Acceptability and preferences for self‐collected screening for cervical cancer within health systems in rural Uganda: A mixed‐methods approach

Abstract

Objective To understand the knowledge, preferences, and barriers for self‐collected cervical cancer screening (SC‐CCS) and follow‐up care at the individual and health system level to inform the implementation of community‐based SC‐CCS. Methods Surveys and focus group discussions (FGDs) with women and FGDs with healthcare providers were conducted in Uganda. Survey data were analyzed using frequencies and FGD data were analyzed using thematic content analysis. Data were triangulated between methods. Results Sixty‐four women were surveyed and 58 participated in FGDs. Facilitators to screening access included decentralization, convenience, privacy, confidentiality, knowledge, and education. Barriers to accessing screening included lack of transportation and knowledge, long wait times, difficulty accessing health care, and lack of trust in the health system. Additional implementation challenges included insufficiently trained human resources and lack of infrastructure. Conclusion Integrating SC‐CCS within rural health systems in low‐resource settings has been under‐evaluated. Community‐based SC‐CSS could prevent high cervical cancer‐related mortalities while working within the human and financial resource limitations of rural health systems. SC‐CCS is acceptable to women and healthcare providers. By addressing rural women's preferences and barriers to care, decision‐makers can build health systems that provide community‐centered care close to women's homes across the care continuum.

Mapping evidence on the acceptability of human papillomavirus self-sampling for cervical cancer screening among women in sub-Saharan Africa: a scoping review

“…Twenty-two articles were excluded at the full article screening stage 17–38. Of the 22 excluded, 14 were conducted on participants less than 25 years old,17 21–23 25–27 29 30 32–34 36 37 7 studies18–20 24 28 31 38 did not measure acceptability, characteristics of acceptability or sampling preference and 1 study was conducted outside SSA 35. The 19 remaining studies39–57 were incorporated into the final analysis.…”

Evaluation of Urine and Vaginal Self-Sampling versus Clinician-Based Sampling for Cervical Cancer Screening: A Field Comparison of the Acceptability of Three Sampling Tests in a Rural Community of Cuenca, Ecuador

“…Self-sampling methods could substitute gynecological examinations in places with a lack of health infrastructure, being cost-effective and well-accepted options, in order to increase cancer screening uptake [ 26 , 35 ]. Moreover, since the lockdown due to COVID-19 has decreased cervical cancer screening, self-sampling methods could be part of the solution for similar situations [ 36 , 37 ].…”

Comparison of the ScreenFire and Xpert HPV assays for the detection of human papillomavirus and cervical precancer among women living with HIV in Malawi

“…3 Studies on the use of HPV-based screening in LMICs have demonstrated that HPV testing on self-collected specimens is comparable to provider-collected specimens for detection of cervical precancer/cancer, 4,5 is cost-effective, 6,7 and highly acceptable across many countries. [8][9][10][11]12 Use of HPV testing for primary screening in LMICs is limited, however, with less than 5 African countries recommending HPV testing as a primary screening method. 13 This limited use is partly due to the cost and logistical challenges of incorporating HPV testing within existing "screen & treat" programs in LMICs.…”

“…3 Studies on the use of HPV-based screening in LMICs have demonstrated that HPV testing on self-collected specimens is comparable to provider-collected specimens for detection of cervical precancer/cancer, 4,5 is cost-effective, 6,7 and highly acceptable across many countries. 8–11,12…”