparities. 

What will it take to close these gaps? 

With the recent uncertainty around NIH funding, many of us in this field are thinking about how to continue making meaningful impacts in the field. And although much of my work focuses on South Africa, the issues extend far beyond global settings. In the United States, despite major advances from HPV vaccination, thousands of women still die each year from a disease that is now entirely preventable. 

You cannot implement evidence-based programs at scale without a supportive policy framework. At the same time, policy must be continually informed by evidence. That dynamic -evidence shaping policy and policy enabling implementation- is essential for eliminating cervical cancer.