Evaluating a community-based cervical cancer screening strategy in Western Kenya: a descriptive study

Abstract

BackgroundThe incidence of cervical cancer in Kenya is among the highest in the world. Few Kenyan women are able to access screening, thus fueling the high cervical cancer burden. Self-collected human papilloma Virus (HPV) tests, administered during community-health campaigns in rural areas may be a way to expand access to screening.MethodsIn December 2015, we carried out a four-day community health campaign (CHC) to educate participants about cervical cancer prevention and offer self-administered HPV screening. Community enumeration, outreach and mobilization preceded the CHC. Samples were sent to Migori County Hospital for HPV DNA testing using careHPV Test Kits. Women were notified of results through their choice of short message service (SMS), phone call, home visit or clinic visit. HPV positive women were referred for cryotherapy following a screen-and-treat strategy.ResultsDoor-to-door enumeration identified approximately 870 eligible women in Ngodhe Community in Migori County. Among the 267 women attending the campaign, 255 women enrolled and collected samples: 243 tests were successfully resulted and 12 were indeterminate. Of the 243 resulted tests, 47 (19%) were positive for HPV, with young age being the only significant predictor of positivity. In multivariate analysis, each additional year of age conferred about a 4% decrease in the odds of testing positive (95% CI 0.1 to 7%, p = 0.046). Just over three-quarters of all women (195/255), were notified of their results. Those who were unable to be reached were more likely to prefer receiving results from clinic (54/60, 90%) and were less likely to have mobile phones (24/60, 73%). Although 76% of HPV positive women were notified of their results, just half (51%) of those testing positive presented for treatment. HPV positive women who successfully accessed the treatment facility did not differ from their non-presenting counterparts by demographics, health history, desired route of notification or access to a mobile phone.ConclusionNearly a third of eligible women in Ngodhe Community attended the CHC and were screened for cervical cancer. Nearly all women who attended the CHC underwent cervical cancer screening by self-collected HPV tests. Three-quarters of all participants received results, but just half of HPV positive participants presented for treatment in a timely fashion, suggesting that linkage to treatment remains a major challenge.Trial registrationNCT02124252, Registered 25 April 2014.

A public health approach to cervical cancer screening in Africa through community-based self-administered HPV testing and mobile treatment provision

“…Majority of the women preferred to receive results via the phone when when we asked them to choose among a variety options to learn of their results. The finding of most participants preferring to receive result via the phone is similar to that of a Kenyan study where 71% of the participants preferred receiving their results by phone communication (call or text) [11]. Indeed evidence has proved that mobile phones have become the most accessible form of communication providing information that results in improved health outcomes and/or changed health behaviors [29].…”

Self-Collection for Cervical Screening Programs: From Research to Reality

“…careHPV is an adapted form of the Hybrid Capture 2 assay and was developed as an affordable HPV-DNA detection technology [35,36]. It is specifically designed for low-resource settings, and for potential use as a point of care test, and has been utilised in a variety of geographical locations such as Ghana [36], Bhutan [37], Western Kenya [38] and rural China [35], with diverse demographics including amongst the general population, unscreened women, and women living with HIV [35][36][37]. It should be noted that the suggested cost per test of US$5 may not be achievable [39].…”

“…There is certainly evidence to suggest that self-collection tested on careHPV facilitates screening by being more acceptable than traditional, speculum-assisted, cervical cytology [37]. A number of studies have been undertaken where there is a lack of a comparator test, either clinician-collected specimen tested on careHPV, or testing of the self-collected specimen on a different HPV assay [37,38], which makes interpretation of the value of the results difficult. A study undertaken in Ghana [36] produced highly concordant results between self-and clinician-collected samples tested on careHPV but did not collect further data to allow assessment of the sensitivity of either test for either cytological or histological markers of disease.…”

A public health approach to cervical cancer screening in Africa through community‐based self‐administered HPV testing and mobile treatment provision

“…9 Offering self-administered tests in the community, without women having to travel to distant health facilities, should, in theory, further increase their use, and there is early evidence for this. 10,11 Regarding treatment, the World Health Organization recommends ablative therapy for a positive HPV result without further diagnostic confirmation. 12 However, there still remain challenges in getting treatment to those with positive tests.…”