Barriers to follow-up after an abnormal cervical cancer screening result and the role of male partners: a qualitative study

Abstract

IntroductionCervical cancer is the leading cause of cancer deaths among women in Malawi, but preventable through screening. Malawi primarily uses visual inspection with acetic acid (VIA) for screening, however, a follow-up for positive screening results remains a major barrier, in rural areas. We interviewed women who underwent a community-based screen-and-treat campaign that offered same-day treatment with thermocoagulation, a heat-based ablative procedure for VIA-positive lesions, to understand the barriers in accessing post-treatment follow-up and the role of male partners in contributing to, or overcoming these barriers.MethodsWe conducted in-depths interviews with 17 women recruited in a pilot study that evaluated the safety and acceptability of community-based screen-and-treat programme using VIA and thermocoagulation for cervical cancer prevention in rural Lilongwe, Malawi. Ten of the women interviewed presented for post-treatment follow-up at the healthcare facility and seven did not. The interviews were analysed for thematic content surrounding barriers for attending for follow-up and role of male partners in screening.ResultsTransportation was identified as a major barrier to post-thermocoagulation follow-up appointment, given long distances to the healthcare facility. Male partners were perceived as both a barrier for some, that is, not supportive of 6-week post-thermocoagulation abstinence recommendation, and as an important source of support for others, that is, encouraging follow-up attendance, providing emotional support to maintaining post-treatment abstinence and as a resource in overcoming transportation barriers. Regardless, the majority of women desired more male partner involvement in cervical cancer screening.ConclusionDespite access to same-day treatment, long travel distances to health facilities for post-treatment follow-up visits remained a major barrier for women in rural Lilongwe. Male partners were identified both as a barrier to, and an important source of support for accessing and completing the screen-and-treat programme. To successfully eliminate cervical cancer in Malawi, it is imperative to understand the day-to-day barriers women face in accessing preventative care.

Perceived acceptability of self-administered topical therapy for cervical precancer treatment among women undergoing cervical cancer screening in Kenya

“…Our study and numerous others from LMICs have highlighted these access issues. 5,7,8,10,13 In our study, the majority of participants pointed to lower transportation costs as a key reason for preferring self-administration of topical therapies over provider-administration in a health facility. This is further demonstrated by a qualitative study from Malawi where women with abnormal cervical cancer screening results cited lack of transportation and high associated costs as a major reason for not presenting for treatment.…”

“…11 There are high rates of loss-to-follow-up due to cost and transportation challenges when women screened in rural areas are referred to central facilities for treatment, 12 as well as lack of adequate skilled healthcare providers to offer treatment. 8,10,13 In a retrospective review of the 2011-2020 Kenya cervical cancer program data, linkage to treatment following positive screening results was 25-40%, even though a structured surveillance system was in place. 9 This gap is consistently observed across multiple LMICs, 5,8,10,11,13 and contributes to the disproportionate burden of cervical cancer.…”

Safety and Acceptability of Three Ablation Treatments for High-Grade Cervical Precancer: Early Data From a Randomized Noninferiority Clinical Trial

“…Other research from LMICs has shown that male partners can complicate adherence to sexual abstinence restrictions. 26 , 44 Although self-reported adherence to recommendations was very high, responses may be subject to acquiescence bias. An additional consideration is that infection rates may be different in populations with high HIV prevalence, although existing research is limited and suggests similar patterns to non-HIV populations.…”

Involving men in cervical cancer prevention; a qualitative enquiry into male perspectives on screening and HPV vaccination in Mid-Western Uganda

“…Male involvement and support are important factors for women to participate in screening programs and adhere to treatment and follow-up recommendations, as demonstrated in qualitative studies in Malawi and Kenya among women attending cervical cancer screening programs [24,25]. Women who did not adhere to the follow-up recommendations mentioned lack of financial and emotional support by their male partners and did not inform their male partners about their HPV-positive result.…”