Acceptability and safety of thermal ablation to prevent cervical cancer in sub-Saharan Africa

Abstract

Background The World Health Organization recommends thermal ablation as an alternative to cryotherapy to treat women with precancerous lesions in low-resource settings. However, limited data are available on women’s experience and adverse events (AEs) of the procedure in the context of Sub-Saharan Africa. The objective of this study was to evaluate the acceptability and safety of thermal ablation in women screened positive for precancerous cervical lesions. Methods Asymptomatic women aged 30–49 years old living in the Dschang Health District were invited to participate in a cervical cancer screening campaign termed “3 T-Approach” (for Test-Triage and Treat). Recruited women were asked to perform HPV self-sampling followed by triage with visual assessment and treatment with thermal ablation if required. After treatment and 4–6 weeks later, interviews were conducted to assess women’s experience on anxiety, discomfort, and pain during thermal ablation. AEs were recorded on pre-defined electronic forms 4–6 weeks after treatment to assess the procedure’s safety. Results Between September 2018 and December 2020, 399 HPV-positive women (18.7% of women screened) were recruited, 236 (59.1%) had a positive visual assessment, 234 were treated by thermal ablation and 198 (84.6%) received therapy in the same visit. Treatment was not considered as painful (score ≤ 4/10) by 209 (90.9%) patients while 5 (2.5%) reported high pain (score 8–10/10). During post-treatment interviews 4–6 weeks later, most reported AEs were graded mild or moderate (grade I-II). The most frequent symptoms reported as mild AEs (grade 1–2) were vaginal watery discharge (75.5%), vaginal bloody-stained discharge (21.5%) and malodourous discharge (14.5%). None of the participants experienced serious AEs (grade 3–4) or AEs requiring admission to hospital or emergency consultation. The vast majority of women (99.6%) would agree to repeat the procedure if necessary and (99.6%) would recommend it to friends or family. Conclusion Thermal ablation is widely accepted by women and appears as a safe procedure. It may contribute to improving the link between screening and treatment in a single visit and to optimizing cervical cancer control in low-resource settings. Trial registration The study was registered on clinicaltrials.gov (NCT03757299) in November 2018 (28/11/2018).

Human papillomavirus testing using existing nucleic acid testing platforms to screen women for cervical cancer: implementation studies from five sub-Saharan African countries

“…Finally, the TAT between receiving VIA and treatment was almost always performed on the same day, due to on-site treatments that were available, in particular thermal ablation. Our findings of 75% for same-day VIA to treatment were slightly lower than a recent study conducted in Cameroon that achieved 85% 20…”

“…Our findings of 75% for same-day VIA to treatment were slightly lower than a recent study conducted in Cameroon that achieved 85%. 20 …”

“…Our findings of 75% for same-day VIA to treatment were slightly lower than a recent study conducted in Cameroon that achieved 85%. 20 Self-collected versus clinician-collected sampling In Malawi, Senegal and Nigeria the number of samples collected by method (self vs clinician) was driven by the supply purchased, not by demand. Anecdotal information as well as the patient questionnaires confirmed that women were very receptive to self-sampling.…”

“ARVs is for HIV and cream is for HPV or precancer:” Women’s Perceptions and Perceived Acceptability of Self-Administered Topical Therapies for Cervical Precancer Treatment: A Qualitative Study from Kenya

“…Thermal ablation, which involves the application of a heated probe to the cervix to destroy precancerous tissue, is performed without local anesthesia to the cervix[6]. Studies in LMICs report that while 83.9% - 90% report no or mild pain with thermal ablation, 2.5% - 16.1% report high or moderate pain with the procedure [27], [28]. In our qualitative findings, some participants described thermal ablation as “ too painful ” or “ painful just as labor pains.…”

“…Most showed a preference for topical therapies, if available, believing they would alleviate these challenges associated with conventional treatment methods that often deter other women from pursuing precancer treatment. The acceptability of thermal ablation, the most widely available precancer treatment method in LMICs that was approved by the WHO in 2019, has been demonstrated in a few studies [27], [28]. Thermal ablation, which involves the application of a heated probe to the cervix to destroy precancerous tissue, is performed without local anesthesia to the cervix [6].…”