Development, Implementation, and Evaluation of a Distance Learning and Telementoring Program for Cervical Cancer Prevention in Cameroon

Abstract

ImportanceAlthough Africa has the highest burden of cervical cancer in the world, educational resources to achieve the 90-70-90 targets set by the World Health Organization in its strategy to eliminate cervical cancer are lacking in the region.ObjectivesTo adapt, implement, and evaluate the Project Extension for Community Health Care Outcomes (ECHO), an innovative learning tool, to build capacity of clinicians to better incorporate new evidence-based guidelines into cervical cancer control policies and clinical practices.Design, Setting, and ParticipantsThis cross-sectional study assessed knowledge and practices of clinicians and support staff regarding cervical cancer prevention and control and compared them among respondents who had attended Project ECHO sessions (prior ECHO attendees) with those who had not but were planning on attending in the near future (newcomers) as part of the Cameroon Cervical Cancer Prevention Project ECHO. Satisfaction of prior ECHO attendees was also evaluated. Data were analyzed from January to March 2022.Main Outcomes and MeasuresMain outcomes were practices and knowledge regarding cervical cancer education and prevention and preinvasive management procedures compared among prior ECHO attendees and newcomers.ResultsOf the 75 participants (mean [SD] age, 36.4 [10.0] years; 65.7% [95% CI, 54.3%-77.1%] women) enrolled in this study, 41 (54.7%; 95% CI, 43.1%-66.2%) were prior ECHO attendees, and most were clinicians (55 respondents [78.6%; 95% CI, 68.7%-88.4%]). Overall, 50% (95% CI, 37.8%-62.2%) of respondents reported performing cervical cancer screening with visual inspection of the cervix after application of acetic acid (VIA) and/or visual inspection of the cervix after application of Lugol’s iodine (VILI), 46.3% (95% CI, 34.0%-58.5%) of respondents reported performing human papillomavirus (HPV) testing, and 30.3% (95% CI, 18.9%-41.7%) of respondents reported performing cervical cytological examination in their practices, Approximately one-fourth of respondents reported performing cryotherapy (25.4% [95% CI, 14.7%-36.1%]), thermal ablation (27.3% [95% CI, 16.2%-38.3%]) or loop electrosurgical excisional procedure (LEEP, 25.0% [95% CI, 14.4%-35.6%]) for treatment of preinvasive disease. The clinical use of many of these screening and treatment tools was significantly higher among prior ECHO attendees compared with newcomers (VIA/VILI: 63.2% [95% CI, 47.4%-78.9%] vs 33.3% [95% CI, 16.0%-50.6%]; P = .03; cryotherapy: 40.5% [95% CI, 24.3%-56.8%] vs 6.7% [95% CI, 0.0%-15.8%]; P = .002; thermal ablation: 43.2% [95% CI, 26.9%-59.6%] vs 6.9% [95% CI, 0.0%-16.4%]; P = .002). Knowledge about cervical cancer education, prevention, and management procedures was satisfactory in 36.1% (95% CI, 23.7%-48.5%) of respondents; this proportion was significantly higher among prior ECHO attendees (53.8% [95% CI, 37.7%-69.9%]) compared with newcomers (4.5% [95% CI, 0.0%-13.5%]; P < .001). Approximately two-thirds of participants (68.8% [95% CI, 51.8%-85.8%]) reported that they had applied knowledge learned in our ECHO sessions to patient care in their practice or adopted best-practice care through their participation in this ECHO program.Conclusions and RelevanceThese findings suggest that the Project ECHO e-learning and telementoring program was associated with improved skills for clinicians and support staff and enhanced quality of care for patients. In the COVID-19 era and beyond, reinforced efforts to strengthen cervical cancer knowledge and best practices through distance learning and collaboration are needed.

Impact of the COVID-19 pandemic on an online cancer screening training programme for healthcare providers in the public sector in India: learnings from a hub and spoke model perspective

“…The challenges encountered in conducting CSTP: Internet issues faced by both the hub and the spokes and limited interactions due to the non-use of video during the session were in concordance with challenges faced by courses from other institutes/countries [ 14 , 15 ].…”

HPV vaccination in Africa in the COVID-19 era: a cross-sectional survey of healthcare providers’ knowledge, training, and recommendation practices

“…The study population consisted of healthcare providers involved in cervical cancer prevention activities from 23 African countries who were enrolled in a distance learning program focusing on cervical cancer and other HPV-related anogenital diseases ( 16 , 17 ). Between 2021 and 2022, providers were invited to take an online survey (in English or French) to assess their training, knowledge, and practices toward cervical cancer screening, management of pre-invasive lesions, and HPV vaccination ( Supplementary Figure S1 ).…”

“…Participation was anonymous and voluntary, and refusal to take the survey had no consequence on participation in the distance learning program. A detailed description of the survey design, content, and administration has been published elsewhere ( 16 ).…”

Utility of colposcopy for the screening and management of cervical cancer in Africa: A cross-sectional analysis of providers’ training and practices.

“…They strengthen the coordination of care and educate patient using culturally adapted interventions. 10 Not only they assist women in the screening procedure, but also, they support those with abnormal results by offering them post-screening counseling and management.…”

“…The contribution of PHPs in addressing cervical cancer has been highlighted in LMICs. 10 In the innovative approach developed by our team, hands-on training 11 is combined with distant learning through the use of a practical and low-cost tele-mentoring tool (the Project ECHO) aimed at sharing best care practices. In this model, PHPs diagnose and manage patients with the assistance of specialists who act as mentors and provide feedback, guidance, and didactical training.…”