Effectiveness of One-Way Text Messaging on Attendance to Follow-Up Cervical Cancer Screening Among Human Papillomavirus–Positive Tanzanian Women (Connected2Care): Parallel-Group Randomized Controlled Trial

Abstract

Background Rapid human papillomavirus (HPV) DNA testing is an emerging cervical cancer screening strategy in resource-limited countries, yet it requires follow-up of women who test HPV positive. Objective This study aimed to determine if one-way text messages improved attendance to a 14-month follow-up cervical cancer screening among HPV-positive women. Methods This multicenter, parallel-group randomized controlled trial was conducted at 3 hospitals in Tanzania. Eligible participants were aged between 25 and 60 years, had tested positive to a rapid HPV test during a patient-initiated screening, had been informed of their HPV result, and had a private mobile phone with a valid number. Participants were randomly assigned in a 1:1 ratio to the intervention or control group through an incorporated algorithm in the text message system. The intervention group received one-way text messages, and the control group received no text messages. The primary outcome was attendance at a 14-month health provider-initiated follow-up screening. Participants were not blinded, but outcome assessors were. The analysis was based on intention to treat. Results Between August 2015 and July 2017, 4080 women were screened for cervical cancer, of which 705 were included in this trial—358 women were allocated to the intervention group, and 347 women were allocated to the control group. Moreover, 16 women were excluded before the analysis because they developed cervical cancer or died (8 from each group). In the intervention group, 24.0% (84/350) women attended their follow-up screening, and in the control group, 23.8% (80/335) women attended their follow-up screening (risk ratio 1.02, 95% CI 0.79-1.33). Conclusions Attendance to a health provider-initiated follow-up cervical cancer screening among HPV-positive women was strikingly low, and one-way text messages did not improve the attendance rate. Implementation of rapid HPV testing as a primary screening method at the clinic level entails the challenge of ensuring a proper follow-up of women. Trial Registration ClinicalTrials.gov NCT02509702; https://clinicaltrials.gov/ct2/show/NCT02509702. International Registered Report Identifier (IRRID) RR2-10.2196/10.2196/15863

<p>Optimizing the Communication with Cancer Patients During the COVID-19 Pandemic: Patient Perspectives</p>

“…4 Surprisingly in our study (mobile application and telemedicine) were not the preferred method and this is likely due to similar technology-specific reasons described by Scott Kruse et al, 19 and we need better ways to assess the quality and effectiveness of mobile health applications. 20 Linde et al examined the effectiveness of one-way text messages 7 and similar to our finding, it is not a preferred communication method. Our study shows that the vast majority of responders preferred to use patient-accessible electronic health records (PAEHRs); and the rates found in our study are higher than those reported by Zanaboni et al 21 These results suggest that our cancer patients are willing to use new technologies to enhance patients experience and access to care.…”

“…6 Linde et al examined the effectiveness of one-way text messages and found that they did not improve the attendance rate to follow up among patients with cervical cancer. 7 The desire to increase cancer knowledge was associated with a higher likelihood of utilizing a mobile application (OR 261.53;95% CI:10.13-6748.71). 8 Mobile health applications improved goal adherence for breast cancer survivors by providing real-time feedback and accountability with the health care team.…”

Acceptability and feasibility of self‐sampling and follow‐up attendance after text message delivery of human papillomavirus results: A cross‐sectional study nested in a cohort in rural Tanzania

“…A web‐based text message platform was developed specifically for this project by an information technology expert. It was inspired by a similar platform developed for another text message study conducted in urban Tanzania 16 . Two types of text messages were prepared and uploaded to the text message platform (Table 1); one for HPV‐positive (A) and one for HPV‐negative (B).…”

“…The test analyzes HPV DNA in cervical and vaginal specimens. It detects the presence of 14 high-risk HPV infection types (16,18,31,33,35,39, 45, 51, 52, 56, 58, 59, 66, and 68). The results are automatically interpreted by the careHPV test system and are displayed graphically on the controller monitor screen as either "positive" or "negative".…”

“…In recent years, there has been an increasing interest around the application of mobile health (mHealth) to support health initiatives in low‐ and middle‐income countries (LMIC) 15 . Studies have demonstrated that the use of short message service (SMS) and phone calls can potentially improve cervical cancer screening attendance in an African context, eg, by providing health‐related information and reminding clients of their appointments 15‐18 . However, it is not well‐established to what extent HPV self‐sampling coupled with SMS is an acceptable method among women living in rural areas, and to what extent these women would attend a follow‐up screening appointment.…”